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Metaferia G, Abayneh M, Aynalem S, Demisse AG, Demtse AG, Eshetu B, Mekasha A, Worku B, Nigussie AK, McClure EM, Goldenberg RL, Muhe LM. Antenatal Steroid Utilization in Ethiopia. Glob Pediatr Health 2021; 8:2333794X21990344. [PMID: 33614845 PMCID: PMC7868499 DOI: 10.1177/2333794x21990344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 12/08/2020] [Accepted: 12/31/2020] [Indexed: 11/21/2022] Open
Abstract
Background. Administration of antenatal corticosteroids to pregnant mothers is one of the most effective interventions to decrease preterm neonatal mortality. In this study we assessed antenatal steroid utilization by the mother and its effect on preterm babies. Method. Two years prospective, multicenter, observational study was conducted in selected hospitals of Ethiopia. Significance of the study outcomes was tested by chi-square and binary logistic regression. Result. Out of 4919 participants, 1575 preterm babies whose gestational ages were below 35 weeks were included in the study. Use of antenatal dexamethasone was 37.5% among study participants. The risk of early onset neonatal sepsis 235 (40.4%) was higher in preterm babies whose mother took antenatal dexamethasone (P-value .002) than those who did not. Conclusion. Antenatal dexamethasone use in our study was comparable with other low and middle-income countries. Risk of early onset neonatal sepsis was higher among infants whose mother took antenatal dexamethasone.
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Affiliation(s)
- Gesit Metaferia
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mahlet Abayneh
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sara Aynalem
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | | | - Lulu M Muhe
- Addis Ababa University, Addis Ababa, Ethiopia
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2
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Aynalem S, Abayneh M, Metaferia G, Demissie AG, Gidi NW, Demtse AG, Berta H, Worku B, Nigussie AK, Mekasha A, Tazu Bonger Z, McClure EM, Goldenberg RL, Muhe LM. Hyperbilirubinemia in Preterm Infants Admitted to Neonatal Intensive Care Units in Ethiopia. Glob Pediatr Health 2021; 7:2333794X20985809. [PMID: 33457466 PMCID: PMC7783876 DOI: 10.1177/2333794x20985809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/28/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background. Hyperbilirubinemia is prevalent and protracted in
preterm infants. This study assessed the pattern of hyperbilirubinemia in
preterm infants in Ethiopia. Methods. This study was part of
multi-centered prospective, cross-sectional, observational study that determined
causes of death among preterm infants. Jaundice was first identified based on
clinical visual assessment. Venous blood was then sent for total and direct
serum bilirubin level measurements. For this study, a total serum bilirubin
level ≥5 mg/dL was taken as the cutoff point to diagnose hyperbilirubinemia.
Based on the bilirubin level and clinical findings, the final diagnoses of
hyperbilirubinemia and associated complications were made by the physician.
Result. A total of 4919 preterm infants were enrolled into
the overall study, and 3852 were admitted to one of the study’s newborn
intensive care units. Of these, 1779 (46.2%) infants were diagnosed with
hyperbilirubinemia. Ten of these (0.6%) developed acute bilirubin
encephalopathy. The prevalence of hyperbilirubinemia was 66.7% among the infants
who were less than 28 weeks of gestation who survived. Rh incompatibility
(P = .002), ABO incompatibility
(P = .0001), and sepsis (P = .0001) were
significantly associated with hyperbilirubinemia. Perinatal asphyxia
(P-value = 0.0001) was negatively associated with
hyperbilirubinemia. Conclusion. The prevalence of
hyperbilirubinemia in preterm babies admitted to neonatal care units in Ethiopia
was high. The major risk factors associated with hyperbilirubinemia in preterm
babies in this study were found to be ABO incompatibility, sepsis, and Rh
isoimmunization.
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Affiliation(s)
- Sara Aynalem
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mahlet Abayneh
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gesit Metaferia
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | | | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Lulu M Muhe
- Addis Ababa University, Addis Ababa, Ethiopia
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Mekasha A, Tazu Z, Muhe L, Abayneh M, Gebreyesus G, Girma A, Berhane M, McClure EM, Goldenberg RL, Nigussie AK. Factors Associated with the Death of Preterm Babies Admitted to Neonatal Intensive Care Units in Ethiopia: A Prospective, Cross-sectional, and Observational Study. Glob Pediatr Health 2020; 7:2333794X20970005. [PMID: 33283024 PMCID: PMC7689001 DOI: 10.1177/2333794x20970005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/05/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
Aim. To determine the risk factors for death among preterm
neonates. Methods and materials. The data set used was derived
from a prospective, multi-center, observational clinical study conducted in 5
tertiary hospitals in Ethiopia from July, 2016 to May, 2018. Subjects were
infants admitted into neonatal intensive care unit. Results.
Risk factors were determined using statistical model developed for this study.
The mean gestational age was 32.87 (SD ± 2.42) weeks with a range of 20 to
36 weeks. There were 2667 (70.69%) survivors and 1106 (29.31%) deaths. The
significant risk factors for preterm death were low gestational age, low birth
weight, being female, feeding problem, no antenatal care visits and vaginal
delivery among mothers with higher educational level.
Conclusions. The study identified several risk factors for
death among preterm neonates. Most of the risk factors are preventable. Thus, it
is important to address neonatal and maternal factors identified in this study
through appropriate ANC and optimum infant medical care and feeding practices to
decrease the high rate of preterm death.
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Affiliation(s)
- Amha Mekasha
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zelalem Tazu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lulu Muhe
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mahlet Abayneh
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Goitom Gebreyesus
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Gidi NW, Goldenberg RL, Nigussie AK, Tazu Bonger Z, McClure EM, Abayneh M, Siebeck M, Genzel-Boroviczény O, Muhe LM. Disparity in Birth Size of Ethiopian Preterm Infants in Comparison to International INTERGROWTH-21st Data. Glob Pediatr Health 2020; 7:2333794X20973484. [PMID: 33283026 PMCID: PMC7684671 DOI: 10.1177/2333794x20973484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background. Patterns of fetal growth are largely influenced by
environmental, nutritional, and socioeconomic factors more than differences in
populations. The aim of this study was to assess anthropometric measurements of
Ethiopian preterm infants at birth and compare the results with the
international INTERGROWTH-21st data. Patients and methods. We
analyzed anthropometric data on live-born singleton preterm infants enrolled in
a hospital-based multicenter study of illness in preterm infants (SIP). Eligible
newborns with gestational age of 28-36 weeks were included. Gestational age (GA)
and sex-specific mean and standard deviations (SD), 10th, 50th, 90th, centile
values for birth weight, length and head circumference (HC) were calculated and
compared with INTERGROWTH-21st data. Result. A total of 2763
preterm infants were included in the study, 54% were male. The prevalence of
small for GA (SGA) (<10th percentile) and large for GA (LGA) (>90th
percentile) were 10.8% and 9.9%, respectively. In all 3 parameters, the mean
values of boys were higher than of girls. Birth weight centiles were comparable
to international averages at lower GA, then after GA of 32 weeks the 10th, 50th,
and 90th centile values were 100-500 g less than the international averages. The
head circumference centiles were mostly comparable, and the 90th centile values
were greater than the international averages across the GA and in both sexes.
Conclusion. The infants’ birth weights were smaller at
higher GA, which may indicate maternal undernutrition in the third trimester of
pregnancy. Strengthening antenatal nutrition counseling and providing nutrition
supplementation might improve the birth weight.
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Affiliation(s)
- Netsanet Workneh Gidi
- Jimma University, Jimma, Ethiopia.,CIHLMU, Center for International Health, University Hospital, LMU Munich, Germany
| | | | | | | | | | - Mahlet Abayneh
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | - Lulu M Muhe
- Addis Ababa University, Addis Ababa, Ethiopia
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Tigabu Kebede Z, Matebe YH, Demisse AG, Yimer MA, Mekasha A, Worku A, Demtse Gebremedhin A, McClure EM, Nigussie AK, Worku B, Gidi NW, Metaferia G, Goldenberg RL, Muhe LM. Hematologic Profiles of Ethiopian Preterm Infants With Clinical Diagnoses of Early-Onset Sepsis, Perinatal Asphyxia, and Respiratory Distress Syndrome. Glob Pediatr Health 2020; 7:2333794X20960264. [PMID: 33088853 PMCID: PMC7545762 DOI: 10.1177/2333794x20960264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/28/2020] [Accepted: 07/16/2020] [Indexed: 12/02/2022] Open
Abstract
Objective. To determine the hematologic profile of preterm infants with regard to different diseases. Methods. A prospective, cross-sectional, observational study, conducted in 5 hospitals in Ethiopia from July 2016 to May 2018. Preterm babies <7 days of age were included and investigated with complete blood counts (CBC) and other investigations, accordingly. Results. Out of 4919 preterms, 3852 (78.3%) were admitted to a newborn intensive care unit, and of these, 68.3% had a CBC performed. The mean values of hemoglobin, white blood cell (WBC) and platelet counts were 17.9 mg/dL; 12 685 cells/mm3, and 159 340 cells/mm3, respectively. Early onset neonatal sepsis (EONS) 1433 (37%), asphyxia 266 (6.9%), and respiratory distress syndrome (RDS) 1738 (45.3%) were common reasons for admission. The WBC count was <5000 cells/mm3 for 8.8%, 9.0%, and 11.1% of neonates with EONS, asphyxia and RDS, respectively. The hemoglobin value was <7 mg/dL for 0.6%, 1.7%, and 0.4% of preterm infants with EONS, asphyxia, and RDS, respectively. The platelet count was <50 000 cells/mm3 for 16.8%, 17.7%, and 19.8% of preterms admitted with a diagnosis of EONS, asphyxia, and RDS, respectively. Conclusion. WBC and platelet counts were the most common to be associated with EONS, asphyxia, and RDS. Further study is recommended to determine the effect of abnormal hematologic profile on the outcome of preterm babies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | | | | | | | - Lulu M Muhe
- Addis Ababa University, Addis Ababa, Ethiopia
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7
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Demtse AG, Pfister RE, Nigussie AK, McClure EM, Ferede YG, Tazu Bonger Z, Mekasha A, Demisse AG, Gidi NW, Metaferia G, Worku B, Goldenberg RL, Muhe LM. Hypothermia in Preterm Newborns: Impact on Survival. Glob Pediatr Health 2020; 7:2333794X20957655. [PMID: 32974416 PMCID: PMC7493265 DOI: 10.1177/2333794x20957655] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 01/21/2023] Open
Abstract
Background. Globally, prematurity is the leading cause of neonatal mortality, and hypothermia is one of its contributing factors. The goal of this study was to determine the association between hypothermia and mortality. Methods. A prospective, multi-center, descriptive clinical study was conducted in 5 hospitals in Ethiopia. Axillary temperatures were taken at the time of admission to the newborn intensive care units (NICU) and followed during the NICU stay. Results. A total of 3852 premature neonates (<37 weeks) were admitted to the NICUs from July 2016 to May 2018. Of these infants, 1109 (28.8%) died and 2991 (79.6%) had hypothermia. Hypothermia was associated with perinatal asphyxia (89.5%), RDS (86.2%), and resuscitation at birth (82.7%). Admission temperatures in preterm newborns were inversely associated with mortality and morbidity. Conclusion. Hypothermia at admission is associated with neonatal mortality in premature neonates in Ethiopia. RDS and perinatal asphyxia were the main factors associated with hypothermia. The very high prevalence and association with mortality warrants quality improvement interventions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Gesit Metaferia
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
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8
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Gidi NW, Mekasha A, Nigussie AK, Goldenberg RL, McClure EM, Worku B, Amaru GM, Tazu Bonger Z, Demtse AG, Kebede ZT, Siebeck M, Genzel-Boroviczény O, Muhe LM. Preterm Nutrition and Clinical Outcomes. Glob Pediatr Health 2020; 7:2333794X20937851. [PMID: 32782918 PMCID: PMC7383644 DOI: 10.1177/2333794x20937851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background. In low-income countries, preterm nutrition is often inadequately addressed. The aim of the study was to assess the patterns of feeding and associated clinical outcomes of preterm neonates admitted to neonatal intensive care units in Ethiopia. Method. This was a multicenter, prospective study. Infants' clinical characteristics at birth, daily monitoring of feeding history, and weight measurements were collected. An outcome assessment was completed at 28 days. Result. For this analysis, 2560 infants (53% male) were eligible. The mean (SD) gestational age was 33.1 (2.2) weeks. During the hospital stay the proportion of infants on breast milk only, preterm formula, term formula, and mixed feeding was 58%, 27.4%, 1.6%, and 34.1%, respectively. Delay in enteral feeding was associated with increased risk of death (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.33-2.78; P < .001) and (OR = 5.06, 95% CI = 3.23-7.87; P < .001) for 1 to 3 and 4 to 6 days of delay in enteral feeding, respectively, after adjusting for possible confounders. The length of delay in enteral feeding was associated with increased risk of hypoglycemia (OR = 1.2, 95% CI = 1.1-1.2; P = .005). The mortality rate was lower in hospitals providing preterm formula more often (P = .04). Half of the infants continued losing weight at the time of discharge. Conclusion. Delayed enteral feeding significantly increases the risk of mortality before discharge and hypoglycemia in preterm infants in resource-limited settings. Ensuring adequate nutritional support of preterm infants is highly needed.
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Affiliation(s)
| | | | | | | | | | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | - Gesit M. Amaru
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | - Matthias Siebeck
- Medical Center of the University of Munich (LMU), Munich, Germany
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9
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Muhe LM, McClure EM, Nigussie AK, Mekasha A, Worku B, Worku A, Demtse A, Eshetu B, Tigabu Z, Gizaw MA, Workneh N, Girma A, Asefa M, Portales R, Bekele T, Bezabih M, Metaferia G, Gashaw M, Abebe B, Berta H, Alemu A, Desta T, Hailu R, Gebreyesus G, Aynalem S, Abdissa AL, Pfister R, Bonger ZT, Gizaw S, Abebe T, Berhane MA, Bekuretsion Y, Dhaded S, Patterson J, Goldenberg RL. Major causes of death in preterm infants in selected hospitals in Ethiopia (SIP): a prospective, cross-sectional, observational study. Lancet Glob Health 2020; 7:e1130-e1138. [PMID: 31303299 PMCID: PMC6639243 DOI: 10.1016/s2214-109x(19)30220-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/17/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Neonatal deaths now account for 47% of all deaths in children younger than 5 years globally. More than a third of newborn deaths are due to preterm birth complications, which is the leading cause of death. Understanding the causes and factors contributing to neonatal deaths is needed to identify interventions that will reduce mortality. We aimed to establish the major causes of preterm mortality in preterm infants in the first 28 days of life in Ethiopia. METHODS We did a prospective, cross-sectional, observational study in five hospitals in Ethiopia. Study participants were preterm infants born in the study hospitals at younger than 37 gestational weeks. Infants whose gestational age could not be reliably estimated and those born as a result of induced abortion were excluded from the study. Data were collected on maternal and obstetric history, clinical maternal and neonatal conditions, and laboratory investigations. For neonates who died of those enrolled, consent was requested from parents for post-mortem examinations (both complete diagnostic autopsy and minimally invasive tissue sampling). An independent panel of experts established the primary and contributory causes of preterm mortality with available data. FINDINGS Between July 1, 2016, to May 31, 2018, 4919 preterm infants were enrolled in the study and 3852 were admitted to neonatal intensive care units. By 28 days of post-natal age, 1109 (29%) of those admitted to the neonatal intensive care unit died. Complete diagnostic autopsy was done in 441 (40%) and minimally invasive tissue sampling in 126 (11%) of the neonatal intensive care unit deaths. The main primary causes of death in the 1109 infants were established as respiratory distress syndrome (502 [45%]); sepsis, pneumonia and meningitis (combined as neonatal infections; 331 [30%]), and asphyxia (151 [14%]). Hypothermia was the most common contributory cause of preterm mortality (770 [69%]). The highest mortality occurred in infants younger than 28 weeks of gestation (89 [86%] of 104), followed by infants aged 28-31 weeks (512 [54%] of 952), 32-34 weeks (349 [18%] of 1975), and 35-36 weeks (159 [8%] of 1888). INTERPRETATION Three conditions accounted for 89% of all deaths among preterm infants in Ethiopia. Scale-up interventions are needed to prevent or treat these conditions. Further research is required to develop effective and affordable interventions to prevent and treat the major causes of preterm death. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Lulu M Muhe
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Elizabeth M McClure
- Social, Statistical and Environmental Health Sciences, Research Triangle Institute, Durham, NC, USA
| | | | - Amha Mekasha
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Demtse
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Mahlet A Gizaw
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | - Mesfin Asefa
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ramon Portales
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | - Gesit Metaferia
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | | | - Tigist Desta
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rahell Hailu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Goitom Gebreyesus
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sara Aynalem
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Riccardo Pfister
- Neonatology Unit, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Solomon Gizaw
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Yonas Bekuretsion
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sangappa Dhaded
- Women's and Children's Health Research Unit, KAHER, J N Medical College, Belgaum, India
| | - Janna Patterson
- Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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10
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Gidi NW, Goldenberg RL, Nigussie AK, McClure E, Mekasha A, Worku B, Siebeck M, Genzel-Boroviczeny O, Muhe LM. Incidence and associated factors of extrauterine growth restriction (EUGR) in preterm infants, a cross-sectional study in selected NICUs in Ethiopia. BMJ Paediatr Open 2020; 4:e000765. [PMID: 33094173 PMCID: PMC7552851 DOI: 10.1136/bmjpo-2020-000765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/25/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Preterm infants have high risk of developing growth restriction and long-term complications. Enteral feeding is often delayed in neonatal intensive care units (NICUs) for the fear of feeding intolerance and the associated necrotising enterocolitis, and recent advances in nutritional support are unavailable in low-income countries. OBJECTIVE The aim of this study was to assess the incidence and associated factors of extrauterine growth restriction (EUGR) among preterm infants in selected NICUs in Ethiopia. METHOD This was a cross-sectional study involving a subgroup analysis of preterm infants admitted to hospitals, from a multicentre descriptive study of cause of illness and death in preterm infants in Ethiopia, conducted from 2016 to 2018. EUGR was defined as weight at discharge Z-scores <-1.29 for corrected age. Clinical profiles of the infants were analysed for associated factors. SPSS V.23 software was used for analysis with a significance level of 5% and 95% CI. RESULT From 436 preterm infants included in the analysis, 223 (51%) were male, 224 (51.4%) very low birth weight (VLBW) and 185 (42.4%) small for gestational age (SGA). The mean (SD) of weight for corrected age Z-score at the time of discharge was -2.5 (1.1). The incidence of EUGR was 86.2%. Infants who were SGA, VLBW and longer hospital stay over 21 days had increased risk of growth restriction (p-value<0.01). SGA infants had a 15-fold higher risk of developing EUGR at the time of discharge from hospital than those who were appropriate or large for gestational age (OR (95% CI)=15.2 (4.6 to 50.1). CONCLUSION The majority of the infants had EUGR at the time of discharge from the hospital, which indicates suboptimal nutrition. Revision of national guidelines for preterm infants feeding and improvement in clinical practice is highly required.
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Affiliation(s)
- Netsanet Workneh Gidi
- CIHLMU Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany.,Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Assaye K Nigussie
- Newborn & Child Health, Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Elizabeth McClure
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, North Carolina, USA
| | - Amha Mekasha
- Department of Pediatrics and Child Health, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia
| | - Bogale Worku
- Department of Pediatrics and Child Health, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia.,Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | - Matthias Siebeck
- Institute for Medical Education, University Hospital, LMU Munich, Germany, Munich, Germany
| | | | - Lulu M Muhe
- Department of Pediatrics and Child Health, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia
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11
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Gidi NW, Goldenberg RL, Nigussie AK, McClure E, Mekasha A, Worku B, Siebeck M, Genzel-Boroviczeny O, Muhe LM. Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28-36 weeks of gestation: a multicentre study in Ethiopia. BMJ Paediatr Open 2020; 4:e000740. [PMID: 32984553 PMCID: PMC7493091 DOI: 10.1136/bmjpo-2020-000740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The aim of this study was to assess morbidity and mortality pattern of small for gestational age (SGA) preterm infants in comparison to appropriate for gestational age (AGA) preterm infants of similar gestational age. METHOD We compared neonatal outcomes of 1336, 1:1 matched, singleton SGA and AGA preterm infants based on their gestational age using data from the study 'Causes of Illness and Death of Preterm Infants in Ethiopia (SIP)'. Data were analysed using SPSS V.23. ORs and 95% CIs and χ2 tests were done, p value of <0.05 was considered statistically significant. RESULT The majority of the infants (1194, 89%) were moderate to late preterm (32-36 weeks of gestation), 763 (57%) were females. Male preterm infants had higher risk of being SGA than female infants (p<0.001). SGA infants had increased risk of hypoglycaemic (OR and 95% CI 1.6 (1.2 to 2.0), necrotising enterocolitis (NEC) 2.3 (1.2 to 4.1), polycythaemia 3.0 (1.6 to 5.4), late-onset neonatal sepsis (LOS) 3.6 (1.1 to 10.9)) and prolonged hospitalisation 2.9 (2.0 to 4.2). The rates of respiratory distress syndrome (RDS), apnoea and mortality were similar in the SGA and AGA groups. CONCLUSION Neonatal complications such as hypoglycaemic, NEC, LOS, polycythaemia and prolonged hospitalisation are more common in SGA infants, while rates of RDS and mortality are similar in SGA and AGA groups. Early recognition of SGA status, high index of suspicion and screening for complications associated and timely intervention to prevent complications need due consideration.
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Affiliation(s)
- Netsanet Workneh Gidi
- Pediatric and Child Health, Jimma University, Jimma, Oromia, Ethiopia.,Center for International Health, University Hospital, LMU, Munich, Germany
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Assaye K Nigussie
- Newborn & Child Health, Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Elizabeth McClure
- Center for Clinical Research Network Coordination, RTI International, Durham, North Carolina, USA
| | - Amha Mekasha
- Pediatrics and Child Heath, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia
| | - Bogale Worku
- Pediatrics and Child Heath, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia.,Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | - Matthias Siebeck
- Institute for Medical Education, University Hospital, LMU, Munich, Germany
| | | | - Lulu M Muhe
- Pediatrics and Child Heath, Addis Ababa University College of Health Sciences, Addis Ababa, Oromia, Ethiopia
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Muhe LM, McClure EM, Mekasha A, Worku B, Worku A, Dimtse A, Gebreyesus G, Tigabu Z, Abayneh M, Workneh N, Eshetu B, Girma A, Asefa M, Portales R, Arayaselassie M, Gebrehiwot Y, Bekele T, Bezabih M, Metaferia G, Gashaw M, Abebe B, Geleta A, Shehibo A, Hailu Y, Berta H, Alemu A, Desta T, Hailu R, Patterson J, Nigussie AK, Goldenberg RL. A Prospective Study of Causes of Illness and Death in Preterm Infants in Ethiopia: The SIP Study Protocol. Reprod Health 2018; 15:116. [PMID: 29945680 PMCID: PMC6020308 DOI: 10.1186/s12978-018-0555-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With nearly 15 million annual preterm births globally, preterm birth is the most common cause of neonatal death. Forty to 60 % of neonatal deaths are directly or indirectly associated with preterm mortality. As countries aim to meet the Sustainable Development Goals to reduce neonatal mortality, significant reductions in preterm mortality are needed. This study aims to identify the common causes of preterm illness and their contribution to preterm mortality in low-resource settings. This article will describe the methods used to undertake the study. METHODS This is a prospective, multi-centre, descriptive clinical study. Socio-demographic, obstetric, and maternal factors, and clinical and laboratory findings will be documented. The major causes of preterm mortality will be identified using clinical, laboratory, imaging, and autopsy methods and use the national Ethiopian guidelines on management of preterm infants including required investigations to reach final diagnoses. The study will document the clinical and management protocols followed in these settings. The approach consists of clinical examinations and monitoring, laboratory investigations, and determination of primary and contributory causes of mortality through both clinical means and by post-mortem examinations. An independent panel of experts will validate the primary and contributory causes of mortality. To obtain the estimated sample size of 5000 preterm births, the study will be undertaken in five hospitals in three regions of Ethiopia, which are geographically distributed across the country. All preterm infants who are either born or transferred to these hospitals will be eligible for the study. Three methods (last menstrual period, physical examination using the New Ballard Score, and ultrasound) will be used to determine gestational age. All clinical procedures will be conducted per hospital protocol and informed consent will be taken from parents or caretakers prior to their participation in the study as well as for autopsy if the infant dies. DISCUSSION This study will determine the major causes of death and illness among hospitalized preterm infants in a low-resource setting. The result will inform policy makers and implementers of areas that can be prioritized in order to contribute to a significant reduction in neonatal mortality.
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Affiliation(s)
- Lulu M. Muhe
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Amha Mekasha
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bogale Worku
- Ethiopian Pediatric Society, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Dimtse
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Goitom Gebreyesus
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Mahlet Abayneh
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | - Mesfin Asefa
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ramon Portales
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Yirgu Gebrehiwot
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Gesit Metaferia
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Hailu Berta
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Tigist Desta
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rahel Hailu
- College of Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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