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Multicenter Study
. 2023 Feb 24;18(2):e0281656.
doi: 10.1371/journal.pone.0281656. eCollection 2023.

Birth asphyxia related mortality in Northwest Ethiopia: A multi-centre cohort study

Daniel Bekele Ketema  1   2 , Fantu Mamo Aragaw  3 , Fasil Wagnew  4 , Misganaw Mekonnen  5 , Abeba Mengist  6 , Alehegn Aderaw Alamneh  7 , Yihalem Abebe Belay  1   8 , Getiye Dejenu Kibret  1   9 , Cheru Tesema Leshargie  1   9 , Molla Yigzaw Birhanu  1 , Yitbarek Tenaw Hibstie  10 , Belisty Temesgen  10 , Animut Alebel  3   9
Affiliations
Multicenter Study

Birth asphyxia related mortality in Northwest Ethiopia: A multi-centre cohort study

Daniel Bekele Ketema et al. PLoS One. .

Abstract

Background: Birth asphyxia is the second leading cause of neonatal death in Ethiopia, next to preterm-associated infections. Understanding the causes of death in asphyxiated newborns will help to design appropriate care. This study identifies predictors of neonatal mortality in asphyxiated newborns in selected hospitals in Northwest Ethiopia.

Methods: An institution-based prospective cohort study of 480 newborns with birth asphyxia was conducted at Debre Markos Comprehensive Specialized Hospital, Shegaw Motta District Hospital, and Injibara General Hospital. All newborns with asphyxia admitted to the neonatal critical care unit from the first of November 2018 to the first of November 2019 were included. Data were obtained prospectively from mothers using an interviewer's administered questionnaire. The Kaplan-Meier survival curve was used to estimate survival time, and Log rank test was used to compare the survival curves. Bivariable and multivariable Cox proportional hazards models were fitted to identify the independent predictors of mortality in asphyxiated newborns. Adjusted hazard Ratios (AHRs) with 95% Cis (Confidence Intervals) were used to measure the strength of association and test statistical significance.

Results: The overall cumulative incidence of mortality among asphyxiated newborns was 42.29% (95% CI: 38%, 46). Asphyxiated neonates with other comorbidities (sepsis, neonatal anemia) (AHR = 2.63, 95% CI:1.69, 4.10), oxygen saturation of 50-69 (AHR = 4.62, 95% CI:2.55, 8.37), oxygen saturation of 70-89 (AHR = 2.82, 95% CI: 1.80, 4.42), severe Apgar score at one minute (AHR = 1.59, 95% CI:1.12, 2.25), neonates with Hypoxic Ischemic Encephalopathy (HIE) (AHR = 6.12, 95% CI:2.23, 16.75) were at higher risk of mortality.

Conclusions: The mortality rate among asphyxiated neonates remains high, and slightly higher than previous studies. Asphyxiated newborns with other comorbidities, severe Apgar score at one minute, who develop HIE, and low oxygen saturation were at higher risk of death. Therefore, designing appropriate interventions and prevention methods should be considered for identified variables.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Plot of log (-log (survival probability)) Vs log (analysis time) by comorbidity (A), 1-minute Apgar score (B), Hypoxic Ischemic Encephalopathy (HIE) (C), and level of Oxygen saturation (D).
Fig 2
Fig 2. Plot of Nelsen-Allen cumulative hazard function against Cox-Snell residual.
Fig 3
Fig 3. Overall Kaplan-Meier curve of newborns with asphyxia in Northwest Ethiopia selected hospitals from November 1, 2018, to November 1, 2019.
Fig 4
Fig 4. Kaplan-Meier survival curve of newborns with asphyxia by comorbidity in Northwest Ethiopia selected hospitals from November 1, 2018, to November 1, 2019.
Fig 5
Fig 5. Kaplan-Meier survival curve of newborns with asphyxia in Northwest Ethiopia selected hospitals from November 1, 2018, to November 1, 2019, by 1-minute Apgar score.
See this image and copyright information in PMC

References

    1. World Health Organization: Guidelines on basic newborn resuscitation available at http://www.who.int/maternal_child_adolescent/documents/basic_newborn_res.... - PubMed
    1. Enweronu-Laryea C, Dickson KE, Moxon SG, Simen-Kapeu A, Nyange C, Niermeyer S, et al.: Basic newborn care and neonatal resuscitation: a multi-country analysis of health system bottlenecks and potential solutions. BMC pregnancy and childbirth 2015, 15(2):S4. doi: 10.1186/1471-2393-15-S2-S4 - DOI - PMC - PubMed
    1. Martinez-Biarge M, Diez-Sebastian J, Wusthoff CJ, Mercuri E, Cowan FM: Antepartum and intrapartum factors preceding neonatal hypoxic-ischemic encephalopathy. Pediatrics 2013:peds. 2013–0511. doi: 10.1542/peds.2013-0511 - DOI - PubMed
    1. The partnership for maternal and child health: Newborn death and illness available at http://www.who.int/pmnch/media/press_materials/fs/fs_newborndealth_illne.... 2015.
    1. Jehan I, Harris H, Salat S, Zeb A, Mobeen N, Pasha O, et al.: Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Bulletin of the world Health Organization 2009, 87(2):130–138. doi: 10.2471/blt.08.050963 - DOI - PMC - PubMed

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