Survival and Predictor of Thrombocytopenic Neonatal Death in Public Hospitals of Addis Ababa, Ethiopia, 2025: Multicenter Prospective Follow Up Study

Background Globally, thrombocytopenia is one of the most common hematologic conditions seen in ill neonates. In countries with limited resources, like Ethiopia, it is a serious concern. Because the burden of thrombocytopenia is so great, generating updates evidence on predictors of mortality and survival status is vital to fight it. However, the problem is not well investigated in Addis Ababa. Therefore, this study aimed to assess survival and predictor of thrombocytopenic neonatal death in Public Hospitals, Addis Ababa, Ethiopia, 2024/2025.

and Materials A prospective follow-up study was done among a total of 350 neonates from March 20, 2025, to April 30, 2025, in Addis Ababa public hospitals. All thrombocytopenic neonates that meet the inclusion criteria were chosen as study participants. Data were collected using the Kobo Tool through direct observation and review of maternal and neonatal charts. After export to an Excel spreadsheet, data cleaning and recoding were performed using SPSS version 26, followed by statistical analysis using STATA version 17. The Kaplan-Meier failure curve was used to demonstrate the pattern of death, estimate the chance of death, and compare failure curves. Collinearity, Schoenfeld residual, and log-rank tests were performed. The Cox proportional hazards model was fitted with global test result of 0.7882. Finally, the findings were presented both descriptively and analytically.

In this study, the overall magnitude of thrombocytopenic neonatal death was 14.1% (95% CI: 10.4–18.1), with an incidence rate of 13.04/1000 (95% CI: 0.009–0.017) neonate-days. The restricted mean time to death in this study was 23.36 days (95% CI: 22.23–24.50). Being born to a mother with severe preeclampsia (AHR = 3.84; 95% CI: 1.78–8.26), very low birth weight (<1499g) (AHR = 3.67; 95% CI: 1.14–11.80), perinatal asphyxia (AHR = 2.76; 95% CI: 1.32–5.79), necrotizing enterocolitis (AHR = 2.45; 95% CI: 1.14–5.31), and delayed initiation of feeding (AHR = 3.37; 95% CI: 1.10–10.29) were the identified predictors of mortality.

and recommendation In this study, a high burden of thrombocytopenic neonatal death. Early detection and treatment of high-risk conditions like severe preeclampsia, very low birth weight, perinatal asphyxia, and necrotizing enterocolitis should be the main goal of efforts to lower thrombocytopenic neonatal mortality. Furthermore, prompt neonatal feeding initiation ought to be given top priority. Competing Interest Statement The authors have declared no competing interest. Clinical Trial NA Funding Statement The author(s) received no specific funding for this work. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: A letter of ethical clearance was first obtained from Institutional Review Board (IRB) of Menelik II Medical and Health Science College and Research and Community Service Directorate Addis Ababa, Ethiopia and from Addis Ababa Public Health Research and Emergency Management Directorate Ethics Review Committee, Addis Ababa Health Bureau, Addis Ababa, Ethiopia with ethical approval letter reference number of አጠ5/38/248 and አ/አ/ጤ/2/245/17 respectively. Then, an official letter was submitted to the selected study area. Informed consent was taken from the respective index mother or father or other relatives found nearby to the neonate. While the informed consent was taken, the indexed mother and father or relatives were informed as the papers were published in international journals. The neonate‘s name and medical record identification information wouldn‘t be collected, and confidentiality would be maintained. All data collected from the chart were kept strictly confidential and used only for the study purpose. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes ABBREVIATIONS AND ACRONYMS - AGA - Appropriate For Gestational Age - APGAR - Appearance, Pulse, Grimace, Activity, Respiration - C/S - Cesarean Section - CPAP - Continuous Positive Airway Pressure - DM - Diabetes Mellitus - EONS - Early onset Neonatal Sepsis - HAI - Hospital Acquired Infection - HIV/AIDS - Human Immune Virus /Acquired Immuno Deficiency Syndrome - KMC - Kangaroo Mother Care - LGA - Large For Gestational Age - NEC - Necrotizing enterocolitis - NHB - Neonatal Hyper Bilirubinemia - NICU - Neonatal Intensive Care Unit - PNA - Perinatal Asphyxia - RD - Respiratory Distress - SGA - Small For Gestational Age - SVD - Spontaneous Vaginal Delivery - WHO - World Health Organization