Risk factors for severe early neonatal morbidity among term neonates admitted at Muhimbili National Hospital, Tanzania: A nested case control study

Abstract Background: Early neonatal period is the first seven days of life, the riskiest period for adverse neonatal outcomes. About 4 million neonatal deaths worldwide occur yearly; three-quarters happen in the first week. Severe morbid neonates are at increased mortality risk than the rest. Studies addressing risk factors for severe early neonatal morbidity concentrate on premature babies with less attention to term neonates. Risk factors differ substantially because term neonates are expected to be healthier due to their physiological maturity. The study focused on term babies admitted at MNH Neonatal Care Unit within the first seven days of life to identify severe morbidity risk factors. Methods: A nested case-control study was conducted on all term neonates admitted within seven days of birth during the study period from September to December 2014. We adopted the MAIN-score checklist during data collection and follow-up. The death or more of the selected morbidity items within seven days of delivery was used to distinguish between severe and less severe-morbid neonates. Data was obtained from the review of neonatal unit case notes, RCH4 cards, delivery records, and interviews with the mothers. Univariate regressions were used to determine Odds ratios and 95% Confidence Intervals estimating risks for severe morbidity and clinical importance of the individual risk factors, respectively. Multivariate was performed, determining the independent risk factors for severe morbidity. The p-value of 0.05 or less was taken as statistically significant. Ethical clearance was obtained from MUHAS Senate Research and Publication Committee and Muhimbili National Hospital. Results: A total of 2104 newborns were admitted at MNH-NCU during the study period, and 1624 didn't meet the criteria for the study. The analysis was done on 463 term neonates, where 220(47.5%) had severe early neonatal morbidity. The proportion of early neonatal morbidity for term neonates was 255.7 per 1000 neonates. Low birth weight in term babies and UTI during pregnancy were independently associated with severe early neonatal morbidity. Conclusion: Severe early neonatal morbidity of term neonates with no congenital anomaly was a serious adverse outcome with a high proportion and warranted further investigations. Furthermore, studies are recommended for the identification of more risk factors.