Admission Hypothermia and Neonatal Mortality in the Ethiopian Neonatal Network.

Background: Admission hypothermia remains a problem in low-income countries.

Methods: This cross-sectional study evaluated the association between admission hypothermia (<36.5°C) and neonatal mortality for newborns discharged from neonatal units at 20 Ethiopian hospitals in 2021.

A retrospective cohort study of premature neonatal mortality rates and contributing factors in a tertiary referral NICU in Addis Ababa, Ethiopia from 2022 to 2023.

Background: Prematurity remains the leading contributor for neonatal death globally, with Ethiopia having the 4th highest incidence of neonatal deaths. Clarifying specific contributors of prematurity-related neonatal death is critical to improve outcomes.

Objective: We evaluated neonatal causes of death among premature neonates at St.

Evaluation of First-Week Fluid Intake and Maximal Weight Loss Percentage with In-Hospital Adverse Outcomes Among Moderately and Very Preterm Newborns in Ethiopia.

We sought to address ongoing gaps in understanding the relationship between first-week percent maximal weight loss (MWL) and average first-week total fluid intake (TFI), enteral intake, and parenteral intake among premature newborns with adverse in-hospital outcomes born in low- and middle-income countries (LMICs). We evaluated newborns born <34 weeks gestation or <1500 g who survived at least 7 days at the St. Paul's Hospital Millennium Medical College (SPHMMC) neonatal intensive care unit in Ethiopia.

Magnitude of multidrug-resistant and extended-spectrum β-lactamase-producing gram-negative bacteria from tracheal aspirates of intensive care unit patients in Ethiopia.

Background: Globally, multidrug-resistant (MDR) and extended-spectrum β-lactamase-producing (ESBL)Gram-negative bacterial pathogens are causing significant public health problems, particularly in intensive care units (ICUs) among patients on mechanical ventilation. The objective of the study was to identify Gram-negative bacterial pathogens from tracheal aspirates, determine the prevalence of MDR, and assess the prevalence of ESBL production among the isolates.

Methods: A hospital-based cross-sectional study was conducted at St.

Remote Mentorship to Improve Continuous Positive Airway Pressure Use in the Ethiopian Neonatal Network.

Background: Continuous positive airway pressure (CPAP) is an evidence-based therapy for respiratory distress syndrome (RDS), the leading cause of death for preterm infants globally. Ethiopian Neonatal Network (ENN) teams identified a quality gap in CPAP use for preterm infants with RDS. We sought to use remote education and mentorship without additional resources to improve CPAP use in this population.

A high prevalence of antibiotic use at two large teaching hospitals in Addis Ababa, Ethiopia: a point prevalence survey.

Objective: Antimicrobial resistance (AMR) renders many bacterial infections untreatable and results in substantial morbidity and mortality worldwide. Understanding antibiotic use in clinical settings including hospitals is critical to optimize antibiotic use and prevent resistance.

Design: Hospital antibiotic point prevalence survey (PPS).

Neonatal Resuscitation and Delivery Room Care: A Changing Global Landscape.

With 98% of neonatal deaths occurring in low- and middle-income countries (LMICs), leading health organizations continue to focus on global reduction of neonatal mortality. The presence of a skilled clinician at delivery has been shown to decrease mortality. However, there remain significant barriers to training and maintaining clinician skills and ensuring that facility-specific resources are consistently available to deliver the most essential, evidence-based newborn care.

Neonatal Tetanus Case Series: A Tale of Survival and Tragedy at St Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Background: Neonatal tetanus remains a significant threat in regions with limited healthcare access, despite being preventable through vaccination. The case-fatality rate of untreated neonatal tetanus is close to 100%. Even one case of neonatal tetanus regarded as a failure of the healthcare system, making it essential to remain mindful of this disease's relevance to public health.

Nutrition and the gut-brain axis in neonatal brain injury and development.

Early nutritional exposures, including during embryogenesis and the immediate postnatal period, affect offspring outcomes in both the short- and long-term. Alterations of these modifiable exposures shape the developing gut microbiome, intestinal development, and even neurodevelopmental outcomes. A gut-brain axis exists, and it is intricately connected to early life feeding and nutritional exposures.

Impact of an Educational Clinical Video Combined with Standard Helping Babies Breathe Training on Acquisition and Retention of Knowledge and Skills among Ethiopian Midwives.

Helping Babies Breathe (HBB) is an evidence-based neonatal resuscitation program designed for implementation in low-resource settings. While HBB reduces rates of early neonatal mortality and stillbirth, maintenance of knowledge and skills remains a challenge. The extent to which the inclusion of educational clinical videos impacts learners' knowledge and skills acquisition, and retention is largely unknown.

High inter-rater reliability between physicians and nurses utilising modified Downes' scores in preterm respiratory distress.

Aim: To assess the inter-rater reliability of modified Downes' scores assigned by physicians and nurses in the Ethiopian Neonatal Network and to calculate the concordance of score-based treatment for preterm infants with respiratory distress.

Methods: We included preterm infants admitted from June 2020 to July 2021 to four tertiary neonatal intensive care units (NICUs) of the Ethiopian Neonatal Network that presented with respiratory distress. We calculated the kappa statistic to determine the nurse and physician correlation for each component of the modified Downes' score and total score on admission and evaluated the concordance of scores above and below the treatment threshold of 4.

Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development.

Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs).

Causes of stillbirth and death among children younger than 5 years in eastern Hararghe, Ethiopia: a population-based post-mortem study.

Background: Child mortality is high in Ethiopia, but reliable data on the causes of death are scarce. We aimed to gather data for the contributory causes of stillbirth and child deaths in eastern Ethiopia.

Methods: In this population-based post-mortem study, we established a death-notification system in health facilities and in the community in Kersa (rural), Haramaya (rural) and Harar (urban) in eastern Ethiopia, at a new site of the Child Health and Mortality Prevention Surveillance (CHAMPS) network.

Provider Perceptions on Bereavement Following Newborn Death: A Qualitative Study from Ethiopia and Ghana.

Objective: The objective of this study was to explore how clinicians in low- and middle-income countries engage and support parents following newborn death.

Study Design: Qualitative interviews of 40 neonatal clinicians with diverse training were conducted in Addis Ababa, Ethiopia, and Kumasi, Ghana. Transcribed interviews were analyzed and coded through the constant comparative method.

Clinical Characteristics and Outcome of Pediatric COVID-19 Patients in Ethiopia During the Early COVID-19 Pandemic: A Prospective Cohort Study.

Introduction: Most previous pediatric COVID-19 studies reported milder disease in children. However, there are limited pediatric data from low-income settings. We aimed to assess the characteristics and outcomes of pediatric COVID-19 in Ethiopia.

Neonatal sepsis and mortality in low-income and middle-income countries from a facility-based birth cohort: an international multisite prospective observational study.

Background: Neonatal sepsis is a primary cause of neonatal mortality and is an urgent global health concern, especially within low-income and middle-income countries (LMICs), where 99% of global neonatal mortality occurs. The aims of this study were to determine the incidence and associations with neonatal sepsis and all-cause mortality in facility-born neonates in LMICs.

Methods: The Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS) study recruited mothers and their neonates into a prospective observational cohort study across 12 clinical sites from Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa.

Deaths Attributed to Respiratory Syncytial Virus in Young Children in High-Mortality Rate Settings: Report from Child Health and Mortality Prevention Surveillance (CHAMPS).

Background: Lower respiratory tract infections are a leading cause of death in young children, but few studies have collected the specimens needed to define the role of specific causes. The Child Health and Mortality Prevention Surveillance (CHAMPS) platform aims to investigate causes of death in children aged <5 years in high-mortality rate settings, using postmortem minimally invasive tissue sampling and other advanced diagnostic techniques. We examined findings for deaths identified in CHAMPS sites in 7 countries in sub-Saharan Africa and south Asia to evaluate the role of respiratory syncytial virus (RSV).

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS).

Background: Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin-gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles.

Prevalence and risk factors for antimicrobial resistance among newborns with gram-negative sepsis.

Introduction: Newborn sepsis accounts for more than a third of neonatal deaths globally and one in five neonatal deaths in Ethiopia. The first-line treatment recommended by WHO is the combination of gentamicin with ampicillin or benzylpenicillin. Gram-negative bacteria (GNB) are increasingly resistant to previously effective antibiotics.

Antenatal Steroid Utilization in Ethiopia.

Administration of antenatal corticosteroids to pregnant mothers is one of the most effective interventions to decrease preterm neonatal mortality. In this study we assessed antenatal steroid utilization by the mother and its effect on preterm babies. Two years prospective, multicenter, observational study was conducted in selected hospitals of Ethiopia.

The use of data in resource limited settings to improve quality of care.

Quality improvement is driven by benchmarking between and within institutions over time and the collaborative improvement efforts that stem from these comparisons. Benchmarking requires systematic collection and use of standardized data. Low- and middle-income countries (LMIC) have great potential for improvements in newborn outcomes but serious obstacles to data collection, analysis, and implementation of robust improvement methodologies exist.

Hyperbilirubinemia in Preterm Infants Admitted to Neonatal Intensive Care Units in Ethiopia.

. Hyperbilirubinemia is prevalent and protracted in preterm infants. This study assessed the pattern of hyperbilirubinemia in preterm infants in Ethiopia.