Proportion And Factors Of Death Among Preterm Neonates Admitted In Aksum University Compressive Specialized Hospital Neonatal Intensive Care Unit Northern Ethiopia 2019.

Background Birth-related complications are the single most direct cause of national neonatal death, 35% of the world’s 3.1 million deaths a year and the second most common cause of under-five deaths associated with the cost of living worldwide. To achieve the goals of designing an effective strategy to manage the problem assessing proportion and factor of death among preterm neonates are important. Methods An Institution-based cognitive research study was conducted at Aksum Referral and General specialty hospital, Northern Ethiopia. All pre-natal isolates that were allowed to enter into a high-growth union during childbirth. The data collected will be cleared and entered into the Epi-info version 7 and exported to STATA version 12 for further analyses. bivariable and multivariable analysis performed to determine the relationship between baseline and explanatory variables. Variables with a p-value of less than 0.05 will be the cut-off point.


Background
Birth-related complications are the single most direct cause of national neonatal death, 35% of the world's 3.1 million deaths a year and the second most common cause of under-five deaths associated with the cost of living worldwide. To achieve the goals of designing an effective strategy to manage the problem assessing proportion and factor of death among preterm neonates are important.

Methods
An Institution-based cognitive research study was conducted at Aksum Referral and General specialty hospital, Northern Ethiopia. All pre-natal isolates that were allowed to enter into a high-growth union during childbirth. The data collected will be cleared and entered into the Epi-info version 7 and exported to STATA version 12 for further analyses. bivariable and multivariable analysis performed to determine the relationship between baseline and explanatory variables. Variables with a p-value of less than 0.05 will be the cut-off point. (1.30-4.72)), Breastfeeding initiated (AOR: 6.35(4.62-11.98)), APGAR score(AOR: 8.63 (3.52 -21.17)), Age (AOR: 4.19 (2.86-12.46)) were predictor for the occurrence of preterm neonate death.
Conclusion the proportion of preterm birth mortality was high. Provide quality care in maternity care, access the intensive care unit at maternity and professional health care institutions and take precautionary measures to prevent complications. And collaboration with the woreda health office improves breastfeeding and kangaroo mother care should be better.

Background
Globally, 35% of all prenatal problems are a major cause of national prenatal problems associated with the cost of living worldwide [1]. In developing regions, the likelihood of dying in childbirth is six times higher than in developed countries, eight times higher than in developed countries [2].
Premature birth can have serious health consequences for the child, and many of the surviving children, often at the expense of family and community, are respiratory problems, mental illness, and mental disorders neurological problems [3,20]. Globally in 2016, 2.6 million newborns were killed. Of these, 99% of maternal deaths occur in low-income and middle-income countries. 39% were reported in South Asia, 39% in South Africa. Ethiopia is one of the five countries that have died in infants, children, Pakistan, Nigeria, and the Democratic Republic of the Congo [5]. May according to the 2016 Ethiopian demographic health survey, the death to all from childbirth is 29 out of 1000 births [6].
Studies reported that preterm neonatal mortality in Ethiopia there is regional variation 28.28% University of Gondar [7], Tigray region Northern Ethiopia 34% [8], and Jimma University Specialized Hospital, Ethiopia 34.9% [9], 47% rural Ethiopia [10], 63% Northern Ethiopia [11]. According to different kinds of literature, factors that are associated with preterm neonatal mortality include; Maternal Age, Residence, Place of delivery, Birth weight, Gestational age at birth, APGAR score, breastfeeding upon birth, kangaroo mother care (KMC), Antenatal care, Pregnancy complications, Labor and delivery complications and so on. [12-15, 5, 16-21, 7-11]. Proper management and the use of timely guidelines improve effectively after childbirth. The Sustainable Development Goal of Child Deaths by 2030, it is possible to protect newborns, and children under 5 years of age, all of which are intended to reduce newborns mortality less than12 death per 1000 live birth and death of under-five less than 25 death per 1000 live birth [5]. Therefore, this study aims to assess the proportion and factors of death among preterm neonates admitted to Aksum University specialized hospital NICU.

Methods
An Institution-based cognitive research study was conducted at Aksum Referral and General specialty hospital, Northern Ethiopia from June 2008 to May 2011 E.C. Aksum General specialty hospital offers higher education to more than seven million people in Ethiopia. The northwest country lies 1,024 km from Adiss Abeba capital city Ethiopia and 246 km from Mekele capital city of Tigray Region.
Neonatology is part of the department of pediatrics and provides and provides services for the treatment of pediatrics patients. All pre-natal intensive care units will provide intensive care, especially for newborns, due to a large number of studies. All pre-natal isolates that were allowed to enter into a high-growth union during childbirth were excluded from the study as they were not readily available in the table room. The sample size was determined by comparing into the classification because the estimated risk of premature mortality was 28.8% [7] using a study by Gondar university using an accurate approach for population, Z-value of 1.96 at 95% confidence level and margin of error of 5% will be considered, but during the study, we made it easier to record 346 standardized checklists and used previously checked checklists. Death: Death from any cause of a preterm neonate. Preterm: neonates who delivered less than 37 completed weeks of gestation.
All necessary adult client information to collect from hospital records is recorded from a table with qualified Midwives. Data quality will be insured by closing data closures and reviewing available data and checking for inconsistencies, code errors, and range completion, accuracy, clarity, missing value and appropriate corrections. The data collected will be cleared and entered into the Epi-info version 7 and exported to STATA version 12 for further analyses. Descriptive and summary statistics will be carried out and presented using texts, graphs, and tables. bivariable and multivariable analysis performed to determine the relationship between baseline and explanatory variables. Variables with a p-value of less than 0.05 in the bivariable analysis will be the cut-off point for selection in the final analysis and the 95% CI is presented and interpreted.

Socio-demographic and obstetric characteristics of mothers
There were 346 participants in this study and a 100% response rate. 346 pre-existing neurological data were included in the analysis. 58.67% of the mothers in the city. Two-thirds (63%) of the mothers were between the age of 29 and 34 years. More than 90% of neonates delivered from the health facility. More than 252(72%) mothers have more than 4 times the regular maternity care (Table 1).

Associated factors of proportions of death for preterm neonates
In binary logistic regression: preterm neonates who were delivered from mothers above 35 years, neonates who were delivered at home, neonates who were delivered from mothers had a history of PROM and PIH, neonates delivered from mothers having less than 4 ANC follow up, neonates whose birth weight was between 1 to 1.5kg, neonates who were not received KMC, neonates who were treated for hypoglycemia, neonates who were not initiated breastfeed following delivery, neonates who were delivered from mothers who undergo induction and neonates whose APGAR score less than or equal to six were significantly associated with the death of preterm neonates However, in the multi-variable analysis neonates whose birth weight was between 1 to 1.5kg, neonates who were not received KMC, neonates who were treated for hypoglycemia, neonates whose APGAR score was less than or equal to six, preterm neonates who have not started breastfeeding, neonates who were delivered at home and neonates who were delivered from mothers above 35 years have remained statistically significant factors.

Discussion
Ongoing problems in developing country the recurrent problem are the lack of general information and general reports on the burden of preterm infants [22]. In contrast to developed communities where reliable statistics are available and provide specific information, it directs every decision regarding early childhood care. The mortality rate among preterm infants was 22.2% at maternity university General specialty hospital. The cause of death is not a single problem leading to death, with the major causes being the first 54.55%, PH 22.1%, and sepsis 14.3%. In several birth analyses, Trinidad and Tobago were 12.4% [15], Cameroon 15.7% [18] in different parts of Ethiopia [9][10][11].
The birth rate and preterm infant were significantly higher (22.25%). This may be due to the number of studies that have been exposed only to the study stations and to the most vulnerable conditions. In contrast, the finding was below the level of research conducted in a different part of the world To save the life and growth of children worldwide reported that preterm neonatal mortality was 36.15 and 29.3 percent respectively [12,23], Jimma University special Hospital, Ethiopia 34.9% [9] Gondar University Hospital, Ethiopia 28.28% [7]. This may be due to the decrease in maternal mortality, increased health care services, pre-referral, community health search and use behavior, and access to trained healthcare providers.
Neonates whose birth weight was between 1-1.5 kg, neonates who were not received KMC, neonates who were treated for hypoglycemia and neonates whose APGAR score was less than or equal to six have remained statistically significant factors.
The odd of death among preterm neonates whose birth weight was between 1-1.5 kg was Five times more likely as compared to neonates whose birth weight was between 1. This is due to the possibility of adipose fat tissue, which serves as a source of glucose until they can feed on additional embryos.
The odds of death were increased by nine times for a neonate with the first minute APGAR score < 7 at birth as compared to the counterpart with. The results were obtained from the Iran [24], Nigeria [25], Tikur Anbesa specialized hospital, Ethiopia [26], University of Gondar hospital. Ethiopia [7].
This finding showed that the difference in mortality among older siblings decreased by 96.5% in kangaroo mother care [AOR = 2.71; 95% CI 2.41 (1.20-6.11)]. This is similar to study conduct at the University of Gondar. This may be KMC that prevents hypothermia by reducing the body surface area to the outside surface and helps easily accessing breast milk.
According to several studies in different areas, the risk of death among maternal-born 35 and above year peers is 4 times higher than that of 20 to 34 years. The world has reported that maternal mortality over 35 years is a prerequisite for premature deaths [12, 13, 15-17, 10, 11, 27, 28].
The mortality rate of premature infants born at home is five times as high as those at the same hospital supported by studies conducted in Johannesburg, South Africa [18,28] and Jimma, Ethiopia [8].
The rate of death for premature infants who do not start breastfeeding is six times higher than their units. Therefore, the early onset of childbirth has been reported to be a preventive measure for premature death.

Conclusions
In this study the proportion of preterm birth mortality was high. The Median survival time was 20 days. In neonates whose birth weight was between 1-1.5kg, neonates who were not received KMC, neonates who were treated for hypoglycemia, neonates whose APGAR score was less than or equal to six, preterm neonates who have not started breastfeeding, neonates who were delivered at home and neonates who were delivered from mothers above the of 35 years remained statistically significant factors. Therefore, Aksum university specialized hospitals must provide quality care in maternity care, access the intensive care unit at maternity and professional health care institutions and take precautionary measures to prevent complications. The Aksum specialty Hospital in collaboration with the woreda health office should improve breastfeeding and kangaroo mother care. The main limitation of this study was a secondary source of information may not have some important variables Figure 1 cause of preterm neonatal death