A Prospective Observational Study of the Causes of Death in Preterm Infants in a Low Resource Setting

Background: Preterm birth is the leading cause of neonatal deaths. Neonatal deaths account for 46% of all under-five deaths. Just over a third of neonatal deaths are a result of preterm-related causes. With the increasing contribution of neonatal deaths to overall child mortality, urgent action is needed to determine the major causes of preterm mortality. Methods: This was a multi-centre prospective observational study in 5 tertiary hospitals in Ethiopia over a period of nearly 2 years to determine the causes of preterm mortality. An independent panel of experts determined the primary and contributory causes of preterm mortality using data on socioeconomic status, maternal/obstetric history, clinical conditions, laboratory investigations and post-mortem examinations (both complete diagnostic autopsy [CDA] and minimally invasive tissue sampling [MITS]). Findings: A total of 4,919 preterm infants were enrolled in the study. Of these 3,852 were admitted to NICU's and of these 1109 died. The main causes of death were RDS (45%), sepsis, pneumonia and meningitis (30%) and asphyxia 14%. Hypothermia was the most common contributory cause of preterm mortality. Interpretation: Three conditions were the primary causes for 89% of all deaths: RDS - 45%, infections - 30 % and asphyxia - 14%. There is a need to scale up interventions against these conditions and in particular those specific to RDS such as continuous positive airway pressure (CPAP), and blended oxygen to contribute to neonatal mortality. Funding Statement: This study was funded by grants from the Bill & Melinda Gates Foundation (OPP1136965). We would like to acknowledge the support we received from the administrative, clinical, nursing, microbiology and pathology technical staff of all study hospitals. Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: The study was approved by the Institutional Review Board of each hospital and at the College of Health Sciences of the Addis Ababa University. Written consent for participation in the study was obtained, with a separate written consent for autopsy and MITS, in cases of death. Consent was obtained in English, Amharic and Oromifa languages, as appropriate. Confidentially of the information was maintained.