Short Term Survival of Premature Infants admitted to the new Born Unit at Moi Teaching and Referral Hospital, Kenya

Abstract

Background: Prematurity is a major contributor to neonatal mortality globally and it accounts for 28% of all neonatal deaths. Preterm infants are at an increased risk of neonatal morbidity and mortality compared to full term infants. In order to achieve the fourth Millennium Development Goal, there is need for reduction of neonatal deaths especially those ascribed to prematurity. Data on hospital based survival rates for preterm infants is important for decision making by obstetricians, neonatologists and hospital management in predicting outcomes of care and development of interventions to improve outcomes of care. Objective: To determine the proportion of premature infants admitted to the newborn unit at Moi Teaching and Referral Hospital who survive to discharge. Methodology: This was a prospective descriptive study conducted in the newborn unit at Moi Teaching and Referral Hospital in Eldoret, Kenya. The study subjects were infants born before 37 completed weeks of gestation. A minimum sample size of 175 premature infants was required. Consecutive sampling was used to identify subjects. Data was collected using a pretested structured questionnaire and analyzed using STATA version 10.0. Descriptive statistics were used for continuous variables and frequency listing for categorical data. Cox Proportional Hazards model was used to determine factors associated with survival and Kaplan-Meier survival curves drawn. Results: A total of 175 neonates were enrolled into the study and followed until discharge or death. There were 82 (46.9%) male and 93 (53.1%) female infants. There were 27 (15.4%) extremely preterm (less than 28 weeks), 54 (30.9%) very preterm (28 to less than 32 weeks) and 94 (53.7%) moderate to late preterm (32 to less than 37 weeks) infants. Neonatal sepsis (88.6%), hypothermia (67.4%) and respiratory distress syndrome (64.6%) were the main diagnoses made. The overall survival to hospital discharge was 60.6% (95% CI 0.53-0.68). The survival rate was 29.6% for infants born less than 28 weeks gestation, 50% for those born at 28-31 weeks and 75.5% for those born at or above 32 weeks. Of the infants who did not survive, 11 (15.9%) died within the first 24 hours while 56 (81.2%) died by the end of the first week. Gestation age of 32 weeks (HR 0.39, 95% CI 0.18-0.8), birth weight >1000g (HR 0.27, 95% CI 0.20-0.78) and maternal antenatal care attendance (HR 0.52, 95% CI 0.3-0.9) were associated with better survival. Caesarian section mode of delivery, versus spontaneous vertex delivery, was associated with increased risk of death (HR 4.26, 95% CI 1.88-9.66). Conclusions: Two thirds of premature infants admitted to MTRH new born unit survived to discharge. The survival gestation age limit was 28 to less than 32 weeks category (50% chance of survival as per WHO). Increasing gestation age, birth weight over 1000g and maternal antenatal care clinic attendance were associated with better survival. We therefore recommend that whenever possible preterm birth delivery should be delayed until after 28 weeks gestation