The first one month of life; the neonatal period is the most risky time for child survival. In Ethiopia, neonatal mortality is unacceptably high, and the trend in reduction is slower as compared to infant and child mortality. The magnitude and associated factors of neonatal mortality in a tertiary care facility were not well documented. Therefore, the aim of this study was to determine neonatal mortality and predictors among neonates admitted to neonatal intensive care unit of Wolaita Sodo University Teaching and Referral Hospital, South Ethiopia. A retrospective cohort study design was done among neonates admitted to neonatal intensive care unit of a University Teaching and Referral Hospital from 2015 to 2017. Data were collected using data extraction checklist from the medical registry. The main outcome was the occurrence of death within the first four weeks. The survival time was calculated in days between the date of admission and the date of death. Kaplan-Meier survival was used to depict the pattern of death in 28 days and Cox-Proportional model was used to identify the predictors of the neonatal mortality. A total of 964 neonates which contributed to 5889 neonates-days were included in the study. There were 159 neonatal deaths during the follow-up time. Overall, the neonatal mortality incidence was 27 per 1000 neonates-days. Predictors of neonatal mortality were: multiple birth, mothers who did not attend antenatal care visits, neonates born by cesarean section, not initiated breast feeding within 1 h of birth, neonates resuscitated, hyaline membrane disease and perinatal asphyxia. Neonatal mortality at neonatal intensive care unit was high. Managing neonatal complications, initiating breast feeding within 1 h of birth, promoting antenatal care visits, improving quality of services and ensuring continuum of care are recommended to increase survival of neonates.

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Predictors of Neonatal mortality in Neonatal intensive care unit at referral Hospital in Southern Ethiopia: a retrospective cohort study

Neonatal sepsis is an invasive infection, usually bacterial, and often occurring during the neonatal period (0–28 days). Neonatal sepsis causes a high burden of morbidity and mortality in developing countries like Ethiopia. There are fragmented, inconsistency, and no review has been conducted to report the magnitude and associated factors of neonatal sepsis in Ethiopia. Thus, this study aimed to assess the pooled prevalence of neonatal sepsis and its association with birth weight and gestational age among admitted neonates in Ethiopia. Electronic media searches like PubMed, CINHAL, EMBASE, Google Scholar, Web of Science, Cochrane library databases and African health science library were used. All original peer-reviewed papers which reported the prevalence of neonatal sepsis in Ethiopia were included in this study. Two reviewers independently extracted the data using a standardized data extraction format for eligibility and appraised their quality. Data were analyzed using Stata version 14 software. The pooled prevalence of neonatal sepsis was estimated with the random-effect model. Heterogeneity between studies was assessed by I 2 statistics test. Subgroup and meta-regression analyses were done to assess the source of variation between the studies. Egger’s test followed by trim and fill analysis were used to determine publication bias. A sensitivity analysis was carried out. A total of 952 research papers reviewed, of which, eight studies were finally included in this systematic review and meta-analysis. The random effect pooled prevalence of neonatal sepsis in Ethiopia was 49.98% (CI: 36.06, 63.90). In subgroup analysis, the pooled estimated neonatal sepsis among cross-sectional studies was 53.15% while the cohort was 40.56%. Newborns with a birth weight of less than 2.5 kg were 1.42 times more likely to develop neonatal sepsis infection compared to normal babies. The odds ratios of preterm babies were 3.36 to develop neonatal sepsis compared to term infants. The pooled prevalence of neonatal sepsis in Ethiopia was high. Thus, health care providers should adhere to aseptic precautions while performing procedures, especially in preterm and low birth weight infants were recommended.

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Neonatal sepsis and its association with birth weight and gestational age among admitted neonates in Ethiopia: systematic review and meta-analysis

Outbreak of Burkholderia cepacia pseudobacteraemia caused by intrinsically contaminated commercial 0.5% chlorhexidine solution in neonatal intensive care units

Inhibition of necroptosis attenuates lung injury and improves survival in neonatal sepsis.

Antimicrobial resistance is one of the major public health emergencies worldwide, and this trend didn’t spare developing countries like Ethiopia. The objective of this study was to evaluate patterns of bacterial isolates and local antimicrobial susceptibility patterns in neonatal sepsis. A hospital based observational study was conducted from April 2016 to May 2017 in Asella teaching and referral hospital (ATRH). A total of 303 neonates with clinical sepsis were included. Collected data were entered into EPI-INFO version 3.5.1 for cleanup; and then exported to SPSS version 21 for further analysis. Frequencies and proportion were used to describe the study population in relation to relevant variables. Bacterial growth was detected in 88 (29.4%) of blood cultures. Predominantly isolated bacteria were coagulase negative staphylococci (CoNS) 22 (25%), Escherichia coli (E.Coli) 18 (20.5%) and Staphylococcus aureus 16 (18%). Resistance rates of S. aureus and CoNS against Ampicillin were 11 (69%) and 20 (91%) respectively. The resistance rate of E. coli against Ampicillin and Gentamycin were 12 (66.7%) and 10 (55.6%) while Klebsiella spp. resistance rate gets much higher against these two first line antibiotics [10 (91%) and 9 (82%) respectively]. Similarly, both Gram-positive and Gram-negative bacteria isolates were also highly resistant to third generation Cephalosporins, and 63 (72%) isolated bacteria showed multidrug-resistance. However; Gram-positive bacteria isolates had better susceptibility patterns to third line antibiotics like Clindamycin, Vancomycin and Ciprofloxacin while Gram-negative isolates had a higher susceptibility to Ciprofloxacin and Amikacin. CoNS, S. aureus, E. coli and Klebsiella spp. were the leading bacterial causes of neonatal sepsis in our study. They were highly resistant to first- and second-line empiric antimicrobial treatment used at NICU (Neonatal intensive care unit), reducing the antimicrobial choices for management of neonatal sepsis. Fortunately, the mentioned isolated bacteria remained susceptible to third line antibiotics used to treat neonatal sepsis.

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Blood culture result profile and antimicrobial resistance pattern: a report from neonatal intensive care unit (NICU), Asella teaching and referral hospital, Asella, south East Ethiopia

Sepsis remains a major cause of morbidity and mortality among neonates. The risk factors and clinical outcomes of sepsis are poorly understood. Most cases of sepsis occurred mostly within the first week of newborns life related to perinatal risk factors. Late onset sepsis is related to hospital acquired infections which is seen after seven days of age. The purpose of this study was to assess clinical outcome and risk factors of neonatal sepsis in Felege Hiwot referral hospital Bahir Dar, North West Ethiopia. Among the total 225 neonatal charts reviewed; 164 (72.9%) were age less than or equal to 7 days, and 144 (64%) were males. About 29 (12.9%) neonates were with irregular respiratory signs and 40 (17.8%) had meconium aspiration syndrome. Regarding the clinical outcome of neonatal sepsis: 189 (84%) were improved after treatment, 9 (4%) were died and 13 (5.8%) referred to other organizations for further treatment. Respiratory distress syndrome [AOR = 0.258 (0.072–0.930)] and meconium aspiration syndrome [AOR = 0.1989 (0.059–0.664)] were the determinant factors for poor outcome of neonatal sepsis. The clinical outcome of neonatal sepsis in Felege Hiwot referral hospital was not satisfactory. The significant risk factors for poor outcome of neonatal sepsis were respiratory distress syndrome and meconium aspiration syndrome. Recommendations to improve neonatal outcome are: performing essential newborn care for all newborns and arranging appropriate follow up until the end of neonatal period, increasing antenatal care and early detection and management of neonatal infections or problems.

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Clinical outcome and risk factors of neonatal sepsis among neonates in Felege Hiwot referral Hospital, Bahir Dar, Amhara Regional State, North West Ethiopia 2016: a retrospective chart review.

Yibeltal Tilahun

Papers

Clinical outcome and risk factors of neonatal sepsis among neonates in Felege Hiwot referral Hospital, Bahir Dar, Amhara Regional State, North West Ethiopia 2016: a retrospective chart review.