Risks of neonatal mortality in neonates with neonatal encephalopathy in a tertiary newborn care unit in zimbabwe over a 12-month period

Background Neonatal encephalopathy (NE) accounts for ∼23% of the 2.4 million annual global neonatal deaths. Most of these deaths occur in sub-Saharan Africa. However, data from low resource settings are scarce. We reviewed risk factors of neonatal mortality in neonates admitted with NE from a tertiary neonatal unit in Zimbabwe. Methods A retrospective review of risk factors of short-term NE mortality was conducted at Sally Mugabe Central Hospital (SMCH) (November 2018 – October 2019). Data were gathered using a tablet-based data capture and quality improvement newborn care application (Neotree). Analyses were performed on data from all admitted neonates with a diagnosis of NE, incorporating maternal, intrapartum and neonatal risk predictors of the primary outcome, mortality. Results 494/2894 neonates had NE on admission and were included. Of these, 94 died giving a NE-case fatality rate (CFR) of 190 per 1000 admitted neonates. Caesarean section (odds ratio (OR) 2.95(95% confidence intervals (CI) 1.39-6.25), convulsions (OR 7.13 (1.41-36.1)), lethargy (OR 3.13 (1.24-7.91)), Thompson score “11-14” (OR 2.98 (1.08-8.22)) or “15-22” (OR 17.61 (1.74-178.0)) were significantly associated with neonatal death. No maternal risk factors were associated with mortality. Conclusion Nearly 1 in 5 neonates diagnosed with NE died before discharge, similar to other low-resource setting but more than in typical high resource centres. The Thompson score, a validated, sensitive and specific tool for diagnosing neonates with NE was a good predictor of worse outcomes in this setting. On univariable analysis time-period, specifically a period of staff shortages due to industrial action, had a significant impact on NE mortality. Emergency caesarean section was associated with increased mortality, suggesting perinatal care is likely to be a key moment for future interventions ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Funders include the Wellcome Trust Digital Innovation Award (215742/Z/19/Z: PI: Heys) and the Healthcare Infection Society (SRG 201802004). Dr F. Fitzgerald is supported by the Academy of Medical Sciences and the funders of the Starter Grants for Clinical Lecturers scheme. This study and Drs M. Heys and F. Fitzgerald are further supported by the National Institute for Health Research, Great Ormond Street Hospital Biomedical Research Centre. The funders had no role in study design, data collection and analysis, or preparation of this report. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Neotree pilot study received approval from Sally Mugabe Central Hospital Research Ethics Committee (Reference number HCHEC070618/58), University College London Ethics Committee (5019/004), Biomedical Research and Training Institute (AP148/18), the Medical Research Council of Zimbabwe MRCZ/A/2570 and the Electronic Health Records Department of the Zimbabwe Ministry of Health and Child Care. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data collected for the study cannot be made publicly available because primary analysis for the pilot implementation evaluation of the Neotree is currently ongoing. One of the aims of the wider Neotree project is the establishment of an open-source anonymised research database of data collected using the Neotree for researchers aiming to improve outcomes for neonates in low resource settings.