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Upper GI bleeding among neonates admitted to Mulago Hospital, Kampala, Uganda: a prospective cohort study
O M Ombeva1, G Ndeezi, J Mugalu
1Department of Paediatrics, Faculty of Health Sciences, Egerton University, P.O Box 536-20115, Egerton, Nakuru, Kenya ; Department of Paediatrics and Child Health, Makerere University Medical School, P.O Box 7072, Kampala.
Insights
Upper GI bleeding (UGIB) affects 1 in 4 sick neonates, with birth asphyxia, cyanosis, and seizures being key risk factors. Understanding these factors is crucial for improving neonatal outcomes.
Area of Science:
- Neonatal Medicine
- Gastroenterology
- Public Health
Background:
- Neonatal infections, prematurity, and fetal distress contribute to 85% of newborn deaths.
- Sick neonates are at risk for upper GI bleeding (UGIB), leading to poor outcomes like prolonged hospitalization.
- The incidence and impact of UGIB in low-income countries remain under-described.
Purpose of the Study:
- To investigate the occurrence of UGIB in neonates admitted to Mulago Hospital's Special Care Unit.
- To identify factors associated with UGIB in this vulnerable population.
Main Methods:
- A prospective cohort study followed 191 neonates for seven days post-admission.
- Daily analysis of gastric aspirates using Guaiac and Apt tests detected UGIB.
- Occurrence and associated factors were analyzed using proportions and Odds Ratios.
Main Results:
- 44 out of 191 neonates (23%) developed UGIB within the first week of life.
- Independent risk factors for UGIB included cyanosis (OR 5.8), neonatal seizures (OR 12.6), and birth asphyxia (OR 6.3).
Conclusions:
- UGIB is a significant concern, affecting approximately 1 in 4 neonates in the study.
- Birth asphyxia, cyanosis, and neonatal seizures are strongly associated with UGIB, highlighting critical areas for intervention.
Background:
The World Health Organization (WHO) reports estimate that 85% of newborn deaths are due to infections, prematurity and fetal distress. These conditions are risk factors for upper GI bleeding (UGIB) in sick neonates. UGIB is associated with poor neonatal outcomes such as prolonged hospitalisation and poor weight gain. The magnitude of UGIB and its contribution to neonatal morbidity has not been described in most low income countries.
Objective:
To determine the occurrence and factors associated with UGIB among neonates admitted to the Special Care Unit (SCU) of Mulago Hospital.
Methods:
This was a prospective single cohort study where neonates admitted within 24 hours of birth were consecutively enrolled and followed up for seven days. Gastric aspirates from the neonates were examined daily over a period of 7 days using Guaiac and Apt tests for evidence of UGIB. Data on occurrence of UGIB has been presented as proportions and Odds Ratios for associated factors.
Results:
Out of 191 neonates, 44 (23 %) developed UGIB. Factors independently associated with UGIB included cyanosis in the neonate [OR 5.8; (95% CI; 1.8 - 19.1) p-value 0.004], neonatal seizures [OR 12.6; (95% CI 2.3 - 70.5); p-value 0.004] and birth asphyxia [OR 6.3; (95% CI 1.9 - 21.6); p-value 0.003].
Conclusions:
In the first seven days of life, UGIB occurred in 1:4 neonates. Factors independently associated with UGIB included birth asphyxia, cyanosis in the neonate and neonatal seizures.
