Major Causes of Death in Preterm Infants in a Low Resource Setting: A Prospective Observational Study in Ethiopia (The SIP Study)

Background: Preterm birth is the leading cause of neonatal deaths. Neonatal deaths account for 46% of under-five deaths. Just over a third of neonatal deaths are a result of preterm-related causes. With the increasing contribution of neonatal deaths to overall child mortality, urgent action is needed to determine the major causes of preterm mortality. Methods: A multi-centre prospective observational study was undertaken in 5 tertiary hospitals in Ethiopia over a period of nearly 2 years to determine the causes of preterm mortality in the first 28 days of life. An independent panel of experts determined the primary and contributory causes of preterm mortality using data on maternal/obstetric history, clinical conditions, laboratory investigations and post-mortem examinations (both complete diagnostic autopsy [CDA] and minimally invasive tissue sampling [MITS]) when consent is obtained. Findings: A total of 4,919 preterm infants were enrolled in the study. Of these 3,852 were admitted to NICU's and of these 1109 died. The main causes of death were RDS (45%), sepsis, pneumonia and meningitis (30%) and asphyxia 14%. Hypothermia was the most common contributory cause of preterm mortality (69%). Interpretation: Three conditions were the primary causes of death among preterm infants accounting for 89% of all deaths. There is a need to scale up interventions against these conditions and in particular those specific to RDS such as continuous positive airway pressure (CPAP), and blended oxygen to contribute to the reduction of neonatal mortality. Funding: This study was funded by grants from the Bill & Melinda Gates Foundation. Declaration of Interest: The authors declare no conflicts of interest. Ethical Approval: The study was approved by the Institutional Review Board of each hospital and at the College of Health Sciences of the Addis Ababa University. Written consent for participation in the study was obtained, with a separate written consent for autopsy and MITS, in cases of death. Consent was obtained in English, Amharic and Oromifa languages, as appropriate. Confidentially of the information was maintained.