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Abstract：
BACKGROUND: Perinatal asphyxia is failure to maintain normal breathing at birth. World Health Organization indicates that perinatal asphyxia is the third major cause of neonatal mortality in developing countries accounting for 23% of neonatal deaths every year. At global and national level efforts have done to reduce neonatal mortality, however fatalities from asphyxia remains high in Ethiopia (24%). And there are no sufficient studies to show incidence and prediction of mortality among asphyxiated neonates. Developing validated risk prediction model is one of the crucial strategies to improve neonatal outcomes with asphyxia. Therefore, this study will help to screen asphyxiated neonate at high-risk for mortality during admission by easily accessible predictors. This study aimed to determine the incidence and develop validated Mortality Prediction model among asphyxiated neonates admitted to the Neonatal Intensive Care Unit at Felege-Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia.
METHODS: Retrospective follow-up study was conducted at Felege-Hiwot Comprehensive Specialized Hospital from September 1, 2017, to March 31, 2021. Simple random sampling was used to select 774 neonates, and 738 were reviewed. Since was data Secondary, it was collected by checklist. After the description of the data by table and graph, Univariable with p-value < 0.25, and stepwise multivariable analysis with p-value < 0.05 were done to develop final reduced prediction model by likelihood ratio test. To improve clinical utility, we developed a simplified risk score to classify asphyxiated neonates at high or low-risk of mortality. The accuracy of the model was evaluated using area under curve, and calibration plot. To measures all accuracy internal validation using bootstrapping technique were assessed. We evaluated the clinical impact of the model using a decision curve analysis across various threshold probabilities.
RESULTS: Incidence of neonatal mortality with asphyxia was 27.2% (95% CI: 24.1, 30.6). Rural residence, bad obstetric history, amniotic fluid status, multiple pregnancy, birth weight (< 2500 g), hypoxic-ischemic encephalopathy (stage II and III), and failure to suck were identified in the final risk prediction score. The area under the curve for mortality using 7 predictors was 0.78 (95% CI 0.74 to 0.82). With ≥ 7 cutoffs the sensitivity and specificity of risk prediction score were 0.64 and 0.82 respectively.
CONCLUSIONS: Incidence of neonatal mortality with asphyxia was high. The risk prediction score had good discrimination power built by rural residence, bad obstetric history, stained amniotic fluid, multiple pregnancy, birth weight (< 2500 g), hypoxic-ischemic encephalopathy (stage II and III), and failure to suck. Thus, using this score chart and improve neonatal and maternal service reduce mortality among asphyxiated neonates.
METHODS: Retrospective follow-up study was conducted at Felege-Hiwot Comprehensive Specialized Hospital from September 1, 2017, to March 31, 2021. Simple random sampling was used to select 774 neonates, and 738 were reviewed. Since was data Secondary, it was collected by checklist. After the description of the data by table and graph, Univariable with p-value < 0.25, and stepwise multivariable analysis with p-value < 0.05 were done to develop final reduced prediction model by likelihood ratio test. To improve clinical utility, we developed a simplified risk score to classify asphyxiated neonates at high or low-risk of mortality. The accuracy of the model was evaluated using area under curve, and calibration plot. To measures all accuracy internal validation using bootstrapping technique were assessed. We evaluated the clinical impact of the model using a decision curve analysis across various threshold probabilities.
RESULTS: Incidence of neonatal mortality with asphyxia was 27.2% (95% CI: 24.1, 30.6). Rural residence, bad obstetric history, amniotic fluid status, multiple pregnancy, birth weight (< 2500 g), hypoxic-ischemic encephalopathy (stage II and III), and failure to suck were identified in the final risk prediction score. The area under the curve for mortality using 7 predictors was 0.78 (95% CI 0.74 to 0.82). With ≥ 7 cutoffs the sensitivity and specificity of risk prediction score were 0.64 and 0.82 respectively.
CONCLUSIONS: Incidence of neonatal mortality with asphyxia was high. The risk prediction score had good discrimination power built by rural residence, bad obstetric history, stained amniotic fluid, multiple pregnancy, birth weight (< 2500 g), hypoxic-ischemic encephalopathy (stage II and III), and failure to suck. Thus, using this score chart and improve neonatal and maternal service reduce mortality among asphyxiated neonates.
摘要：
背景：围产期窒息是出生时无法维持正常呼吸。世界卫生组织指出，围产期窒息是发展中国家新生儿死亡的第三大原因，每年占新生儿死亡的23%。在全球和国家一级，已经努力降低新生儿死亡率，然而，埃塞俄比亚的窒息死亡率仍然很高（24％）。并且没有足够的研究来显示窒息新生儿的发病率和死亡率预测。建立有效的风险预测模型是改善新生儿窒息结局的重要策略之一。因此,这项研究将有助于通过容易获得的预测因素来筛查住院期间死亡率高的窒息新生儿.本研究旨在确定Felege-Hiwot综合专科医院新生儿重症监护病房的窒息新生儿的发病率并开发有效的死亡率预测模型。BahirDar,埃塞俄比亚。
方法：回顾性随访研究于2017年9月1日至2021年3月31日在Felege-Hiwot综合专科医院进行。采用简单随机抽样方法选择774例新生儿，738人被审查。因为数据是次要的，它是通过清单收集的。通过表和图描述数据后，采用似然比检验建立p值<0.25的单变量和p值<0.05的多变量逐步回归预测模型。为了提高临床效用，我们建立了简化的风险评分,将窒息新生儿的死亡率高或低.使用曲线下面积评估模型的准确性，和校准图。为了测量所有准确性，使用自举技术评估了内部验证。我们使用各种阈值概率的决策曲线分析评估了模型的临床影响。
结果：新生儿窒息死亡率为27.2%（95%CI：24.1，30.6）。农村住宅,不良产科史,羊水状态，多胎妊娠,出生体重（<2500克），缺氧缺血性脑病（II期和III期），在最终的风险预测评分中确定了未能吸吮。使用7个预测因子的死亡率曲线下面积为0.78（95％CI0.74至0.82）。在≥7个截止值的情况下，风险预测评分的敏感性和特异性分别为0.64和0.82。
结论：新生儿窒息死亡率高。风险预测得分具有良好的农村居民点鉴别力，不良产科史,羊水染色，多胎妊娠,出生体重（<2500克），缺氧缺血性脑病（II期和III期），失败了。因此，使用此评分图并改善新生儿和孕产妇服务可降低窒息新生儿的死亡率。
方法：回顾性随访研究于2017年9月1日至2021年3月31日在Felege-Hiwot综合专科医院进行。采用简单随机抽样方法选择774例新生儿，738人被审查。因为数据是次要的，它是通过清单收集的。通过表和图描述数据后，采用似然比检验建立p值<0.25的单变量和p值<0.05的多变量逐步回归预测模型。为了提高临床效用，我们建立了简化的风险评分,将窒息新生儿的死亡率高或低.使用曲线下面积评估模型的准确性，和校准图。为了测量所有准确性，使用自举技术评估了内部验证。我们使用各种阈值概率的决策曲线分析评估了模型的临床影响。
结果：新生儿窒息死亡率为27.2%（95%CI：24.1，30.6）。农村住宅,不良产科史,羊水状态，多胎妊娠,出生体重（<2500克），缺氧缺血性脑病（II期和III期），在最终的风险预测评分中确定了未能吸吮。使用7个预测因子的死亡率曲线下面积为0.78（95％CI0.74至0.82）。在≥7个截止值的情况下，风险预测评分的敏感性和特异性分别为0.64和0.82。
结论：新生儿窒息死亡率高。风险预测得分具有良好的农村居民点鉴别力，不良产科史,羊水染色，多胎妊娠,出生体重（<2500克），缺氧缺血性脑病（II期和III期），失败了。因此，使用此评分图并改善新生儿和孕产妇服务可降低窒息新生儿的死亡率。
