Survival status and predictors of mortality among preterm neonates admitted to a tertiary hospital in Sierra Leone
Keywords:
Preterm, Neonates, Survival, Predictors, Mortality, Sierra LeoneAbstract
Background: Prematurity contributes significantly to the neonatal mortality burden in sub-Saharan Africa. The survival rate of preterm neonates and its predictors may be varied from setting to setting and time to time due to different reasons. This study therefore aimed to assess the survival status and predictors of mortality among preterm neonates at a tertiary hospital in Sierra Leone.
Method: A prospective study of 82 consecutively enrolled preterm neonates was conducted from May to July 2024. Interviewer-administered questionnaires and physical assessment of neonates were used to obtain socio-demographic and clinical data for mothers and their preterm neonates. Descriptive statistics were generated and tests of association done with multinomial logistic regression to establish the determinants of mortality outcome. A p-value <0.05 was considered statistically significant.
Results: At the end of this study, 20.7% (17/82) of admitted preterm neonates died, with 76.5% (13/17) of the deaths occurring within 72 hours of admission. Birth weight (p <0.001), gestational age (p <0.001), type of gestation (p=0.026), APGAR score at 5 minutes (p<0.001), post natal age (p=0.016), hypothermia (p=0.003) and lack of kangaroo mother care (p<0.001) were significantly associated with survival of preterm babies.
Conclusion: This study shows that in spite of limited resources and access to neonatal intensive care facilities, a decent survival rate can be achieved for babies born too soon. Factors such as singleton pregnancy, gestational age, birth weight, low apgar scores, hypothermia, hypoglycaemia, respiratory distress syndrome, post natal age and kangaroo mother care were significant predictors of mortality.
References
Blencowe H, Cousens S. Review: addressing the challenge of neonatal mortality. Trop Med Int Health. 2013;18(3):303–312. doi:10.1111/ tmi.12048
WHO, UNICEF. Reaching the Every Newborn National 2020 Milestones country Progress, Plans and Moving Forward; 2017; p. 2015–8.
Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the sustainable development goals. Lancet. (2016);388:3027–35. doi: 10.1016/S0140-6736(16)31593-8
Lawn J, Mongi P, Cousens S. counting them and making them count. In: Africa ’ s newborns [Internet]. 2015; p.16. Available from: https:// www. google. com/ url? sa= t&rct= j&q= &esrc= s& source= web& cd= &ved= 2ahUKEwjVu 96HkK j2AhV XPewKHRzPBlsQFnoECAM QAQ&url= https% 3A% 2F% 2Fwww. who. int%2Fpmn ch% 2Fmed ia% 2Fpub licat ions% 2Faon section_I. pdf&
Lawn JE, Kinney M. Preterm birth: now the leading cause of child death worldwide. Sci Transl Med. 2014;6(263):19–22.94
Engle WA, Tomashek KM, Wallman C. “Late-preterm” infants: a population at risk. Pediatrics. 2007;120(6):1390–1401.doi:10.1542/peds.2007-2952
Federal Ministry of Health of Ethiopia AA. Neonatal Intensive Care Unit (NICU) Training Management Protocol(2014).
Gebreslassie HG, Gebregziabher B, Hailu T, Gebreegziabiher G. Patterns of preterm neonatal death and associated factors in ayder referral hospital neonatal unit (five years record review), Tigray Region, North Ethiopia. IntJ ContempPediatr. (2018). p.10060–5
Hirvonen M, Ojala R, Korhonen P, Haataja P, Eriksson K, Gissler M, et al. Visual and hearing impairments after preterm birth. Pediatrics. (2018);142:e20173888. doi: 10.1542/peds.2017-3888
Majewska J, Zajkiewicz K, Wacław-Abdul K, Baran J, Szymczyk D. Neuromotor development of children aged 6 and 7 years born before the 30th week gestation. BioMed Res Int. (2018) 2018:2820932. doi:10.1155/2018/2820932
Vaughn VC,McKay RJ, Behrman RE, NelsonW.E. Textbook of Pediatrics. 21st ed. Philadelphia, PA:WB Saunders Company (2019).
Richardus JH, Graafmans WC, Verloove-Vanhorick SP, Mackenbach JP; EuroNatal International Audit Panel; Euro Natal Working Group. Differences in perinatal mortality and suboptimal care between 10 European regions:Results of an international audit. BJOG. 2003;110(2):97-105.
Labcharoenwongs P, Chamnanvanakij S, Rasamimari P, Saengaroon P. Mortality and morbidity of very low birth weight (VLBW) and preterm infants of gestational age <33 weeks at phramongkutklao Hospital. R Thai Army Med J. 2002; 55:205-11.
Ibhanesebhor SE, Afadapa MA. Epidemiology of preterm delivery in Benin City. Niger J Paediatr. 1996; 23:27-32.
Sritipsukho S, Suarod T, Sritipsukho P. Survival and outcome of very low birth weight infants born in a university hospital with level II NICU. J Med Assoc Thai. 2007;90(7):1323-9.
Trotman H, Lord C. Outcome of extremely low birthweight infants at the University Hospital of the West Indies, Jamaica. West Indian Med J. 2007;56(5):409-13.
Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard score, expanded to include extremely premature infants. J Pediatr. 1991; 119:417–423.
Mandy AGT. Incidence and mortality of the preterm infant. Up To Date[Internet]. 2020; Available from: https://www. google. com/ url? sa= t&rct= j&q= &esrc= s& source= web& cd= & cad= rja&uact= 8&ved= 2ahUK Ewje67SWoK j2AhU 8wAIH HbdrD m8QFn oECBA QAQ&url= https% 3A% 2F% 2Fwww. uptod ate. com%2Fcon tents% 2Finc idence- and- mortality- of- theprete rm- infant% 2Fpri nt% 3Fsea rch% 3Dant enatal- corticoste roids- therapyfor- reduction- of- neonatal- morbidity- and- mortality- from- prete rm- delivery% 26sou rce%3Dsea rch_ result% 26sel ected Title% 3D10~150% 26usa ge_type% 3Ddef ault% 26dis play_ rank%3D10&usg= AOvVa w3_ H2dJH mciTY22hRj b9jPN.
Kimberly G.L. Identifying the High-risk Newborn and Evaluating Gestational Age, Prematurity, Postmaturity, Large-for-Gestational-Age, and Small-for-Gestational-Age Infants. In: Cloherty JP, Eichenwald EC, Stark AR (editors). Manual of Neonatal Care. 6th Edition. Lippincott Williams & Wilkins, 2008; 41-58.
Lubchenco L, Hansman C, Dressler M, Boyd E. Intrauterine growth as estimated from live born birth weight data at 24 to 42 weeks of gestation. Pediatrics. 1963; 32:793–800.
Abdallah Y, Namiiro F, Mugalu J. Is facility based neonatal care in low resource setting keeping pace? A glance at Uganda’s National Referral Hospital. Afr Health Sci. 2016;16(2):347–355. doi:10.4314/ ahs.v16i2.2
Lyoke AC, Lawani OL, Ezugwu EC. Prevalence and perinatal mortality associated with preterm births in a tertiary medical center in South East Nigeria. Int J Women’s Health. 2014; 6:881–888. doi:10.2147/IJWH.S72229
Agbeno EK, Osarfo J, Ashong J, Anane- Fenin B, Okai E, Ofori AA, et al. (2021) Determinants of preterm survival in a tertiary hospital in Ghana: A ten-year review. PLoS ONE 16(1): e0246005. https://doi.org/10.1371/journal. pone.0246005
Wesenu M, Kulkarni S, Tilahun T. Modeling determinants of time-to- death in premature infants admitted to neonatal intensive care unit in Jimma university specialized hospital. Ann Data Sci. 2017;4 (3):361–381.doi:10.1007/s40745-017-0107-2
Xu F, Kong X, Duan S, Lv H, Ju R, Li Z, et al. Care practices, morbidity and mortality of preterm neonates in China, 2013–2014: a retrospective study. Sci Rep. 2019;9(1):2013–4 Available from: https:// doi. org/ 10. 1038/s41598- 019- 56101-x.
Haghighi L, Nojomi M, Mohabbatian B, Najmi Z. Survival predictors ofpreterm neonates: hospital based study in Iran (2010-2011). Iran J Reprod Med. 2013;11(12):957–64.
Sankar MJ, Natarajan CK, Das RR, Agarwal R, Chandrasekaran A, Paul VK. When do newborns die? A systematic review of timing of overall and cause-specific neonatal deaths in developing countries. J Perinatol.2016;36:S1–S11. doi:10.1038/jp.2016.27
Yismaw AE, Tarekegn AA. Proportion and factors of death among preterm neonates admitted in University of Gondar comprehensive specialized hospital neonatal intensive care unit, Northwest Ethiopia. BMC Res Notes. 2018; 11:867. doi:10.1186/s13104-018-3970-9 Survival status and predictors of mortality among preterm neonates admitted to a tertiary hospital in Sierra Leone Ronita DC Luke et al 95
Mbawala GB, Fredrick F, Kamugisha E. Factors associated with mortality among premature babies admitted at Bugando Medical Centre, Mwanza - Tanzania. East Afr J Public Health. 2014;11 (1):641–645.
Garg P, Abdel-Latif ME, Bolisetty S, Bajuk B, Vincent T, Lui K. Perinatal characteristics and outcome of preterm singleton, twin and triplet infants in NSW and the ACT, Australia (1994–2005). Arch Dis Child Fetal Neonatal Ed. 2010;95:F20–F24. doi:10.1136/ adc.2009.157701
Papiernik E, Zeitlin J, Delmas D. Differences in outcome between twins and singletons born very preterm: results from a population-based European cohort. Human Reprod. 2010;25 (4):1035–1043. doi:10.1093/humrep/dep430
Albasri SF, Shouib GM, Bajouh OS, Nasrat HA, Ahmad E, Algreisi FM. Maternal and neonatal outcomes in twin and triplet gestations in Western Saudi Arabia. Saudi Med J. 2017;38 (6):657–661. doi:10.15537/smj.2017.6.17699
Fajolu I, Akintan PE, Ezenwa B, Ezeaka VC. Survival of extremely preterm neonates in a resource-limited setting. Iran J Neonatol. 2019;10(3):32–37. doi:10.22038/ijn.2019.38772.1611
Kong X, Xu F, Wu R. Neonatal mortality and morbidity among infants between 24 to 31 complete weeks: a multicenter survey in China from 2013 to 2014. BMC Pediatr. 2016; 16:174. doi:10.1186/ s12887-016-0716-5
Muhe LM, Mcclure EM, Nigussie AK. Major causes of death in preterm infants in selected hospitals in Ethiopia(SIP): a prospective, cross-sectional, observational study. Lancet Glob Health. 2019;7(8): e1130–e1138.doi:10.1016/S2214-109X(19)30220-7
Bello M, Pius S, Ibrahim BA. Characteristics and predictors of outcome of care of preterm newborns in resource constraints setting, Maiduguri, Northeastern Nigeria. J Clin Neonatol. 2019;8:39–46. doi:10.4103/jcn.JCN
Shah S, Zemichael O, Meng HD. Factors associated with mortality and length of stay in hospitalised neonates in Eritrea, Africa: a cross-sectional study. BMJ Open. (2012);2:e000792. doi: 10.1136/bmjopen-2011-000792
Shah R, Mullany LC, Darmstadt GL, Talukder RR, Rahman SM, Mannan I, et al. Neonatal mortality risks among preterm births in a rural B angladeshi cohort. Paediatr Perinat Epidemiol. (2014); 28:510–20. doi: 10.1111/ppe.12145
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