Research Article
Treatment Outcomes of Neonatal Sepsis and Predictors in Neonatal Intensive Care Unit at a Tertiary Hospital in Eastern Ethiopia.
Abstract
Background: Neonatal sepsis affects about 40.25% of neonates in Ethiopia. Despite the heavy burden of the disease in the country, data on treatment outcomes and determinant factors are limited.
Methods: Institution based cross-sectional study was conducted from February 15 to April 15, 2020 among neonates with sepsis hospitalized at Hiwot Fana Specialized University Hospital, eastern Ethiopia. Data were analyzed using SPSS version 24.0. Multivariable logistic regression analysis was performed to identify predictors of recovery from neonatal sepsis.
Results: A total of 180 (71.7%) neonates with early onset and 71 (28.3%) with late onset neonatal sepsis were included in the study. Of these, 3.2 % (eight) died, twenty-five (9.96%) were self-discharge, and 0.4% (n=1) were transferred to other health institutions. The overall recovery rate was 86.5% with higher recovery rate for early onset than late onset neonatal sepsis (73.3% vs 26.7%). Being pre-term (< 37 weeks), (Adjusted Odds Ratio (OR) = 0.21 95 % CI: 0.09 – 0.48), having severe disease at hospitalization (critical case) (OR= 0.42, 95% CI: 0.17 – 1.01), failure of feeding (OR= 0.39, 95% CI: 0.16 – 0.96) and delivery at health centers (OR=5.16 95% CI: 1.40 – 18.95) were significantly associated with recovery from neonatal sepsis.
Conclusion: Most neonates had early onset neonatal sepsis and the majority of them were recovered with higher recovery rates for early onset neonatal sepsis. Delivering at healthcare facilities, and early initiation of breast feeding and providing special attention for pre-term, and critical cases could improve neonatal recovery from sepsis.
Keywords: Neonatal Sepsis; Treatment Outcomes; Recovery; Eastern Ethiopia
Introduction
Neonatal sepsis (NS) is defined as a clinical syndrome characterized by non-specific systemic signs and symptoms of infection during the first 28 days of the infant’s life [1]. Based on the time when infection occurs, neonatal sepsis is classified as an early onset neonatal sepsis (EONS) if it occurs within the first three days of life; or late onset neonatal sepsis (LONS) if occurs from the third day or one week to the fourth week of the infant’s life [1]. This distinction has clinical significance, as EONS is mainly due to bacterial acquired through prenatal and intrapartum maternal transmission, whereas LONS acquired postnatally from the environment such as nosocomial or community [2].
The estimated global burden of NS is about 22 per 1000 live births, with mortality rates ranging from 11% to 19% [3]. The third Sustainable Development Goal for child health which aimed to end preventable deaths of newborns and children under five years of age by 2030, may not be achieved without a substantial reduction of infection-specific neonatal mortalities in developing countries [4]. In sub-Saharan Africa, South Asia, and Latin America where the prevalence of neonatal infections is considerably high, the case fatality rate associated with severe bacterial infections in the first month of life is 9.8% [4]. The Global Sepsis Alliance (GSA) identified that infections causing sepsis are responsible for about one-fifth of the world’s annual 2.7 million neonatal deaths, and in South Asia and sub-Saharan Africa, they are responsible for one-fourth of all neonatal deaths [5].
Globally, the neonatal deaths have decreased by over 3.6 million per year since 2000, mainly due to the decrease in the incidence of major conditions such as pneumonia and diarrhea. Despite this success, literature indicates that NS remains a notable hindrance to the progress in the decline of cause-specific mortality rates [3]. To date, Neonatal sepsis is responsible for 1.6 times the global number of childhood deaths as malaria, and over four times the number of childhood deaths caused by HIV [4].
According to the systematic review and meta-analysis conducted in Ethiopia, the magnitude of NS among hospitalized neonates in different parts of the country ranged from 11.7% to 77. 9%, with an overall pooled estimate of 40.25% [6]. Despite the heavy burden of NS in the country, there is limited research on in-hospital treatment outcomes and contributing factors among hospitalised neonates in Ethiopia. Furthermore, no previous studies have evaluated the in-hospital treatment outcomes and contributing factors in Eastern Ethiopia. Therefore, this study aimed to assess treatment outcomes of neonatal sepsis and predictors among neonates hospitalised to the Neonatal Intensive Care Unit (NICU) at Hiwot Fana Specialized University Hospital (HFSUH), Harar, eastern Ethiopia.
Methods
Study Area and Period
The study was conducted in Hiwot Fana Specialized University Hospital (HFSUH). HFSUH is the largest teaching and referral center in East Ethiopia. It provides a 24hour inpatient, outpatient, delivery and emergency services for the population residing in the eastern part of the country. HFSUH has medical, surgical, pediatrics, gynecology and Obstetrics wards, and various outpatient clinics. The pediatric ward has six units, including the intensive care unit, nutritional rehabilitation unit, neonatal intensive care unit, and the chronic follow up unit. The study was conducted from February 15 to April 15, 2020 in the neonatal intensive care unit of the pediatric ward.
Study Design and Population
Institution based cross-sectional study was used. Medical records of neonates who had confirmed diagnosis and treated for either early or late onset neonatal sepsis were included in the study. Medical records with sepsis above the neonatal age were excluded.
Sample size determination
The sample size was calculated using single population proportion formula by taking the following assumption: 5% confidence level, 50% estimate of prevalence rate for recovery and 5% margin of error. Accordingly, the calculated sample size was 384. Since the source population is less than 10,000, we applied the correction formula, and determined the final sample size for the study to be 251 neonates.
Data collection
A semi-structured data collection tool was developed after trough literature review and pre-tested on 5% of medical charts. The content of the tool was checked by a consultant pediatrician and feedback was incorporated. The data were collected by pharmacy intern after being given a training for two days. Pertinent data, such as maternal and neonatal sociodemographic information, sign and symptoms, gestational age, place of delivery, mode of delivery, birth weight, laboratory values, medication administered, and final outcomes were extracted.
Statistical Analysis
The collected data were checked, categorized, entered and analyzed by using SPSS version 24.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics such as frequency and proportion were computed for categorical variables. Bivariate regression analysis was performed and variables that have significant association with the outcome of interest (recovery) at 0.25 significance level were transferred into multivariable regression analysis to identify the predictors of neonatal recovery. During multivariable analysis a p value < 0.05% was considered significant.
Result
Neonatal and maternal characteristics
Overall, 180 (71.7%) neonates with early onset and 71 (28.3%) with late onset neonatal sepsis were included in the study. More than half (n=132, 52.6%) were male and 180 (71.7%) were aged less than seven days. Eighty (32.7%) neonates were under-weight (< 2.5 kg) and 22.7% were pre-term (< 37 weeks). Of the total mothers, 46.2% cannot read and write and 8.4% had an income < 150 Ethiopian Birr per-month. The majority (81.7%) of the mothers had Antenatal care follow up during pregnancy and 66.9% delivered in the hospital, out of which, 14.7% delivered by caesarean section (Table 1).
Table: 1 Neonatal and maternal characteristics among neonates with sepsis hospitalized in neonatal intensive care unit at Hiwot Fana Specialized University Hospital, eastern Ethiopia.
| Variable | EONS (N=180) | LONS (N=71) | Total (N=251) | |
|---|---|---|---|---|
| Sex | Male | 53.3% | 50.7% | 52.6% |
| Female | 46.7% | 49.3% | 47.4% | |
| Age | 0- 7 days | 100.0% | 0.0% | 71.7% |
| 8- 28 days | 0.0% | 100.0% | 28.3% | |
| Birth weight | < 2.5 kg | 36.7% | 22.5% | 32.7% |
| 2.5 – 4kg | 61.7% | 77.5% | 65.7% | |
| > 4 kg | 1.2% | 1.4% | 1.6% | |
| Gestational age | < 37 weeks | 21.7% | 25.4% | 22.7% |
| 37- 42 weeks | 73.3% | 73.2% | 73.3% | |
| > 42 weeks | 5.0% | 1.4% | 3.9% | |
| Educational background | Illiterate | 43.3% | 53.5% | 46.2% |
| read and write | 22.2% | 12.7% | 19.5% | |
| primary school | 12.2% | 12.7% | 12.4% | |
| secondary school | 13.9% | 12.7% | 13.5% | |
| higher education | 8.3% | 8.5% | 8.4% | |
| Monthly income (in Ethiopian Birr) | < 150 | 0.6% | 1.4% | 0.8% |
| 151-650 | 16.1% | 2.8% | 12.4% | |
| 651-1400 | 27.8% | 35.2% | 29.9% | |
| >1400 | 55.5% | 60.6% | 56.7% | |
| ANC follow-up | Yes | 80.0% | 86.0% | 81.7% |
| No | 20.0% | 14.0% | 18.3% | |
| Maternal fever | Yes | 42.8% | 50.7% | 45.0% |
| No | 52.2% | 49.3% | 55.0% | |
| Foul smell liquor | Yes | 26.1% | 23.9% | 25.5% |
| No | 73.9% | 76.1% | 75.5% | |
| Chorioamnionitis | Yes | 21.1% | 8.5% | 17.5% |
| No | 78.9% | 91.5% | 82.5% | |
| PRM | Yes | 22.2% | 32.4% | 25.1% |
| No | 77.8% | 67.6% | 74.9% | |
| DPRM | < 12 hours | 12.8% | 4.2% | 10.4% |
| 12 - 18 hours | 6.7% | 4.2% | 6.4% | |
| > 18 hours | 2.8% | 4.2% | 3.2% | |
| Mode of delivery | Vaginal | 76.1% | 88.7% | 79.7% |
| Caesarean section | 17.2% | 8.4% | 14.7% | |
| Vacuum | 6.7% | 2.8% | 5.6% | |
| Place of delivery | Hospital | 78.3% | 38.0% | 70.0% |
| Health Center | 12.8% | 26.8% | 16.7% | |
| Clinics | 4.4% | 22.5% | 9.6% | |
| Home | 4.4% | 12.7% | 6.7% | |
Note: EONS-Early-onset Neonatal Sepsis; LONS-Late Onset Neonatal Sepsis; ANC – Antenatal care; PRM– Premature rupture of membrane; DPRM – Duration of pre-mature rupture of membranes
Clinical Features
Of the total neonates, 42.2% were hyperthermic, 27.1% were irritable, and 46.6% were in respiratory distress. More than half (59.0%) were lethargic, 5.2% had seizure, 16.7% had jaundice, and 43% had lower APGAR score (< 7) (Table 2).
Table: 2 Clinical features of neonates with sepsis hospitalized in neonatal intensive care unit at Hiwot Fana Specialized University Hospital, eastern Ethiopia.
| Variables | EONS (N=180) | LONS (N=71) | Total (N=251) | |
|---|---|---|---|---|
| Hyperthermia(>38.0°C) | Yes | 27.2% | 55.0% | 42.2% |
| No | 72.8% | 45.0% | 57.8% | |
| Hypothermia(<36.5°C) | Yes | 62.2% | 46.5% | 57.8% |
| No | 37.8% | 53.5% | 42.2% | |
| Irritability | Yes | 27.7% | 25.4% | 27.1% |
| No | 72.3% | 74.6% | 79.9% | |
| Respiratory distress | Yes | 48.9% | 40.8% | 46.6% |
| No | 51.1% | 59.2% | 53.4 | |
| Vomiting | Yes | 0.0% | 5.6% | 1.6% |
| No | 100.0% | 94.4% | 98.4% | |
| Cyanosis | Yes | 0.0% | 1.4% | 0.4% |
| No | 100.0% | 98.6% | 99.6% | |
| Diarrhoea | Yes | 6.7% | 8.5% | 7.2% |
| No | 93.3% | 91.5% | 92.8% | |
| Abdominal distention | Yes | 5.0% | 8.5% | 6.0% |
| No | 95.0% | 91.5% | 94.0% | |
| Lethargic | Yes | 56.7% | 64.8% | 59.0% |
| No | 43.3% | 35.2% | 41.0% | |
| Failure feeding | Yes | 23.3% | 12.7% | 20.3% |
| No | 76.7% | 87.3% | 79.7% | |
| Bulging fontanels | Yes | 2.8% | 7.0% | 3.9% |
| No | 97.2% | 93.0% | 96.1% | |
| Coma | Yes | 2.2% | 2.8% | 2.4% |
| No | 97.8% | 97.2% | 97.6% | |
| Seizure | Yes | 5.6% | 2.8% | 4.8% |
| No | 94.4% | 97.2% | 95.2% | |
| Edema | Yes | 0.0% | 5.6% | 1.6% |
| No | 100.0% | 94.4% | 98.4% | |
| Jaundice | Yes | 16.1% | 18.3% | 16.7% |
| No | 83.9% | 81.7% | 83.3% | |
| Hepatomegaly | Yes | 1.1% | 0.0% | 0.8% |
| No | 98.9% | 100.0% | 99.2% | |
Note: EONS-Early-onset Neonatal Sepsis; LONS-Late Onset Neonatal Sepsis
Laboratory Tests
The random blood glucose, complete blood cell count (CBC), and Cerebrospinal fluid analysis (CSF) tests were performed in 42.6%, 97.6%, and 6.4% neonates, respectively. Three neonates had lower random blood glucose (< 70mg/dl) while more than half (59.0%) had elevated white blood cell count. The cerebrospinal fluid glucose and protein were < 50mg/dl and < 60mg/dl in 4.4% and 3.2% neonates, respectively (Table 3).
Table: 3 Laboratory tests among neonates with sepsis hospitalized in neonatal intensive care unit at Hiwot Fana Specialized University Hospital, eastern Ethiopia.
| Lab Tests | EONS (N=180) | LONS (N=71) | Total (N=251) | |
|---|---|---|---|---|
| Random blood glucose | < 70 mg/dl | 1.7% | 0.0% | 1.2% |
| 70- 115 mg/dl | 40.0% | 35.2% | 38.6% | |
| > 115 mg/l | 3.3% | 1.4% | 2.8% | |
| Haemoglobin | < 15 mg/dl | 21.7% | 29.6% | 23.9% |
| 15- 22 mg/dl | 73.3% | 64.8% | 70.9% | |
| > 22 mg/dl | 3.3% | 1.4% | 2.8% | |
| WBC Count | < 5000 cell/mm3 | 22.2% | 47.9% | 29.5% |
| 5000-12000 cells/mm3 | 6.1% | 25.4% | 11.5% | |
| >12000 cell/mm3 | 54.4% | 70.4% | 59.0% | |
| Hematocrit | < 42 % | 82.2% | 90.1% | 84.5% |
| 42-65 % | 15.2% | 5.6% | 12.7% | |
| > 65% | 0.6% | 0.0% | 0.4% | |
| MCV | < 80 FL | 10.2% | 15.5% | 12.0% |
| 80- 115 FL | 87.2% | 77.5% | 84.5% | |
| > 115 FL | 0.6% | 2.8% | 1.2% | |
| Platelet | < 150 k/UL | 75.6% | 69.0% | 73.7% |
| 150 - 450 k/UL | 22.8 | 26.8% | 23.9% | |
| CSF appearance | Clear | 0.6% | 11.3% | 3.6% |
| Cloud | 1.7% | 1.4% | 1.6% | |
| Bloody | 1.2% | 1.4% | 1.2% | |
| WBC in CSF | < 5 cells/µL | 1.2% | 9.8% | 3.6% |
| > 5 cells/µL | 2.2% | 4.3% | 2.8% | |
| Glucose in CSF | >50 mg /dl | 2.8% | 8.5% | 4.4% |
| < 50 mg/dl | 0.6% | 5.6% | 2.0% | |
| Protein in CSF | < 60 mg/dl | 0.6% | 9.8% | 3.2% |
| > 60mg/dl | 2.8% | 4.2% | 3.2% | |
Note: MG/dl: milligram per deciliter, MCV: Mean Corpuscular Volume, WBC: White Blood Cell Count; EONS-Early-onset Neonatal Sepsis; LONS-Late Onset Neonatal Sepsis; CSF-Cerebrospinal fluid
Medication administered, length of hospitalization and in-hospital outcomes
All neonates were prescribed Ampicillin and Gentamycin. One-hundred forty-four (57.4%) neonates were hospitalised for < 7 days and five were hospitalised for > 14 days. Of the total neonates, the majority (86.5%) recovered, eight died, and twentyfive (9.96%) were self-discharged (Table 4).
Table 4: Medication given, length of hospitalization and treatment outcomes among neonates with sepsis hospitalized in neonatal intensive care unit at Hiwot Fana Specialized University Hospital, eastern Ethiopia.
| Medications | EONS (N=180) | LONS (N=71) | Total (N=251) | |
|---|---|---|---|---|
| Ampicillin and Gentamycin | 100.0% | 100.0% | 100.0% | |
| Vancomycin | 7.2% | 11.3% | 8.4% | |
| Ceftazidime | 10.0% | 12.7% | 10.7% | |
| Vitamin K | 15.0% | 1.4% | 11.2% | |
| Phenobarbital | 4.4% | 5.6% | 4.8% | |
| Duration of hospitalization | ||||
| < 7 days | 61.1% | 47.9% | 57.4% | |
| 7 - 14 days | 37.8% | 47.9% | 40.6% | |
| > 14 days | 1.1% | 4.2% | 2.0% | |
| Treatment outcomes | Died | 2.8% | 4.2% | 3.2% |
| Recovered | 88.3% | 81.7% | 86.5% | |
| Self-discharge | 9.96% | 11.3% | 9.9% | |
| Referred to another center | 0.0% | 1.4% | 0.4% | |
Note: EONS-Early-onset Neonatal Sepsis; LONS-Late Onset Neonatal Sepsis
Factors associated with recovery
Pre-term neonates had 79% lower probability to recover from neonatal sepsis (OR=0.21, 95 % CI: 0.09 – 0.48; P=0.000) as compared to term neonates. Similarly, neonates who had severe disease at hospitalization (Critical patient) had 58% lower probability to recover from neonatal sepsis (OR= 0.42, 95% CI: 0.17 – 1.01; P=0.042) as compared to those who had mild disease. Moreover, neonates who were unable to feed properly had 61.0% lower probability to recover from neonatal sepsis (OR= 0.39 95% CI: 0.18 – 0.96; P=0.04) than their counterparts. On the other hand, neonates who were delivered at the health center were 5.16 times (OR=5.16 95% CI: 1.40 – 18.95, P=0.01) more likely to recover from neonatal sepsis as compared to those neonates who were delivered at home (Table 5).
Table 5: Determinants of recovery among neonates with sepsis hospitalized in the neonatal intensive care unit at Hiwot Fana Specialized University Hospital, eastern Ethiopia.
| Variable | Recovery | COR, 95% CI | AOR, 95% CI | P-value | ||
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Age | 0-7 days | 159 | 21 | 1.70 (0.79 - 3.61) | 1.21 (0.45 – 3.28) | 0.71 |
| 8-28 days | 58 | 13 | 1 | 1 | ||
| Gestational age | < 37 weeks | 40 | 17 | 0.22 (0.10 - 0.48) | 0.21 (0.09 - 0.48) | 0.000 |
| 37- 42 weeks | 168 | 16 | 0.26 (0.03 - 2.23) | 0.000 (0.000-) | - | |
| > 42 weeks | 9 | 1 | 1 | 1 | ||
| ANC | Yes | 177 | 28 | 0.95 (0.37 - 2.44) | 2.11 (0.55- 8.12) | 0.28 |
| No | 40 | 6 | 1 | 1 | ||
| Maternal fever | Yes | 94 | 19 | 0.60 (0.29 - 1.25) | 1.20 (0.46 – 3.12) | 0.71 |
| No | 123 | 15 | 1 | 1 | ||
| Foul smell liquor | Yes | 49 | 15 | 0.37 (0.18 - 0.78) | 0.53 (0.20 – 1.40) | 0.20 |
| No | 168 | 19 | 1 | 1 | ||
| Failure feeding | Yes | 39 | 12 | 0.40 (0.18 - 0.88) | 0.39 (0.16 – 0.96) | 0.04 |
| No | 178 | 22 | 1 | 1 | ||
| PRM | Yes | 49 | 24 | 0.42 (0.196 - 0.89) | 0.88 (0.31- 2.45) | 0.80 |
| No | 168 | 20 | 1 | 1 | ||
| Place of delivery | Hospital | 149 | 19 | 0.83 (0.27 - 2.57) | 1.67 (0.45 – 6.21) | 0.45 |
| Health Center | 38 | 4 | 2.61 (0.92 - 7.40) | 5.16 (1.40 – 18.95) | 0.01 | |
| Clinics | 18 | 6 | 3.27 (1.04 -10.29) | 1.82 (0.36 – 9.24) | 0.47 | |
| Home | 12 | 5 | 1 | 1 | ||
| Condition ofthe neonate at hospitalization | Critical | 41 | 15 | 0.29 (0.14 -0.63) | 0.42 (0.17- 1.01) | 0.042 |
| Not critical | 176 | 19 | 1 | 1 | ||
| Hyperthermia (>38°C) | Yes | 88 | 18 | 0.61 (0.29 - 1.25) | 0.65 (0.26 – 1.63) | 0.36 |
| No | 129 | 16 | 1 | 1 | ||
| Platelet count | < 150 k/UL | 161 | 24 | 0.479 (0.159 - 1.44) | 0.73 (0.21 - 2.50) | 0.62 |
| >150 k/UL | 56 | 4 | 1 | 1 | ||
| Types of neonatal sepsis | EONS | 159 | 21 | 1.70 (0.798 - 3.61) | 0.05(0.00 - 17.48) | 0.312 |
| LONS | 58 | 13 | 1 | 1 | ||
Note: ANC-Antenatal Care; PRM-Pre-mature Rupture of Membrane; EONS-Early-onset Neonatal Sepsis; LONS-Late Onset Neonatal Sepsis; COR-Crude Odds Ratio; AOR-Adjusted Odds Ratio
Discussion
To the best of our knowledge, this study is the first to evaluate the in-hospital outcomes of neonatal sepsis in eastern Ethiopia. It included 251 neonates receiving care in a neonatal intensive care unit at hiwot fauna specialized university hospital, eastern Ethiopia. The findings of this study revealed that, 71.7% of neonates were aged less than seven days and 22.7% were pre-term. The proportion of neonates who were pre-term in our study was lower when compared with the results of a study conducted in North east Ethiopia (7), but comparable with reports of a study conducted in North West Ethiopia (8). The proportion of underweight neonates in this study was lower when compared with the findings of a study conducted in Southwest Ethiopia in which 50.0% of the neonates were underweight (9). The inconsistency could be attributed to the variation in sample size and the clinical characteristics of the mother and the neonates. The results of this a study showed that the majority (81.7%) of mothers had a regular antenatal care follow up and 45.0% had a history of fever. The proportion of mothers who had a regular antenatal care follow up in this a study was comparable with the results of study conducted in Bishoftu, Ethiopia (10). Likewise, the proportion of mothers who delivered in the hospitals is comparable with the results of a study conducted in western Ethiopia (11) in which 68.62% of the mothers delivered their newborn in hospitals.
Of the total neonates, most (71.7%) of them had early onset neonatal sepsis and the majority (96.0%) were received combination of ampicillin and gentamycin antibiotics. In line with our findings, a comparable magnitude of early onset neonatal sepsis was reported in a study conducted by Fikadu et al in Western Ethiopia (11), however, a lower (26.9%) proportion of early onset neonatal sepsis was reported in a study by Mersha et al in Southern Ethiopia (12). On the other hand, the types of antibiotics that most commonly prescribed in this study (i.e., ampicillin plus gentamycin) was similar with reports of previous studies conducted in various parts of Ethiopia (8, 10, 11). This was due to the fact this combination of antibiotics was the recommended regimen for treating sepsis in this age group.
Of the total neonates, the majority (86.5%) recovered and more than half (57.4%) were hospitalized for less than seven days. The proportion of neonates who had recovery i was comparable with the findings of a study by Fikadu et al (90.5%) (11), but slightly higher when compared with reports of a study conducted by Woldu et al (74.84%) (10).
In our study it was found that neonates with severe disease at hospitalization (critical) had 58% lower probability to recover from neonatal sepsis. Likewise, pre-term neonates had 79% lower probability to recover from the disease. This was due to the fact being a pre-term is both a risk factor and poor prognostic factor for neonatal sepsis (13). Moreover, neonates who were not fed properly had 61% lower chance to recover from neonatal sepsis. This was due to the fact that early breast milk provides several immunocompetent factors such as immunoglobulins and lymphocytes that in turn stimulates the immune systems (14) (15). The immunocompetent factors will also reduce gastrointestinal permeability and translocation of microorganism (15). Besides, the close contact between the mother and neonates may also stimulate the mucosa associated with lymphoid tissue system (16). On the other hand, neonates who were delivered at health centres had 5.16 times more chance to recover from neonatal sepsis when compared with neonates who were delivered at home.
Limitation
The study design (being cross-sectional), being limited to a single center and the small sample size could be the possible limitation of this a study. Additionally, inability to assess the specific etiology and their antimicrobial susceptibility was another possible limitation of the study.
Conclusion
Most neonates had early onset neonatal sepsis. More than half of the study participants were male and about one-third were under-weight. The majority of the mothers had a regular antenatal care follow up during pregnancy and seventeen were delivered at home. The majority of neonates were recovered and the recovery rate was higher among neonates with early onset neonatal sepsis. Being pre-term, having severe disease at hospitalization (critical), failure of feeding, and delivery at the health centre were significantly associated with recovery from neonatal sepsis.
Ethics
The study approved by the Institutional Research Ethics Review Committee (IRERC) of Haramaya University. The permission to collect data was obtained from the hospital. Informed consent was not sought for the present study because the study is retrospective and the data were collected from patients’ medical record.
Acknowledgments
We acknowledge the hospital and workers at the medical record keeping office for their cooperation during conducting the study
Funding
No funding was received to conduct the study
Data Availability
The raw data used for this study was included in the manuscript
Conflict of interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article
Authors’ contributions
All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work
Funding
No funding was received to conduct the study
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