{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T10:31:32Z","timestamp":1774780292628,"version":"3.50.1"},"reference-count":29,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2022,9,6]],"date-time":"2022-09-06T00:00:00Z","timestamp":1662422400000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Melissa Ketunuti Memorial Global Health Fund","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,7,24]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>A disproportionate number of neonatal deaths occur in low\/middle-income countries, with sepsis a leading contributor of mortality. In this study, we investigate risk factors for mortality in a cohort of high-risk hospitalised neonates in Botswana. Independent predictors for mortality for infants experiencing either a sepsis or a non-sepsis-related death are described.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This is a prospective observational cohort study with infants enrolled from July to October 2018 at the neonatal unit (NNU) of Princess Marina Hospital (PMH) in Gaborone, Botswana. Data on demographic, clinical and unit-specific variables were obtained. Neonates were followed to death or discharge, including transfer to another hospital. Death was determined to be infectious versus non-infectious based on primary diagnosis listed on day of death by lead clinician on duty.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Our full cohort consisted of 229 patients. The overall death rate was 227 per 1000 live births, with cumulative proportion of deaths of 22.7% (n=47). Univariate analysis revealed that sepsis, extremely low birth weight (ELBW) status, hypoxic ischaemic encephalopathy, critical illness and infants born at home were associated with an increased risk of all-cause mortality. Our multivariate model revealed that critical illness (HR 3.07, 95% CI 1.56 to 6.03) and being born at home (HR 4.82, 95% CI 1.76 to 13.19) were independently associated with all-cause mortality. Low birth weight status was independently associated with a decreased risk of mortality (HR 0.24, 95% CI 0.11 to 0.53). There was a high burden of infection in the cohort with more than half of infants (140, 61.14%) diagnosed with sepsis at least once during their NNU admission. Approximately 20% (n=25) of infants with sepsis died before discharge. Our univariate subanalysis of the sepsis cohort revealed that ELBW and critical illness were associated with an increased risk of death. These findings persisted in the multivariate model with HR 3.60 (95% CI 1.11 to 11.71) and HR 2.39 (95% CI 1 to 5.77), respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>High rates of neonatal mortality were noted. Urgent interventions are needed to improve survival rates at PMH NNU and to prioritise care for critically ill infants at time of NNU admission, particularly those born at home and\/or of ELBW.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-062776","type":"journal-article","created":{"date-parts":[[2022,9,6]],"date-time":"2022-09-06T11:38:05Z","timestamp":1662464285000},"page":"e062776","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Risk factors for mortality in a hospitalised neonatal cohort in Botswana"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0142-2726","authenticated-orcid":false,"given":"Eimear","family":"Kitt","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"},{"name":"Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Molly","family":"Hayes","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morgan","family":"Congdon","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"},{"name":"Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"Section of Hospital Medicine, CHOP, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lance","family":"Ballester","sequence":"additional","affiliation":[{"name":"Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kgotlaetsile B","family":"Sewawa","sequence":"additional","affiliation":[{"name":"Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, South-East District, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Unami","family":"Mulale","sequence":"additional","affiliation":[{"name":"Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, South-East District, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loeto","family":"Mazhani","sequence":"additional","affiliation":[{"name":"Department of Paediatric & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, South-East District, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tonya","family":"Arscott-Mills","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Steenhoff","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"},{"name":"Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Coffin","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"},{"name":"Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,9,6]]},"reference":[{"key":"2025101813061057000_12.9.e062776.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-019-1545-0"},{"key":"2025101813061057000_12.9.e062776.2","unstructured":"World Health Organization . Newborns: improving survival and well-being, 2020. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/newborns-reducing-mortality [Accessed 27 Jul 2021]."},{"key":"2025101813061057000_12.9.e062776.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)71048-5"},{"key":"2025101813061057000_12.9.e062776.4","unstructured":"UNICEF . UNICEF Data: Levels & trends in child mortality: Neonatal Mortality Data, 2020. Available: https:\/\/data.unicef.org\/resources\/dataset\/neonatal-mortality-data\/ [Accessed 26 Aug 2021]."},{"key":"2025101813061057000_12.9.e062776.5","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1038\/jp.2016.27","article-title":"When do newborns die? 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