Preterm neonatal mortality and its associated factors in the neonatal intensive care unit of Fort Portal Regional Referral Hospital

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Kampala International University; School of Health Sciences (Western Campus)
Background: In Uganda, prematurity accounts for 0.7% of all hospital admissions, and yet responsible for 5% of all deaths and 11.1% of under-five deaths. The Tooro sub-region has an increasing burden of preterm newborn admissions in the neonatal intensive care units (NICUs). The study was done to determine the proportion of preterm neonatal death, describe the medical conditions at admission and factors associated with mortality of preterm neonates in the NICU. Methods: A prospective cohort study was conducted in the NICU of Fort Portal Regional Referral Hospital between March and June 2019. The main outcome was the occurrence of death within 28 days of life. Questionnaires were used to obtain clinical and socio demographic data for mothers and their preterm neonates. Data were analyzed using chi square, bivariate and multivariate logistic regression analysis for mortality outcome. A p-value <0.05 was considered statistically significant. Results: Three hundred and fifty one consecutively enrolled preterm neonates were studied. The proportion of preterm neonatal deaths was 31.6% (95% CI: 26.9-36.7) and majority (65.8%) of deaths occurred within 72 hours of admission. The most common medical conditions at admission were hypothermia (67.2%), respiratory distress syndrome (43.0%), and small-for-gestational age (15.7%), and perinatal asphyxia (14.5%). Under multivariate regression modelling, maternal age ~35 years (aOR 4.5, 95% CI: 1.35-15.31,p0.014), lack of antenatal care (aOR 4.7, 95% CI: 1.05- 21.2l,p0.043), >4 ANC visits (aOR 5.3, 95% CI: 1.88-15.21,p0.002), neonatal resuscitation (aOR 3.4, 95% CI: 1.66-6.82,p 0.001), out-born status (aOR 2.3, 95%CI: 1.20-4.50,p0.013), singleton pregnancy (aOR 3.7, 95% CI: 1.74-7.89,p0.001), gestational age <28 weeks (aOR 12.0, 95% CI: 2.24-64.27, p0.004), and male sex (aOR 2.0, 95% CI: 1.04-3.74, p0.038) were statistically significant. Medical conditions that were independently associated with death were respiratory distress syndrome (aOR 2.6, 95% CI: 1.22-5.70,p0.014), small for gestational age (aOR 4.7, 95% CI: 2.06-10.74, p<0.001), apnea (aOR 6.2, 95.5% CI: 1.09-35.38,p0.039), and hypothermia (aOR 2.3, 95% CI: 1.09-4.92, p0.029). Conclusion: The proportion ofpreterm neonatal deaths was high. The study identified respiratory distress syndrome, small-for-gestational-age, apnea and hypothermia as major causes of preterm neonatal mortality. Specific and cost-effective measures are required to abate the modifiable factors associated with mortality.
A research dissertation submitted in partial fulfillment of the requirements for the Award of the Degree of Master of Medicine in Pediatrics and Child Health of Kampala International University
Preterm neonatal mortality, Neonatal intensive care unit, Fort Portal Regional Referral Hospital, Uganda