Survival status and predictors of mortality among low-birthweight neonates admitted to KMC units of five public hospitals in Ethiopia: Frailty survival regression model

Abstract

Background Low birth weight (LBW) and preterm birth are leading causes of under-five and neonatal mortality globally. Data about the timing of death and outcomes for LBW and preterm births are limited in Ethiopia and could be used to strengthen neonatal healthcare. This study describes the incidence of neonatal mortality rates (NMR) stratified by newborn size at birth for gestational age and identifies its predictors at five public hospitals in Ethiopia. Methods A prospective follow-up study enrolled 808 LBW neonates from March 2017 to February 2019. Sex-specific birthweight for gestational age percentile was constructed using Intergrowth 21st charts. Mortality patterns by birthweight for-gestational-age-specific survival curves were compared using the log-rank test and Kaplan-Meier survival curves. A random-effects frailty survival model was employed to identify predictors of time to death. Results Among the 808 newborns, the birthweight distribution was 3.2% <1000 g, 28.3% <1500 g, and 68.1% <2000 g, respectively. Birthweight for gestational age categories were 40.0% both preterm and small for gestational age (SGA), 20.4% term SGA, 35.4% appropriate weight for gestational age, and 4.2% large for gestational age (LGA). The sample included 242 deaths, of which 47.5% were both preterm and SGA. The incidence rate of mortality was 16.17/1000 (95% CI 14.26–18.34) neonatal-days of observation. Neonatal characteristics independently related to increased risk of time-to-death were male sex (adjusted hazards ratio [AHR] 3.21 95% CI 1.33–7.76), born preterm (AHR 8.56 95% CI 1.59–46.14), having been diagnosed with a complication (AHR 4.68 95% CI 1.49–14.76); some maternal characteristics and newborn care practices (like lack of effective KMC, AHR 3.54 95% CI 1.14–11.02) were also significantly associated with time-to-death. Conclusions High mortality rates were measured for low birthweight neonates–especially those both preterm and SGA births–even in the context of tertiary care. These findings highlight the need for improved quality of neonatal care, especially for the smallest newborns.