Aetiology, survival time and mortality predictors among early neonates at two tertiary hospitals of Lusaka, Zambia

BACKGROUND: Over 2.3 million neonatal deaths occurred globally in 2022, representing 1 in 58 newborns, with neonatal deaths of about 6,300 every day. Of these, 73% died in the early neonatal period and one third within 24 h. Despite the 47% globally neonatal deaths decline from 2000 to 2015, Zambia's perinatal and neonatal mortality rates have remained high at 33 and 27 per 1000 total births, respectively. This study aimed to determine the aetiology of early neonatal deaths and to analyse survival time and mortality predictors among normal and low birthweight early neonates in the neonatal intensive care units at two tertiary hospitals of Lusaka, Zambia. METHODS: A prospective cohort study was conducted involving neonatal deaths that occurred in the neonatal intensive care units at the Women Newborn Hospital (WNH) and Levy Mwanawasa Teaching Hospital (LMUTH) tertiary hospitals of Lusaka, Zambia from September 1, 2023 to January 30, 2024. Data were analysed using SPSS Version 30. Associations with death were studied using Chi square and Fischer's exact tests. Descriptive statistics were used to summarise frequency distributions, and cox proportional hazard regression to analyze predictors of early neonatal deaths and survival time. RESULTS: Among the 404 participants, prematurity, sepsis, birth asphyxia and congenital anomalies were notable causes of death. A total of 62 neonates (42.5%) died within the first 30 min of admission, while 224 (58.8%) died within 1.5 h of arrival. Predictors of shorter neonatal survivor included maternal age > 35 AHR 5.70 (95% CI: 1.41-23.10, p < 0.015), foetal seizures AHR 1.81 (95% CI: 1.33-2.46, p < 0.0001), ANC booking had strong association with birthweight (p = 0.001) but was not in the adjusted model. and Rhesus negative 10 (2.5%) AHR 4.48 (95% CI: 1.58-12.70, p < 0.005). Low birthweight babies had AHR 1.95 (1.33-2.86, p < 0.001), walking and use of public transport to hospital had AHR 4.99 (95% CI: 1.07-23.28, p < 0.041) and 4.24 (95% CI: 1.10-16.36, p < 0.036), respectively and foetal anomalies AHR 2.48 (95% CI: 1.25-4.94, p < 0.010). CONCLUSION: Almost 60% of early neonatal deaths occurred within 1.5 h of admission, with the majority (42%) having been within 30 min. Major causes of death included prematurity, sepsis, birth asphyxia, and congenital anomalies. Predictors to shorter survival time highlight critical areas that need attention. There is need to strengthen health promotion on the importance of early antenatal booking. This will enhance early detection of disease, targeted interventions to manage of high-risk pregnancies and access to comprehensive emergency obstetrics and neonatal care sites.