Survival Status and Predictors of Mortality Among Preterm Neonates in Southwest Ethiopia: A Retrospective Cohort Study

Abstract Background: Prematurity is a global public health priority linked with high neonatal morbidity and mortality. There is limited evidence regarding preterm neonatal mortality and its predictors to inform programs and policies in Ethiopia. The aim of this study was therefore to assess survival status and predictors of mortality among preterm neonates admitted to the neonatal intensive care unit of Jimma University Medical Center. Methods: Facility-based retrospective cohort study was conducted from March 11 to April 20, 2020, among 505 randomly selected preterm neonates admitted to the Neonatal Intensive Care Unit (NICU) of Jimma University Medical Center (JUMC). Data were collected from medical records and registers using a structured data collection checklist. Data were entered into Epi-Data 3.1, exported to, and analyzed with STATA version 15. Kaplan Meir method and log-rank test were used to estimate survival time, and compare survival experience. Cox-regression analysis was fitted to identify predictors of time to death. The assumption of the proportional hazard model was checked using Schoenfeld residual test. Adjusted hazard ratio (AHR) with its 95% confidence interval (CI) and corresponding p-value <0.05 was set to declare statistical significance. Result: In this study, 127 (25.1%) neonates died with neonatal morality rate of 28.9 deaths per 1,000 neonate-days [95%CI: 24.33, 34.46]. About 103 (81.1%) deaths occurred during early neonatal period. Antenatal steroid use [AHR=0.55, 95%CI: 0.34, 0.90], obstetric complications [AHR=1.84, 95%CI: 1.20, 2.82], gestational age increment by week [AHR= 0.81, 95%CI: 0.75, 0.87], respiratory distress syndrome [AHR=1.52, 95%CI: 1.01, 2.29], neonatal sepsis [AHR=1.71, 95%CI: 1.18, 2.49], perinatal asphyxia [AHR=2.44, 95%CI: 1.33, 4.49], and receiving kangaroo-mother care [AHR=0.48, 95%CI: 0.30, 0.77] were predictors of preterm neonatal mortality.Conclusion: Preterm neonatal mortality rate was high. Most neonatal deaths occurred in the early neonatal period. Predictors of preterm neonatal mortality were antenatal steroid use, obstetric complications, gestational age increment by week, respiratory distress syndrome, neonatal sepsis, perinatal asphyxia, and receiving kangaroo-mother care. Hence, early detection and management of obstetric and neonatal complications, use of antenatal steroids, kangaroo-mother care, and ensuring a continuum of care should be strengthened to increase preterm neonatal survival.