{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T21:18:29Z","timestamp":1791839909715,"version":"4.3.4"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T00:00:00Z","timestamp":1718064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Background<\/jats:title>\n Most 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. Previous studies on morbidity and mortality among low birth weight infants after early discharge mainly focused on very low birth weight infants, and none described post-discharge neonatal mortality. This study aimed to determine the proportion and predictors of mortality among low birth weight neonates discharged from the Special Care Baby Unit at Mulago National Referral Hospital in Uganda.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This was a prospective cohort study of 220 low birth weight neonates discharged from the 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 220 enrolled participants, 216 (98.1%) completed the follow-up. The mean gestational age of study participants was 34 \u00b13 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\u201316 days). The predictors of mortality were a discharge weight of less than 1,200g (adj HR: 23.47,\n p<\/jats:italic>\n <0.001), a 5-minute Apgar score of less than 7 (adj HR: 4.25,\n p<\/jats:italic>\n = 0.016), and a diagnosis of neonatal sepsis during admission (adj HR: 7.93,\n p =<\/jats:italic>\n 0.009).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Post-discharge mortality among low birth weight neonates at Mulago National Referral Hospital 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0303454","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T14:03:04Z","timestamp":1718114584000},"page":"e0303454","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Predictors of mortality among low birth weight neonates after hospital discharge in a low-resource setting: A case study in Uganda"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8327-241X","authenticated-orcid":true,"given":"Ronald","family":"Nsubuga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Rujumba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleh","family":"Nyende","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stevens","family":"Kisaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Idro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolly","family":"Nankunda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,6,11]]},"reference":[{"key":"pone.0303454.ref001","unstructured":"World Health Organization. International statistical classification of diseases and related health problems. World Health Organization; 2011."},{"key":"pone.0303454.ref002","first-page":"6518","article-title":"Small for gestational age: Case definition & guidelines for data collection, analysis, and presentation of maternal immunisation safety data","author":"EP Schlaudecker","year":"2017","journal-title":"Vaccine. Elsevier Ltd"},{"key":"pone.0303454.ref003","unstructured":"Eds CP Howson, MV Kinney JLawnWHOrganizationG. Born too soon. Born Too Soon, The Global Action Report on Preterm Birth World Health Organization Geneva. 2012;13: 1\u2013126. doi:http:\/\/whqlibdoc.who.int\/publications\/2012\/9789241503433_eng.pdf."},{"key":"pone.0303454.ref004","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0140-6736(14)60496-7","article-title":"Every Newborn: progress, priorities, and potential beyond survival","volume":"384","author":"JE Lawn","year":"2014","journal-title":"The Lancet"},{"key":"pone.0303454.ref005","first-page":"608","article-title":"Neonatal mortality of low-birth-weight infants in Bangladesh","volume":"79","author":"S Yasmin","year":"2001","journal-title":"Bull World Health Organ"},{"key":"pone.0303454.ref006","first-page":"204","article-title":"Trend analysis and socio-economic differentials in infant mortality in the Southern Health Board, Ireland (1988\u20131997)","volume":"93","author":"CA Ryan","year":"2000","journal-title":"Ir Med J"},{"key":"pone.0303454.ref007","doi-asserted-by":"crossref","unstructured":"WHO. Kangaroo mother care: A practical guide. WHO Reproductive Health and Research. 2003; 1\u201348. doi: 10.4038\/sljch.v34i1.564","DOI":"10.4038\/sljch.v34i1.564"},{"key":"pone.0303454.ref008","unstructured":"Uganda Bureau of Statistics, ICF, DHS Program. Uganda Demographic and Health Survey. 2016."},{"key":"pone.0303454.ref009","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.2014.19.37.3928","article-title":"Helping small babies survive: An evaluation of facility-based Kangaroo Mother Care implementation progress in Uganda","volume":"19","author":"P Aliganyira","year":"2014","journal-title":"Pan African Medical Journal"},{"key":"pone.0303454.ref010","author":"A-M Bergh","year":"2012","journal-title":"Evaluation of kangaroo mother care services in Uganda"},{"key":"pone.0303454.ref011","article-title":"Kangaroo mother care to reduce morbidity and mortality in low birthweight infants","author":"John Wiley and Sons Ltd","year":"2014","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"pone.0303454.ref012","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-018-1226-4","article-title":"Mortality among very low birth weight infants after hospital discharge in a low resource setting","volume":"18","author":"Y Abdallah","year":"2018","journal-title":"BMC Pediatr"},{"key":"pone.0303454.ref013","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jpeds.2011.12.038","article-title":"Risk Factors for Post-Neonatal Intensive Care Unit Discharge Mortality among Extremely Low Birth Weight Infants","volume":"161","author":"LC De Jesus","year":"2012","journal-title":"J Pediatr"},{"key":"pone.0303454.ref014","doi-asserted-by":"crossref","first-page":"e788","DOI":"10.1542\/peds.2006-3765","article-title":"Postdischarge Infant Mortality Among Very Low Birth Weight Infants: A Population-Based Study","volume":"120","author":"A Kugelman","year":"2007","journal-title":"Pediatrics"},{"key":"pone.0303454.ref015","author":"S. Kevin M","journal-title":"OpenEpi \u2010 Open Source Statistics for Public Health"},{"key":"pone.0303454.ref016","unstructured":"WHO. Verbal Autopsy Standards: The 2016 WHO verbal autopsy instrument. In: WHO. 2016."},{"key":"pone.0303454.ref017","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1093\/tropej\/fmn116","article-title":"Safety, effectiveness and barriers to follow-up using an \u201cearly discharge\u201d kangaroo care policy in a resource poor setting","volume":"55","author":"H Blencowe","year":"2009","journal-title":"J Trop Pediatr"},{"key":"pone.0303454.ref018","first-page":"87","article-title":"Survival rate of low and very low birth weight neonates in an Iranian community","volume":"41","author":"R Vazirinejad","year":"2012","journal-title":"Iran J Public Health"},{"key":"pone.0303454.ref019","first-page":"451","article-title":"Immediate Seven Day Outcomes and Risk Factors of Low Birth Weight Neonates at Referral Hospitals in Mwanza City, Tanzania in October 2020","volume":"34","author":"SE Kibona","year":"2021","journal-title":"Afr J Health Sci"},{"key":"pone.0303454.ref020","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.siny.2003.11.006","article-title":"Relationship between respiratory control and feeding in the developing infant","volume":"9","author":"MJ Miller","year":"2004","journal-title":"Seminars in Neonatology"},{"key":"pone.0303454.ref021","unstructured":"UNICEF. Uganda Maternal and Newborn Health Disparities. 2015."},{"key":"pone.0303454.ref022","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0140-6736(14)60496-7","article-title":"Every Newborn: progress, priorities, and potential beyond survival","volume":"384","author":"JE Lawn","year":"2014","journal-title":"The Lancet"},{"key":"pone.0303454.ref023","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/1471-2393-12-48","article-title":"Risk factors and prognosis for neonatal sepsis in southeastern Mexico: analysis of a four-year historic cohort follow-up","volume":"12","author":"YA Leal","year":"2012","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0303454.ref024","doi-asserted-by":"crossref","first-page":"48","DOI":"10.4103\/1755-6783.145013","article-title":"Intraventricular hemorrhage in newborns weighing <1500 g: Epidemiology and short-term clinical outcome in a resource-poor setting","volume":"7","author":"S Adegoke","year":"2014","journal-title":"Ann Trop Med Public Health"},{"key":"pone.0303454.ref025","doi-asserted-by":"crossref","DOI":"10.1155\/2018\/6153501","article-title":"Risk Factors for Neonatal Sepsis: A Retrospective Case-Control Study among Neonates Who Were Delivered by Caesarean Section at the Trauma and Specialist Hospital, Winneba, Ghana","volume":"2018","author":"P Adatara","year":"2018","journal-title":"Biomed Res Int"},{"key":"pone.0303454.ref026","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0097253","article-title":"Inadequate knowledge of neonatal danger signs among recently delivered women in southwestern rural Uganda: A community survey","volume":"9","author":"J Sandberg","year":"2014","journal-title":"PLoS One"},{"key":"pone.0303454.ref027","doi-asserted-by":"crossref","first-page":"574","DOI":"10.2471\/BLT.16.180273","article-title":"A cohort study of low birth weight and health outcomes in the first year of life, Ghana","volume":"95","author":"M O\u2019Leary","year":"2017","journal-title":"Bull World Health Organ"},{"key":"pone.0303454.ref028","doi-asserted-by":"crossref","first-page":"14","DOI":"10.4049\/immunohorizons.1700057","article-title":"The Impact of IgG transplacental transfer on early life immunity","volume":"2","author":"GG Fouda","year":"2018","journal-title":"Immunohorizons"},{"key":"pone.0303454.ref029","doi-asserted-by":"crossref","DOI":"10.3402\/gha.v9.30445","article-title":"Risk factors associated with neonatal deaths: A matched case-control study in Indonesia","volume":"9","author":"A Abdullah","year":"2016","journal-title":"Glob Health Action"},{"key":"pone.0303454.ref030","first-page":"1","article-title":"Clinical Epidemiology Association of Apgar scores with death and neurologic disability","volume":"1","author":"V. Ehrenstein","year":"2009","journal-title":"Clin Epidemiol"},{"key":"pone.0303454.ref031","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1056\/NEJMoa1915075","article-title":"Apgar Score and Risk of Neonatal Death among Preterm Infants","volume":"383","author":"S Cnattingius","year":"2020","journal-title":"New England Journal of Medicine"},{"key":"pone.0303454.ref032","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2015\/978079","article-title":"Preterm Birth: A Prominent Risk Factor for Low Apgar Scores","volume":"2015","author":"M Svenvik","year":"2015","journal-title":"Biomed Res Int"},{"key":"pone.0303454.ref033","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S2352-4642(21)00311-4","article-title":"Global, regional, and national causes of under-5 mortality in 2000\u201319: an updated systematic analysis with implications for the Sustainable Development Goals","volume":"6","author":"J Perin","year":"2022","journal-title":"Lancet Child Adolesc Health"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0303454","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T14:03:35Z","timestamp":1718114615000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0303454"}},"subtitle":[],"editor":[{"given":"Douglas Aninng","family":"Opoku","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,6,11]]},"references-count":33,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0303454","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2023.07.01.23292109","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,11]]}}}