Abstract / Summary
Neonatal sepsis is a leading cause of neonatal morbidity and mortality, particularly in low- and middle-income countries with limited diagnostic and supportive-care capacity. Although survival outcomes have been widely reported, time to recovery, relevant to clinical monitoring, resource planning, and family counselling, remains poorly characterized in Ethiopia. This study estimated time to recovery from neonatal sepsis and identified its predictors among neonates admitted to the neonatal intensive care unit (NICU) at ARTH, Southeast Ethiopia. An institution-based retrospective cohort study included 386 neonates diagnosed with neonatal sepsis and admitted to the NICU at ARTH between September 2022 and September 2024. Data were abstracted from maternal and neonatal medical records using a structured checklist. Time to recovery was estimated using the Kaplan–Meier method, with between-group differences assessed by the log-rank test. Independent predictors of time to recovery were identified using multivariable Cox proportional-hazards regression, reported as adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs). Of the 386 neonates included, 238 (61.7%) recovered during follow-up, contributing 4,505 neonate-days of observation. The recovery incidence rate was 52.9 per 1,000 neonate-days (95% CI: 46.1–59.6), and the median time to recovery was 8.5 days (IQR: 6–16 days). In the multivariable Cox regression analysis, preterm birth (AHR = 0.67; 95% CI: 0.34–0.83), induced labor (AHR = 0.37; 95% CI: 0.14–0.92), maternal intrapartum fever (AHR = 0.50; 95% CI: 0.28–0.89), altered mental status at admission (AHR = 0.32; 95% CI: 0.13–0.78), and early-onset neonatal sepsis (AHR = 0.73; 95% CI: 0.31–0.96) were independently associated with a lower hazard of recovery. Conversely, normal baseline platelet counts were associated with a higher hazard of recovery (AHR = 2.15; 95% CI: 1.13–4.12). In this cohort, fewer than two-thirds of neonates with sepsis recovered during follow-up, with a median time to recovery of 8.5 days. Maternal and neonatal factors were associated with differences in recovery time, highlighting the importance of early identification and close monitoring of neonates at higher risk of delayed recovery, particularly preterm infants and those with severe clinical presentations. These findings provide context-specific evidence to inform neonatal care and health program planning in similar resource-limited settings.