Predictors of mortality among low birth weight neonates after hospital discharge in a low-resource setting: A case study in Uganda

Background Most of neonatal deaths occur among low birth weight infants. However, in resource-limited settings, these infants are commonly discharged early which further exposes them to mortality. This study aimed at determining the proportion and predictors of mortality among low birth weight neonates that are discharged from Mulago National Referral Hospital in Uganda. Methods This was a prospective cohort study of 220 low birth weight neonates discharged from a Special Care Baby Unit at Mulago National Referral Hospital. These were followed up to 28 completed days of life, or death, whichever occurred first. Proportions were used to express mortality. To determine the predictors of mortality, Cox hazards regression was performed. Results Of the 220 enrolled participants, 216 (98.1%) completed the follow-up. The mean gestational age of study participants was 34 ±3 weeks. The median weight at discharge was 1,650g (IQR: 1,315g -1,922g) and 46.1% were small for gestational age. During follow-up, 14/216 (6.5%) of neonates died. Mortality was highest (7/34, 20.6%) among neonates with discharge weights less than 1,200g. The causes of death included presumed neonatal sepsis (10/14, 71.4%), suspected aspiration pneumonia (2/14, 14.3%), and suspected cot death (2/14, 14.3%). The median time to death after discharge was 11 days (range 3-16 days). The predictors of mortality were a discharge weight of less than 1,200g (adj HR: 23.47, p <0.001), a 5-minute Apgar score of less than 7 (adj HR: 4.25, p = 0.016), and a diagnosis of neonatal sepsis during admission (adj HR: 7.93, p = 0.009). Conclusion Post-discharge mortality among low birth weight neonates in Uganda is high. A discharge weight of less than 1,200g may be considered unsafe among neonates. Caregiver education about neonatal danger signs, and measures to prevent sepsis, aspiration, and cot death should be emphasized before discharge and during follow-up visits. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This study did not receive any funding ### 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 Makerere University School of Medicine Research Ethics Committee gave ethical approval for this work. 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, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data are available upon request to the authors * ANC : Antenatal care BPD : Bronchopulmonary dysplasia CPAP : Continuous Positive Airway Pressure ELBW : Extremely low birth weight HIV : Human Immunodeficiency Virus IMR : Infant Mortality Rate IVH : Intraventricular hemorrhage KMC : Kangaroo Mother Care LBW : Low birth weight LMIC : Low and middle-income countries LNMP : Last Normal Menstruation Period NEC : Necrotising enterocolitis NICU : Neonatal Intensive Care Unit NMR : Neonatal Mortality Rate MNRH : Mulago National Referral Hospital SCBU : Special Care Baby Unit SDGs : Sustainable Development Goals SGA : Small for Gestational Age SSA : Sub-Saharan Africa VLBW : Very low birth weight