Identifying neonates at risk for post-discharge mortality in Dar es Salaam, Tanzania, and Monrovia, Liberia: Derivation and internal validation of a novel risk assessment tool.

Autor:	Rees CA; Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA chrisrees2@gmail.com.; Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA., Ideh RC; Department of Pediatrics, John F Kennedy Medical Center, Monrovia, Liberia., Kisenge R; Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania., Kamara J; Department of Pediatrics, John F Kennedy Medical Center, Monrovia, Liberia., Coleman-Nekar YG; Department of Pediatrics, John F Kennedy Medical Center, Monrovia, Liberia., Samma A; Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania., Godfrey E; Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania., Manji HK; Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Dar es Salaam, United Republic of Tanzania.; Accident and Emergency Department, The Aga Khan Health Services, Dar es Salaam, Dar es Salaam, United Republic of Tanzania., Sudfeld CR; Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Boston, USA., Westbrook AL; Pediatric Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA., Niescierenko M; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.; Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA., Morris CR; Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.; Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA., Whitney CG; Emory Global Health Institute, Emory University, Atlanta, Georgia, USA., Breiman RF; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.; Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Johannesburg, South Africa., Duggan CP; Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Boston, USA.; Center for Nutrition, Children's Hospital Boston, Boston, Massachusetts, USA., Manji KP; Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2024 Feb 15; Vol. 14 (2), pp. e079389. Date of Electronic Publication: 2024 Feb 15.
DOI:	10.1136/bmjopen-2023-079389
Abstrakt:	Introduction: The immediate period after hospital discharge carries a large burden of childhood mortality in sub-Saharan Africa. Our objective was to derive and internally validate a risk assessment tool to identify neonates discharged from the neonatal ward at risk for 60-day post-discharge mortality. Methods: We conducted a prospective observational cohort study of neonates discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania, and John F Kennedy Medical Centre in Monrovia, Liberia. Research staff called caregivers to ascertain vital status up to 60 days after discharge. We conducted multivariable logistic regression analyses with best subset selection to identify socioeconomic, demographic, clinical, and anthropometric factors associated with post-discharge mortality. We used adjusted log coefficients to assign points to each variable and internally validated our tool with bootstrap validation with 500 repetitions. Results: There were 2344 neonates discharged and 2310 (98.5%) had post-discharge outcomes available. The median (IQR) age at discharge was 8 (4, 15) days; 1238 (53.6%) were male. In total, 71 (3.1%) died during follow-up (26.8% within 7 days of discharge). Leaving against medical advice (adjusted OR [aOR] 5.62, 95% CI 2.40 to 12.10) and diagnosis of meconium aspiration (aOR 6.98, 95% CI 1.69 to 21.70) conferred the greatest risk for post-discharge mortality. The risk assessment tool included nine variables (total possible score=63) and had an optimism corrected area under the receiver operating characteristic curve of 0.77 (95% CI 0.75 to 0.80). A score of ≥6 was most optimal (sensitivity 68.3% [95% CI 64.8% to 71.5%], specificity 72.1% [95% CI 71.5% to 72.7%]). Conclusions: A small number of factors predicted all-cause, 60-day mortality after discharge from neonatal wards in Tanzania and Liberia. After external validation, this risk assessment tool may facilitate clinical decision making for eligibility for discharge and the direction of resources to follow-up high risk neonates. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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