Treatment Outcome of Neonatal Sepsis and Associated Factors among Neonates Admitted to Neonatal Intensive Care Unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Retrospective Cohort Study.
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Date
2022-02
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Addis Ababa University
Abstract
Globally, neonatal sepsis is a major cause of neonatal death. A definitive early diagnosis and
appropriate antimicrobial therapy which significantly reduce mortality are challenging in
resource limited settings like Ethiopia. This study aimed to assess the treatment outcome
and factors associated with neonatal sepsis mortality among those treated at the neonatal
intensive care unit of Tikur Anbessa referral hospital (TASH), Addis Ababa, Ethiopia. A
retrospective cohort study was conducted from September, 2018 to September, 2020.Neonates
diagnosed with sepsis by the attending physician either clinically or laboratory-confirmation was
included in the study. Data such as patient’s age, sex, and address, type of antimicrobial
administered, date of treatment started and completed, microbiological results and other clinical
characteristics were collected retrospectively from medical chart. Data were entered and
analyzed using the Statistical Package for Social Sciences version 25. Survival analysis was
performed using Kaplan Meier Method. Log-rank test was used to determine survival period
differences and cox hazard regression was used to identify associated factors of neonatal
mortality. Systematic random sampling technique was employed to recruit the study participants.
Binary logistic regression was used to predict determinants of length of hospital stay. Statistical
significance was declared at p-value <0.05.The total number of neonates in this study was 206.
One hundred ninety three (93.7%) neonates have survived from neonatal sepsis and 77 (37.4%)
of the neonates stayed in the hospital for more than seven days. Multivariable analysis showed
that risk hazard of neonatal mortality was 5.486 higher among pregnant women with history of
vaginal discharge compared to pregnant women’s without discharge (AHR, 5.486, 95% CI:
1.308-26.134).Conversely, absence of Premature rupture of membranes (PROM) (0.503 CI:
0.326-0.776) and those neonates delivered through SVD (AHR 0.265, CI: 0.091-0.767), were
associated with decreased risk of mortality.
Kaplan-Meier survival analysis using log-rank test shows there was a statistically significant
decrease in survival period among neonates delivered through spontaneous vaginal delivery
(SVD) than neonates delivered by caesarian section (CS) (p = 0.014).
Low-birth weight (AOR=11.87, 95%CI: 2.344-60.15) and being on Ampicillin (AOR=16.09, CI:
4.484-57.74) were associated with prolonged hospitalization.
On the other hand, being female (AOR= 0.090, 95%CI: 0.018-0.458); absence of GI symptoms
(AOR= 0.214, 95%CI: 0.19-0.350); and antibiotics dose change from initial treatment (AOR=
0.081, 95% CI: 0.001-0.703) were associated with a decreased rate of hospitalization. The
Obstetrics and gynecology department should promote delivery though SVD, and to increase
Antenatal care and aggressively manage of pregnant women with vaginal discharge as it
significantly affects the outcome of their newborns with neonatal sepsis. Emphasis should be
given on meticulous management of neonatal sepsis and early change of antibiotics is imperative
when needed as it reduces length of hospital stay thereby decreasing mortality.
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Keywords
Hospitalization, Neonates, Neonatal Sepsis, Ethiopia, Treatment Outcome,