Time to Death and Its Predictors among Neonates Hospitalized with Sepsis in Eastern Ethiopia

Abstract

Background. Although neonatal sepsis is a major public health problem contributing to 30-50% of neonatal deaths in low- and middle-income countries, data on predictors of time to death are limited in Eastern Ethiopia. This study is aimed at determining predictors of time to death among neonates with sepsis admitted in public hospitals in Eastern Ethiopia. Methods. An institutional-based retrospective cohort study was conducted among 415 neonates admitted to referral hospitals in Eastern Ethiopia with sepsis from January 1, 2021, to December 31, 2021. Data were collected from medical records by using structured checklist and entered using EpiData 3.1 and analyzed using Stata 17. The Kaplan-Meier curves and log-rank tests were used to describe survival experience among different categories. The proportional hazard assumption and goodness of fit for the Cox regression model were checked. The Cox regression model was used to identify the significant predictors. Hazard ratios (HRs) with 95% confidence intervals (CI) were calculated. Finally, statistical significance was set at a $p$ value < 0.05 in the Cox regression analysis. Results. Of the 415 neonates with neonatal sepsis, 71 (17.1%) (95% CI: 13.60-21.08) died at discharge, with a median time to death of 14 days. The overall incidence rate of mortality was 36.5 per 1000 neonate days. Low birthweight ($\text{AHR}=2.50$; 95% CI: 1.15-5.44), maternal $\text{age}\ge 35$ years ($\text{AHR}=3.17$; 95% CI: 1.11, 9.04), low fifth-minute Apgar score (AHR: 2.32; 95% CI: 1.30-4.14), and late initiation of breastfeeding ($\text{AHR}=4.82$; 95% CI: 1.40-16.65) were independent predictors of mortality among neonates with sepsis. Conclusions. Almost one in five neonates with sepsis died at discharge. Low birthweight, maternal $\text{age}\ge 35$ years, low fifth-minute Apgar score, and late initiation of breastfeeding were predictors of mortality.