Occurrence and factors associated with upper GI bleeding among neonates admitted to the Special Care Unit of Mulago Hospital

Abstract

Background: In Uganda, the neonatal mortality rate is 29 deaths per 1000 live births, and this contributes 40% of all infant deaths. The World Health Organization (WHO) estimates that 85% of newborn deaths are due to infections, prematurity, fetal distress, hypotension, hypoxia, and acidosis. These conditions are also etiological and risk factors for upper GI bleeding (UGIB) in sick neonates. Other problems associated with upper GI bleeding include maternal conditions such as diabetes, hypertension in pregnancy and smoking. Infants with UGIB tend to stay longer in hospital, have a slower rate of weight gain, are prone to developing hypoglycemia and delayed oral feeding. Few studies on UGIB have been done in neonates, while no such studies have been reported in Africa. The magnitude and factors associated with UGIB in Ugandan neonates is not known. Study setting: The Special Care Unit of Mulago hospital Study design: Prospective single cohort study Study population: Newborn babies admitted to the Special Care Unit of Mulago Hospital Method: Neonates admitted to the special care unit of Mulago Hospital were consecutively enrolled into the study and followed up for seven days. Data about clinical history and examination findings was captured into case report forms. Gestational age was estimated using the New Ballard Score (NBS). Gastric aspirates from the neonates were examined daily over a period of 7 days using Guaiac and Apt tests for evidence of upper GI bleeding. Data was entered into the computer using EPIDATA package 3.1, exported to statistical software STATA version 10, then analyzed and presented in tables. Results: Out of 191 neonates followed up in this study, 44 (23 %) developed UGIB, 26/44 (59 %) of whom were male neonates. Preterm babies comprised 15/44 (40.9 %) of the neonates who developed UGIB. On the first day of follow up, there were no neonates with detectable upper GI bleeding. However 38.6% of the cases of bleeding were detected on the second day of follow up, 25% on the third day while fewer numbers were reported on the other days of follow up. Factors found to be independently associated with UGIB in neonates 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 diagnosis of birth asphyxia [OR 6.3; (95% CI 1.9 – 21.6); p-value 0.003]. Conclusions: In the first seven days of life, Upper GI Bleeding occurred in 1 in 4 neonates admitted to the Special Care Unit of Mulago Hospital. Factors independently associated with Upper GI Bleeding among these neonates included birth asphyxia, cyanosis and neonatal seizures. Recommendations: Upper GI bleeding is common in our setting, affecting 1 in every 4 sick neonates and should therefore be looked for among neonates admitted to neonatal units in Uganda. Since birth asphyxia was found to be a major risk factor for UGIB in neonates, there is need for concerted efforts to ensure adequate monitoring of labor and delivery to reduce the risk of birth asphyxia. There is also need to ensure provision of timely neonatal resuscitation in the immediate post delivery care of newborn babies to reduce the risk of developing birth asphyxia, cyanosis and seizures among neonates. A majority of deliveries in Uganda occur outside the hospital. There is therefore need to do a similar study among neonates born outside the hospital to determine whether the results are the same.