Early outcomes and predictors of mortality among preterm neonates with respiratory distress syndrome admitted at Kawempe National Referral Hospital; A prospective study

Abstract

Background: Respiratory distress syndrome (RDS) is a severe condition in preterm newborns, marked by a lack of surfactant, which results in high rates of illness and death. The burden of RDS is greater in low- and middle-income countries, where it significantly increases mortality rates and admissions to neonatal intensive care units. Despite global efforts to reduce neonatal mortality, RDS remains a major challenge, particularly in places like Uganda, where there is limited research specifically examining the outcomes of preterm neonates with RDS. The study aimed to determine early outcomes and predictors of mortality among preterm neonates with respiratory distress syndrome admitted to Kawempe National Referral Hospital (KNRH) in Uganda. Methods: This was a hospital-based prospective cohort study conducted at the Neonatal Special Care Unit of Kawempe National Referral Hospital among preterm neonates aged less than 24 hours whose respiratory distress commenced within the first 6 hours of life. Quantitative data were collected using structured questionnaires, focusing on maternal and neonatal characteristics, as well as early outcomes of the preterm babies. Early outcomes comprised survival and mortality assessed within three days of follow-up. The Kaplan-Meier method estimated survival curves, with differences between these curves analyzed using the log-rank test. Bivariate and multivariate Cox proportional hazards regression was used to assess the predictors of mortality with statistical significance set at <0.05. Results: Among the 201 preterm neonates with respiratory distress syndrome admitted to KNRH, 25(12.4%) died within the three-day follow-up, with most of the deaths (24), occurring within the first 2 days. Preterm neonates who did not receive xanthine derivatives had approximately three times higher hazard of death compared with those who received xanthine derivatives (aHR=2.99; p=0.034). Similarly, neonates delivered vaginally had more than four times increased hazard of death compared with those delivered by caesarean section (aHR=4.33; p=0.013). (Table 8). Conclusion: Preterm neonates with respiratory distress syndrome admitted at Kawempe National Referral Hospital experienced early mortality mainly within the first two days of life. The hospital needs to ensure timely access to caffeine therapy and consider safe delivery options for preterm births to improve survival outcomes in this high-risk population.