Overnight admissions to a neonatal intensive care unit in Ethiopia are not associated with increased mortality.

BACKGROUND: In 2019, 2.4 million neonates died globally, with most deaths occurring in low-resource settings. Despite the introduction of neonatal intensive care units (NICUs) in these settings, neonatal mortality remains high, and caring for sick neonates around the clock can be challenging due to limited staff and resources. OBJECTIVE: To evaluate whether neonatal intensive care admissions during daytime and overnight hours affects in-hospital neonatal mortality. METHODS: A retrospective case-control study was conducted using 2016 chart data at a University hospital in Ethiopia. Cases were defined as neonates who died in the NICU, and controls were defined as neonates who survived. Overnight hours were defined as 17:00 to 07:59, and day hours were defined as 08:00 to 16:59. Univariate and multivariate logistic regressions were used to investigate the relationship between time of admission and mortality, along with perinatal characteristics. RESULTS: A total of 812 neonates, 207 cases and 605 controls, met inclusion criteria. There were 342 admissions during the day and 470 overnight. Neonatal mortality (aOR 1.02, 95% CI [0.64-1.62], p = 0.93) was not associated with overnight admissions after controlling for maternal age, parity, C-section, birthweight, and gestational age, respiratory distress, and admission level of consciousness. Admission heart rate >160 (aOR 0.52, 95% CI [0.30-0.91], p = 0.02) was the only variable significantly associated with overnight admissions. CONCLUSION: Being admitted overnight to the NICU in Gondar, Ethiopia was not associated with increased mortality, consistent with a constant level of care, regardless of the time of admission. Further qualitative and implementation research are needed to understand contextual factors that have affected these data.

Aspects of Parent-Child Interaction from Infancy to Late Adolescence Are Associated with Severity of Childhood Maltreatment through Age 18.

Childhood maltreatment (CM) is a pervasive public health problem worldwide, with negative health consequences across the lifespan. Despite these adverse outcomes, identifying children who are being maltreated remains a challenge. Thus, there is a need to identify reliably observable features of parent-child interaction that indicate risk for CM and that can instigate strategically targeted family supports. The aim of this longitudinal study was to assess multiple aspects of observed mother-child interaction from infancy to late adolescence as risk indicators of the overall severity of CM by age 18. Mother-child dyads were assessed in infancy (N = 56), at age 7 years (N = 56), and at age 19 years (N = 56/110). Severity of CM through age 18 was indexed by combined prospective and retrospective assessments. Interactions associated with severity of CM by age 18 included maternal hostility in infancy, maternal withdrawal in infancy and middle childhood, child disorganized attachment behavior in middle childhood and late adolescence, as well as hostile and role-confused interactions in late adolescence. This study identifies new indices of maternal and child behavior as important risk indicators for the severity of CM. These indices could be used to improve early identification and tailor preventive interventions for families at risk for CM.