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Background: The mortality rate remains high in pediatrics intensive care units. Hence, predicting mortality in a pediatric intensive care unit (PICU) is vital for improving the quality of care and survival of children. The pediatric index of mortality-2 (PIM-2), is one of the most used prediction models in resource-limited setups, which does not need extensive laboratory investigation. Thus, this study aimed at assessing the performance of the modified PIM-2 score in a pediatric intensive care unit at the University of Gondar Comprehensive Specialized Hospital, Ethiopia. Method: A single-centered prospective cohort study was conducted among 313 children admitted to the pediatrics intensive care unit at the University of Gondar Comprehensive Specialized Hospital. Data were collected by structured checklists adapted from different pieces of literature, through history taking, patient document review, and physical examination. The modified PIM-2 was scored within the first hour of admission. The standardized mortality ratio (SMR) was calculated using the Mid-P exact method. The discriminatory function was assessed by the area under the receiver operating characteristic (ROC) curve. The Hosmer-Lemeshow goodness of fit test was used for calibration. Result: A total of 313 participants with a median age of 48 months (IQR: 12–122) at admission were included in this analysis. Of those 59.7% were males. The median duration of hospital stay was three days (IQR: 1–6).A total of 102 (32.6%) children died during the study period. The overall predicted mortality rate by the PIM-2 score was 11.1%, giving an SMR of 2.93 (95% CI: 2.11, 3.95). The area under receiver operating characteristics (AUROC) of PIM-2 was 0.79 (95% CI: 0.76, 0.86), and the Hosmer-Lemeshow goodness of fit test across deciles of risk strata showed good calibration (X2=7.45, df=8, p=0.489) as well as across subgroups by age, diagnosis, and nutritional status. Conclusion: The modified PIM-2 had a fair discriminatory function and good calibration in the study setting. Though it can be used to prioritize care and for the assessment of the quality of care, we recommend developing and validating another parsimonious risk score with a better discriminatory function., Ethiopian Journal of Health and Biomedical Sciences, Vol. 13 No. 1 (2023)

Hailu Tazebew Amare, Ashenafi Tazebew Amare Department of Pediatrics and Child Health, University of Gondar, College of Medicine and Health Sciences, Gondar, EthiopiaCorrespondence: Ashenafi Tazebew AmareDepartment of Pediatrics and Child Health, P.O. Box 196, Bekafa Street, Gondar, EthiopiaTel + 251-913-16-47-22Email ash_gondar@yahoo.comBackground: Neonatal seizures are the most common neurological dysfunction in the neonatal period. Neonatal seizure patterns and short-term neurologic outcomes, particularly in the Ethiopian context, have not been adequately studied.Objective: The main aim of this study is to assess the pattern, probable etiology, short-term outcomes, and determinants of neonatal seizures in the neonatal intensive care unit of Gondar University Specialized Comprehensive Hospital.Methods: A hospital-based prospective observational cohort study was conducted from October 1, 2016, to September 30, 2018.Results: Among the 117 neonates enrolled, the most common type of neonatal seizure was subtle (60.6%), followed by tonic (15.4%), and clonic (12.8%) seizures. The most common etiology for the seizure was perinatal asphyxia (PNA) with hypoxic-ischemic encephalopathy (HIE; 74.4%) followed by electrolyte disturbances (12.8%). In the follow-up, 23 (19.7%) died during the acute neonatal illness. The most common cause of death was PNA with HIE, accounting for 73.9% of the deaths. Among the surviving newborns, 10 (10.6%) had neurodevelopmental deficits at discharge. Being a multiparous mother (OR= 0.172; 95% CI: 0.033, 0.880), being female (OR= 0.171; 95% CI: 0.055, 0.538), and having tonic (OR= 0.164; 95% CI: 0.030, 0.885) and myoclonic seizures (OR= 0.040; 95% CI: 0.055, 0.538) were significantly associated with mortality poor short-term outcome.Conclusion: Subtle seizures were the most common seizure semiology. The most common etiology for seizure was PNA with HIE. Parity, gestational age, neonatal sex, and seizure type were determinants of short-term outcomes.Keywords: hypoxia-ischemic encephalopathy, neonatal seizures, newborn, etiology, mortality