Time-to-death and predictors of mortality among preterm neonates diagnosed with neonatal sepsis, Southwest Ethiopia, 2022: prospective follow-up study

Abstract

Abstract Objective Neonatal sepsis is a critical pathology that particularly affects neonates, especially preterm and low birth weight neonates, with varying incidence according to the onset (early or late) of the disease. Although preterm neonatal mortality related to sepsis is high in Ethiopia and in the study area, limited studies have been conducted on the time-to-death and predictors of mortality among preterm neonates diagnosed with neonatal sepsis. Therefore, this study aimed to determine the time-to-death and predictors of mortality among preterm neonates with neonatal sepsis admitted to government hospitals in Southwest Ethiopia in 2022. Methods A prospective cohort study was conducted at the Southwest government hospitals between March 2021 and January 30, 2022. The data were entered into Epi-data version 4.4.2.1 and exported to Stata version 14 for editing, cleaning, and analysis. The Cox proportional hazards (CPH) model was used to identify the predictors of mortality. Results In this study, out of 354 preterm neonates diagnosed with neonatal sepsis, 121 (34.18%) had died with an incidence rate of 59.8% (95% confidence interval [CI]: 50–71.5) deaths per 1000 person-day-observations. The median survival time of preterm neonates diagnosed with neonatal sepsis was 15 days. The following factors were the predictors of mortality among preterm neonates diagnosed with neonatal sepsis: (1) the neonate’s mother did not have antenatal care (ANC) follow-up (adjusted hazard ratio [AHR] 2.5 [95% CI: 1.3–4.84]); (2) the neonates had an APGAR score <7 (5th-minute activity, pulse, grimace, appearance, and respiration) (AHR 1.5 [95% CI: 1.29–3.46]); (3) and they had comorbidities such as respiratory distress syndrome (RDS) (AHR 1.50 [95% CI: 1.13–2.31]) and jaundice (AHR 1.89 [95% CI: 1.26–2.84]). Conclusions In this study, preterm neonates diagnosed with neonatal sepsis showed a higher incidence of mortality compared with other national and local studies. The median survival time of neonates was 15 days. Born from mothers who did not have ANC follow-up, 5th-minute APGAR score <7, and comorbidities such as RDS and jaundice were independent predictors of mortality among preterm neonates diagnosed with neonatal sepsis. Therefore, healthcare providers and other stakeholders should consider prompt and timely diagnosis and therapeutic interventions to preterm neonates with neonatal sepsis.