2022年至2023年埃塞俄比亚亚的斯亚贝巴三级转诊NICU早产儿死亡率及其影响因素回顾性队列研究

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health Pub Date : 2025-07-01 DOI:10.1016/j.cegh.2025.102118

Gregory C. Valentine , Krystle M. Perez , Olivia C. Brandon , Sharla Rent , Gal Barbut , Merhawit Abadi , Gesit Metaferia , Redeat Workneh , Mahlet Abayneh

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引用次数: 0

摘要

背景早产仍然是全球新生儿死亡的主要原因，埃塞俄比亚的新生儿死亡率排名第四。明确与早产相关的新生儿死亡的具体原因对于改善结局至关重要。目的探讨圣保罗医院千禧医学院（SPHMMC）新生儿重症监护病房（NICU）早产儿死亡原因。研究设计通过回顾性电子数据库，我们评估了2022年2月至2023年5月SPHMMC NICU收治的妊娠37周及以下新生儿的死亡率，排除了先天性异常的新生儿。逻辑回归模型评估变量和结果之间的关联。结果本组1033例早产儿死亡228例（22.1%）。死亡率与出生体重呈负相关，极低出生体重的新生儿（≤1000g）死亡率为84%。早产相关死亡的前3位原因为呼吸窘迫综合征（67.7%,159/228）、败血症（39.5%,90/228）和肺出血（25.0%,57/228）。死于肺出血的新生儿有较高的产前皮质类固醇（ACS）暴露(66.7% vs 36.7%, p <；0.001)，较少的绒毛膜羊膜炎（29.5%比55.5%,p = 0.004）和较高的剖宫产率（71.9%比53.1%,p = 0.02）。值得注意的是，在多变量模型的整体队列中，死亡率与ACS暴露或缺乏ACS暴露之间没有关联。结论呼吸窘迫综合征和脓毒症是常见的早产儿死亡原因，但令人惊讶的是，在SPHMMC新生儿重症监护病房，25%的早产儿死于肺出血。需要进一步调查，以澄清导致过早死亡的原因和影响因素，并确定肺出血是否是全球过早相关死亡的一个未被报道和未被充分认识的因素。

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A retrospective cohort study of premature neonatal mortality rates and contributing factors in a tertiary referral NICU in Addis Ababa, Ethiopia from 2022 to 2023

Background

Prematurity remains the leading contributor for neonatal death globally, with Ethiopia having the 4th highest incidence of neonatal deaths. Clarifying specific contributors of prematurity-related neonatal death is critical to improve outcomes.

Objective

We evaluated neonatal causes of death among premature neonates at St. Paul's Hospital Millennium Medical College's (SPHMMC) neonatal intensive care unit (NICU).

Study design

Through a retrospective electronic database, we evaluated mortality outcomes for neonates <37 weeks’ gestation admitted to SPHMMC NICU from February 2022–May 2023, excluding those with congenital anomalies. Logistic regression models assessed the association between variables and outcomes.

Results

Of 1033 premature neonates included in the analysis, 228 (22.1 %) died. Mortality was inversely related to birthweight with extremely low birthweight neonates (≤1000g) having 84 % mortality. The top 3 causes of prematurity-related mortality included respiratory distress syndrome (67.7 %, 159/228), sepsis (39.5 %, 90/228), and pulmonary hemorrhage (25.0 %, 57/228). Neonates that died from pulmonary hemorrhage had higher antenatal corticosteroids (ACS) exposure (66.7 % vs 36.7 %, p < 0.001), less chorioamnionitis (29.5 % vs 55.5 %, p = 0.004), and higher cesarean section delivery (71.9 % vs 53.1 %, p = 0.02). Notably, there were no associations between mortality and ACS exposure or lack thereof in the overall cohort in multivariate models.

Conclusion

While respiratory distress syndrome and sepsis are commonly reported findings of premature mortality, surprisingly, 25 % of premature newborns died from pulmonary hemorrhage at SPHMMC NICU. Further investigations are needed to clarify the causes and contributing factors leading to premature death and to determine whether pulmonary hemorrhage is an underreported, underrecognized contributor to prematurity-related mortality globally.

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来源期刊

Clinical Epidemiology and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.60

自引率

7.70%

发文量

218

审稿时长

66 days

期刊介绍： Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.