742 - Leading Causes of Premature Neonatal Death at a Tertiary Referral NICU in Addis Ababa, Ethiopia: A Graphical Network Approach to Understanding Contributing Factors

Publication Number: 742.5776

Gal Barbut, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Olivia C. Brandon, University of Washington: Magnuson Health Sciences Center – RR 544A, Seattle, WA, United States; Gregory C.. Valentine, University of Washington School of Medicine, Tacoma, WA, United States; Krystle M.. Perez, University of Washington, Seattle, WA, United States; Thomas R. Wood, University of Washington School of Medicine, Seattle, WA, United States; Sharla Rent, Duke University School of Medicine, Durham, NC, United States; Merhawit Abadi, Saint Paul's Hospital Millennium Medical College, ADDIS ABABA, Adis Abeba, Ethiopia; Redeat Workneh, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, Adis Abeba, Ethiopia; Mahlet Abayneh, St Paul's Hospital Millennium Medical College, Addis ABABA, Adis Abeba, Ethiopia

Background: Prematurity is the leading cause of neonatal death globally, with Ethiopia having the 4th highest number of neonatal deaths worldwide. We have previously described the leading 3 contributors of death in premature infants (respiratory distress syndrome (RDS), presumed or culture-positive sepsis, and pulmonary hemorrhage) at St. Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia. Yet, the relationship between maternal and infant factors with the leading contributors of preterm mortality remains unclear.

Objective: To evaluate the relationships between maternal and infant factors associated with any preterm ( < 37 weeks gestation) death at SPHMMC and cause-specific death for the three leading contributors of mortality.

Design/Methods: We performed a retrospective analysis of premature neonates admitted to the SPHMMC NICU from February 2022 – August 2024. Graphical network analysis was performed based on an inverse covariance matrix to identify factors associated with (a) death of any hospitalized preterm neonates, and (b) the three leading contributors of premature neonatal death – RDS, culture-positive or presumed sepsis, and pulmonary hemorrhage. Significant relationships were determined using 95% confidence intervals for partial correlations.

Results: Of N=1656 premature infants hospitalized, n=403 died (24.3% mortality rate; Table 1) with numerous maternal and infant factors significantly associated with death. Graphical network analysis (Figure 1) revealed variables associated with death that Table 1 did not identify: intrauterine growth restriction and mode of delivery. Of those that died, n=274, n=143, and n=100 died from RDS, culture-positive or presumed sepsis, and pulmonary hemorrhage, respectively. Compared to neonates who died with other respective contributors of mortality, RDS was associated with a lower gestational age and being inborn (Figure 2A). Culture-positive or presumed sepsis was associated with a lower gestational age and being a multiple (Figure 2B). Pulmonary hemorrhage was associated with antenatal corticosteroid administration during pregnancy (Figure 2C).

Conclusion(s): Gestational age is associated with all-cause death and death due to RDS and sepsis but was not associated with deaths due to pulmonary hemorrhage. As the third leading cause of death, pulmonary hemorrhage is not associated with traditional morality risk factors for preterm death. Further studies are needed to explore the underlying pathophysiology and diagnostic criteria for pulmonary hemorrhage – an entity with a high burden of death in our LMIC context.

Table 1
Maternal and infant characteristics among infants who died during hospital stay and those who survived.

Figure 1
Graphical network illustrating relationships between maternal and infant factors to all-cause mortality.

Figure 2
Graphical networks illustrating relationships between maternal and infant factors with specific causes of death due to (A) Respiratory Distress Syndrome (B) Sepsis – presumed or culture positive, and (C) Pulmonary hemorrhage