{
    "abstract": "Neonatal deaths now account for 47% of all deaths in children younger than 5 years globally. More than a third of newborn deaths are due to preterm birth complications, which is the leading cause of death. Understanding the causes and factors contributing to neonatal deaths is needed to identify interventions that will reduce mortality. We aimed to establish the major causes of preterm mortality in preterm infants in the first 28 days of life in Ethiopia.\nWe did a prospective, cross-sectional, observational study in five hospitals in Ethiopia. Study participants were preterm infants born in the study hospitals at younger than 37 gestational weeks. Infants whose gestational age could not be reliably estimated and those born as a result of induced abortion were excluded from the study. Data were collected on maternal and obstetric history, clinical maternal and neonatal conditions, and laboratory investigations. For neonates who died of those enrolled, consent was requested from parents for post-mortem examinations (both complete diagnostic autopsy and minimally invasive tissue sampling). An independent panel of experts established the primary and contributory causes of preterm mortality with available data.\nBetween July 1, 2016, to May 31, 2018, 4919 preterm infants were enrolled in the study and 3852 were admitted to neonatal intensive care units. By 28 days of post-natal age, 1109 (29%) of those admitted to the neonatal intensive care unit died. Complete diagnostic autopsy was done in 441 (40%) and minimally invasive tissue sampling in 126 (11%) of the neonatal intensive care unit deaths. The main primary causes of death in the 1109 infants were established as respiratory distress syndrome (502 [45%]); sepsis, pneumonia and meningitis (combined as neonatal infections; 331 [30%]), and asphyxia (151 [14%]). Hypothermia was the most common contributory cause of preterm mortality (770 [69%]). The highest mortality occurred in infants younger than 28 weeks of gestation (89 [86%] of 104), followed by infants aged 28-31 weeks (512 [54%] of 952), 32-34 weeks (349 [18%] of 1975), and 35-36 weeks (159 [8%] of 1888).\nThree conditions accounted for 89% of all deaths among preterm infants in Ethiopia. Scale-up interventions are needed to prevent or treat these conditions. Further research is required to develop effective and affordable interventions to prevent and treat the major causes of preterm death.\nBill & Melinda Gates Foundation.",
    "authors": [
        {
            "affiliation": "College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. Electronic address: muhe1952@gmail.com.",
            "firstname": "Lulu M",
            "initials": "LM",
            "lastname": "Muhe"
        },
        {
            "affiliation": "Social, Statistical and Environmental Health Sciences, Research Triangle Institute, Durham, NC, USA.",
            "firstname": "Elizabeth M",
            "initials": "EM",
            "lastname": "McClure"
        },
        {
            "affiliation": "Bill & Melinda Gates Foundation, Seattle, WA, USA.",
            "firstname": "Assaye K",
            "initials": "AK",
            "lastname": "Nigussie"
        },
        {
            "affiliation": "College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.",
            "firstname": "Amha",
            "initials": "A",
            "lastname": "Mekasha"
        },
        {
            "affiliation": "Ethiopian Pediatric Society, Addis Ababa, Ethiopia.",
            "firstname": "Bogale",
            "initials": "B",
            "lastname": "Worku"
        },
        {
            "affiliation": "College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.",
            "firstname": "Alemayehu",
            "initials": "A",
            "lastname": "Worku"
        },
        {
            "affiliation": "College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.",
            "firstname": "Asrat",
            "initials": "A",
            "lastname": "Demtse"
        },
        {
            "affiliation": "Jimma University, Jimma, Ethiopia.",
            "firstname": "Beza",
            "initials": "B",
            "lastname": "Eshetu"
        },
        {
            "affiliation": "University of Gondar, Gondar, Ethiopia.",
            "firstname": "Zemene",
            "initials": "Z",
            "lastname": "Tigabu"
        },
        {
            "affiliation": "St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.",
            "firstname": "Mahlet A",
            "initials": "MA",
            "lastname": "Gizaw"
        },
        {
            "affiliation": "Jimma University, Jimma, Ethiopia.",
            "firstname": "Netsanet",
            "initials": "N",
            "lastname": "Workneh"
        },
        {
            "affiliation": "University of Gondar, Gondar, Ethiopia.",
            "firstname": "Abayneh",
            "initials": "A",
            "lastname": "Girma"
        },
        {
            "affiliation": "St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.",
            "firstname": "Mesfin",
            "initials": "M",
            "lastname": "Asefa"
        },
        {
            "affiliation": "St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.",
            "firstname": "Ramon",
            "initials": "R",
            "lastname": "Portales"
        },
        {
            "affiliation": "University of Gondar, Gondar, Ethiopia.",
            "firstname": "Tiruzer",
            "initials": "T",
            "lastname": "Bekele"
        },
        {
            "affiliation": "Jimma University, Jimma, Ethiopia.",
            "firstname": "Mesele",
            "initials": "M",
            "lastname": "Bezabih"
        },
        {
            "affiliation": "St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.",
            "firstname": "Gesit",
            "initials": "G",
            "lastname": "Metaferia"
        },
        {
            "affiliation": "Jimma University, Jimma, Ethiopia.",
            "firstname": "Mulatu",
            "initials": "M",
            "lastname": "Gashaw"
        },
        {
            "affiliation": "University of Gondar, Gondar, Ethiopia.",
            "firstname": "Bewketu",
            "initials": "B",
            "lastname": "Abebe"
        },
        {
            "affiliation": "Zewditu Hospital, Addis Ababa, Ethiopia.",
            "firstname": "Hailu",
            "initials": "H",
            "lastname": "Berta"
        },
        {
            "affiliation": "Jimma University, Jimma, Ethiopia.",
            "firstname": "Addisu",
            "initials": "A",
            "lastname": "Alemu"
        },
        {
            "affiliation": "College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.",
            "firstname": "Tigist",
            "initials": "T",
            "lastname": "Desta"
        },
        {
            "affiliation": "College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.",
            "firstname": "Rahell",
            "initials": "R",
            "lastname": "Hailu"
        },
        {
            "affiliation": "College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.",
            "firstname": "Goitom",
            "initials": "G",
            "lastname": "Gebreyesus"
        },
        {
            "affiliation": "St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.",
            "firstname": "Sara",
            "initials": "S",
            "lastname": "Aynalem"
        },
        {
            "affiliation": "Jimma University, Jimma, Ethiopia.",
            "firstname": "Alemseged L",
            "initials": "AL",
            "lastname": "Abdissa"
        },
        {
            "affiliation": "Neonatology Unit, H\u00f4pitaux Universitaires de Gen\u00e8ve, Geneva, Switzerland.",
            "firstname": "Riccardo",
            "initials": "R",
            "lastname": "Pfister"
        },
        {
            "affiliation": "College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.",
            "firstname": "Zelalem Tazu",
            "initials": "ZT",
            "lastname": "Bonger"
        },
        {
            "affiliation": "College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.",
            "firstname": "Solomon",
            "initials": "S",
            "lastname": "Gizaw"
        },
        {
            "affiliation": "College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.",
            "firstname": "Tamrat",
            "initials": "T",
            "lastname": "Abebe"
        },
        {
            "affiliation": "Jimma University, Jimma, Ethiopia.",
            "firstname": "Melkamu A",
            "initials": "MA",
            "lastname": "Berhane"
        },
        {
            "affiliation": "College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.",
            "firstname": "Yonas",
            "initials": "Y",
            "lastname": "Bekuretsion"
        },
        {
            "affiliation": "Women's and Children's Health Research Unit, KAHER, J N Medical College, Belgaum, India.",
            "firstname": "Sangappa",
            "initials": "S",
            "lastname": "Dhaded"
        },
        {
            "affiliation": "Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, USA.",
            "firstname": "Janna",
            "initials": "J",
            "lastname": "Patterson"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA.",
            "firstname": "Robert L",
            "initials": "RL",
            "lastname": "Goldenberg"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.",
    "doi": "10.1016/S2214-109X(19)30220-7",
    "journal": "The Lancet. Global health",
    "keywords": [],
    "methods": null,
    "publication_date": "2019-07-16",
    "pubmed_id": "31303299\n27839855\n30389451\n27839855\n24853593\n29025635\n25558104\n26447264\n29945680\n30134756\n29240678\n27403390\n14569335\n28222717\n26014127\n15791277\n26063125\n29423175\n29793543\n14979386",
    "results": null,
    "title": "Major causes of death in preterm infants in selected hospitals in Ethiopia (SIP): a prospective, cross-sectional, observational study.",
    "xml": "<Element 'PubmedArticle' at 0x788504321f30>"
}