Time to Death and Its Predictors Among Neonates Admitted With Neonatal Sepsis at Public Referral Hospitals of Bahir Dar City, Northwest Ethiopia, 2021: Retrospective Cohort Study

Abstract Background: In spite of recent advances in health care, neonatal sepsis is still one of the major causes of morbidity and mortality in neonates and is an ongoing major global public health challenge. Its incidence of mortality varies from health institution to health institution and within the same health institution at varied times and depends on predisposing factors. So the aim of this study was to determine the time to death and its predictors among neonates admitted with neonatal sepsis. Methods: An institutional based retrospective cohort study was conducted among 500 randomly selected neonatal charts. The data was entered using Epi data version 3.1, and exported to and analyzed at STATA version 14. Bivariable and multivariable cox regression analysis were conducted to identify predictors of mortality. Association was summarized using adjusted hazard ratio (AHR) and statistical significances were declared at 95% CI and P-value <0.05. Proportionality assumption was tested by global test based on Schoenfeld residuals analysis. Results: During the follow up time, 58 (11.6%) neonates were died with neonatal sepsis while the rest were censored. In this study the overall death incidence rate was 20.5 per 1000 neonate days. Comorbidity (AHR: 1.81, 95%, CI: 1.04, 3.17), late initiation of exclusive breast feeding over one hour (AHR: 2.29, 95%CI: 1.13,4.63), history of intra-partum fever(AHR: 7.37 95%CI: 2.28,23.79), Birth weight (AHR: 3.37, 95%CI: 1.54, 7.34) and place of delivery(AHR: 3.83, 95%, CI: 1.24, 11.83) were found potential independent predictors of mortality among neonates with neonatal sepsis.Conclusion: In this study, high death incidence rate was observed. The mean time to death among neonates was 4.41 days. With regard to predictors: birth weight, comorbidity, late initiation of exclusive breast feeding over one hour, history of intra partum fever and place of delivery were significant predictors of mortality among neonates admitted with neonatal sepsis.