Survival status and predictors of mortality among neonates admitted with hyperbilirubinemia in neonatal intensive care units of public hospitals in Addis Ababa, Ethiopia, 2023
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Date
2023
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Addis Ababa University
Abstract
Background: Neonatal jaundice is a major cause of neonatal intensive care unit admission and is
one of the leading causes of morbidity in neonate. However, little is known about the time to death
and its predictors among neonates with hyperbilirubinemia. Therefore, this study aimed to assess
survival status and predictors of mortality among neonates admitted with hyperbilirubinemia in
neonatal intensive care units of public hospitals in Addis Ababa.
Methods: This retrospective cohort study was conducted in public hospitals in Addis Ababa,
Ethiopia, and included 380 neonates admitted with hyperbilirubinemia from January 2021 to
December 2022. The data was collected from patient cards using a simple random sampling
method with a pretested checklist between March 16 and April 16, 2023. Data entry was performed
using Kobo toolbox, and analysis was conducted using SPSS version 26. Kaplan Meier analysis
was used to estimate the median survival time and cumulative probability of survival, while the
logrank test was used to compare survival curves among different predictor groups. The
relationship between independent and outcome variables was analyzed using the Cox proportional
hazard regression model, with statistical significance set at a p-value of <0.05 and a 95%
confidence interval.
Results: The overall incidence density of mortality was 18 per 1000 person-day observations (CI:
13-25) with 1980 follow-up days. Several factors were identified as significant predictors of
mortality, including maternal age below 20 years (AHR = 18.2, 95% CI: 3.2–102.7), living in a
rural area (AHR = 4.16, 95% CI: 1.64-10.52), premature rupture of membranes (AHR = 3.49, 95%
CI: 1.14-10.66), gestational age below 37 weeks (AHR = 7.3, 95% CI: 1.84-28.8), birth weight
below 2500gm (AHR = 15.1, 95% CI: 3.85-59.5), requiring both phototherapy and exchange blood
transfusions (AHR = 48.6, 95% CI: 7.30-323.4), and presence of sepsis (AHR = 3.03, 95% CI:
1.17-7.9).
Conclusion: The neonatal mortality among neonates admitted with hyperbilirubinemia in Addis Ababa
hospitals is high. This suggests that there is a room for improvement in order to meet the 2030 WHO
target of 12 or less deaths per 1,000 live births. Therefore, special emphasis should be given for
neonates who were born from mother whose age is <20 years and from rural settings, present with
PROM and neonates with GA <37 weeks, Birth weight <2500gm and neonates with sepsis
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Keywords
Addis Ababa, Neonatal hyperbilirubinemia, Neonate, Survival Status, Neonatal Jaundice, Predictors