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Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period

Neonatal encephalopathy (NE) accounts for ~23% of the 2.4 million annual global neonatal deaths. Approximately 99% of global neonatal deaths occur in low-resource settings, however, accurate data from these low-resource settings are scarce. We reviewed risk factors of neonatal mortality in neonates...

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Autores principales: Gannon, Hannah, Chimhini, Gwendoline, Cortina-Borja, Mario, Chiyaka, Tarisai, Mangiza, Marcia, Fitzgerald, Felicity, Heys, Michelle, Neal, Samuel R., Chimhuya, Simbarashe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021203/
https://www.ncbi.nlm.nih.gov/pubmed/36962805
http://dx.doi.org/10.1371/journal.pgph.0000911
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author Gannon, Hannah
Chimhini, Gwendoline
Cortina-Borja, Mario
Chiyaka, Tarisai
Mangiza, Marcia
Fitzgerald, Felicity
Heys, Michelle
Neal, Samuel R.
Chimhuya, Simbarashe
author_facet Gannon, Hannah
Chimhini, Gwendoline
Cortina-Borja, Mario
Chiyaka, Tarisai
Mangiza, Marcia
Fitzgerald, Felicity
Heys, Michelle
Neal, Samuel R.
Chimhuya, Simbarashe
author_sort Gannon, Hannah
collection PubMed
description Neonatal encephalopathy (NE) accounts for ~23% of the 2.4 million annual global neonatal deaths. Approximately 99% of global neonatal deaths occur in low-resource settings, however, accurate data from these low-resource settings are scarce. We reviewed risk factors of neonatal mortality in neonates admitted with neonatal encephalopathy from a tertiary neonatal unit in Zimbabwe. A retrospective review of risk factors of short-term neonatal encephalopathy mortality was conducted at Sally Mugabe Central Hospital (SMCH) (November 2018 –October 2019). Data were gathered using a tablet-based data capture and quality improvement newborn care application (Neotree). Analyses were performed on data from all admitted neonates with a diagnosis of neonatal encephalopathy, incorporating maternal, intrapartum, and neonatal risk predictors of the primary outcome: mortality. 494/2894 neonates had neonatal encephalopathy on admission and were included. Of these, 94 died giving a neonatal encephalopathy-case fatality rate (CFR) of 190 per 1000 admitted neonates. Caesarean section (odds ratio (OR) 2.95(95% confidence interval (CI) 1.39–6.25), convulsions (OR 7.13 (1.41–36.1)), lethargy (OR 3.13 (1.24–7.91)), Thompson score “11–14” (OR 2.98 (1.08–8.22)) or “15–22” (OR 17.61 (1.74–178.0)) were significantly associated with neonatal death. No maternal risk factors were associated with mortality. Nearly 1 in 5 neonates diagnosed with neonatal encephalopathy died before discharge, similar to other low-resource settings but more than in typical high-resource centres. The Thompson score, a validated, sensitive and specific tool for diagnosing neonates with neonatal encephalopathy was an appropriate predictive clinical scoring system to identify at risk neonates in this setting. On univariable analysis time-period, specifically a period of staff shortages due to industrial action, had a significant impact on neonatal encephalopathy mortality. Emergency caesarean section was associated with increased mortality, suggesting perinatal care is likely to be a key moment for future interventions.
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spelling pubmed-100212032023-03-17 Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period Gannon, Hannah Chimhini, Gwendoline Cortina-Borja, Mario Chiyaka, Tarisai Mangiza, Marcia Fitzgerald, Felicity Heys, Michelle Neal, Samuel R. Chimhuya, Simbarashe PLOS Glob Public Health Research Article Neonatal encephalopathy (NE) accounts for ~23% of the 2.4 million annual global neonatal deaths. Approximately 99% of global neonatal deaths occur in low-resource settings, however, accurate data from these low-resource settings are scarce. We reviewed risk factors of neonatal mortality in neonates admitted with neonatal encephalopathy from a tertiary neonatal unit in Zimbabwe. A retrospective review of risk factors of short-term neonatal encephalopathy mortality was conducted at Sally Mugabe Central Hospital (SMCH) (November 2018 –October 2019). Data were gathered using a tablet-based data capture and quality improvement newborn care application (Neotree). Analyses were performed on data from all admitted neonates with a diagnosis of neonatal encephalopathy, incorporating maternal, intrapartum, and neonatal risk predictors of the primary outcome: mortality. 494/2894 neonates had neonatal encephalopathy on admission and were included. Of these, 94 died giving a neonatal encephalopathy-case fatality rate (CFR) of 190 per 1000 admitted neonates. Caesarean section (odds ratio (OR) 2.95(95% confidence interval (CI) 1.39–6.25), convulsions (OR 7.13 (1.41–36.1)), lethargy (OR 3.13 (1.24–7.91)), Thompson score “11–14” (OR 2.98 (1.08–8.22)) or “15–22” (OR 17.61 (1.74–178.0)) were significantly associated with neonatal death. No maternal risk factors were associated with mortality. Nearly 1 in 5 neonates diagnosed with neonatal encephalopathy died before discharge, similar to other low-resource settings but more than in typical high-resource centres. The Thompson score, a validated, sensitive and specific tool for diagnosing neonates with neonatal encephalopathy was an appropriate predictive clinical scoring system to identify at risk neonates in this setting. On univariable analysis time-period, specifically a period of staff shortages due to industrial action, had a significant impact on neonatal encephalopathy mortality. Emergency caesarean section was associated with increased mortality, suggesting perinatal care is likely to be a key moment for future interventions. Public Library of Science 2022-12-20 /pmc/articles/PMC10021203/ /pubmed/36962805 http://dx.doi.org/10.1371/journal.pgph.0000911 Text en © 2022 Gannon et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Gannon, Hannah
Chimhini, Gwendoline
Cortina-Borja, Mario
Chiyaka, Tarisai
Mangiza, Marcia
Fitzgerald, Felicity
Heys, Michelle
Neal, Samuel R.
Chimhuya, Simbarashe
Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period
title Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period
title_full Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period
title_fullStr Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period
title_full_unstemmed Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period
title_short Risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in Zimbabwe over a 12-month period
title_sort risk factors of mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in zimbabwe over a 12-month period
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021203/
https://www.ncbi.nlm.nih.gov/pubmed/36962805
http://dx.doi.org/10.1371/journal.pgph.0000911
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