Prevalence and Outcome of Preterm Admissions at the Neonatal Unit of a Tertiary Health Centre in Southern Nigeria

DOI: 10.4236/ojped.2014.41009   PDF   HTML     4,748 Downloads   7,169 Views   Citations

Abstract

Background: Preterm babies have increased risk of morbidity and mortality which is inversely related to both gestational age and birth weight. Most preterm births result from maternal or foetal medical conditions. Objectives: To determine the prevalence and outcome of preterm admissions at the Special Care Baby Unit of the Niger Delta University Teaching Hospital, as well as theirmorbidity pattern and risk factors for preterm birth. Methodology: All preterm babies admitted from January 2010 to December 2012 were retrospectively studied. Information obtained included gestational age at birth, sex, risk factors for preterm birth, duration of admission, medical problems during admission and outcome. Results: Preterm admissions constituted 24.0% of the total admissions with a male to female ratio of 1.1:1. The commonest risk factor for preterm birth was preterm rupture of foetal membranes (46.4%) followed by lack of maternal antenatal care (35.5%) and multiple pregnancy (26.8%) respectively. The commonest medical conditions were respiratory problems in 95 (68.8%) followed by jaundice in 94 (68.1%) and sepsis in 54 (39.1%) of the patients. The case fatality rate was highest in the patients with necrotizing enterocolitis and seizures (66.7%) followed by respiratory problems (63.2%) and bleeding disorders (60.0%). The overall survival rate was 65.9%. The survival rate was significantly higher in the mild preterm category compared to the very preterm and extremely preterm for birth categories χ2 = 29.24, p value = 0.000. Conclusion: Preterms constituted a significant percentage of neonatal admissions at the Niger Delta University Teaching Hospital with the case fatality being highest among those with infections and respiratory problems. There is an urgent need for the establishment of a neonatal intensive care unit with facilities for thorough evaluation and management of preterm babies in order to improve survival rate of this vulnerable group of patients.

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Kunle-Olowu, O. , Peterside, O. and Adeyemi, O. (2014) Prevalence and Outcome of Preterm Admissions at the Neonatal Unit of a Tertiary Health Centre in Southern Nigeria. Open Journal of Pediatrics, 4, 67-75. doi: 10.4236/ojped.2014.41009.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] World Health Organization (1992) International Classification of Diseases and Related Health Problems. 10th Revision, Geneva.
[2] Huddy, C.L., Johnson, A. and Hope, P.L. (2001) Educational and Behavioral Problems in Babies of 32 - 35 Weeks Gestation. Archives of Disease in Childhood. Fetal and Neonatal Edition, 85, 23-28.
http://dx.doi.org/10.1136/fn.85.1.F23
[3] Wang, M.L., Dorer, D.J., Fleming, M.P. and Catlin, E.A. (2004) Clinical Outcomes of Near-Term Infants. Pediatrics, 114, 372-374. http://dx.doi.org/10.1542/peds.114.2.372
[4] Engle, W.A., Tomashek, K.M., Wallman, C. and the Committee of Fetus and Newborn (2007) “Late-Preterm” Infants: a Population at Risk. A Clinical Report. Pediatrics, 120, 1390-1401.
http://dx.doi.org/10.1542/peds.2007-2952
[5] Federal Ministry of Health (2011) Saving Newborn Lives in Nigeria. Newborn Health I the Context of the Integrated Maternal, Newborn and Child Health Strategy. Revised 2nd Edition, 2011.
[6] Mohammad, T., Khattak, A.A., Shafiq-Ur-Rehman. (2009) Mortality and Morbidity Pattern in Small-For-Gestational Age and Appropriate-For-Gestational Age Very Preterm Babies: A Hospital Based Study. Journal of Ayub Medical College Abbottabad, 21, 16-21.
[7] PeriStats (Online Database). White Plains, March of Dimes, New York, 2006.
http://www.marchofdimes.com/peristats/
[8] Engle, W.A. and Kominiarek, M.A. (2008) Late Preterm Infants, Early Term Infants and Timing of Elective Deliveries. Clinics in Perinatology, 35, 325-341. http://dx.doi.org/10.1016/j.clp.2008.03.003
[9] Beck, S., Wojdyla, D., Say, L., betran, A.P., Merialdi, M., Requejo, J.H., et al. (2010) The Worldwide Incidence of Preterm Birth: A Systematic Review of Maternal Mortality and Morbidity. Bulletin of the World Health Organization, 88, 31-38. http://dx.doi.org/10.2471/BLT.08.062554
[10] Goldenberg, R.L., Culhane, J.F., Iams, J.D. and Romero, R. (2008) Epidemiology and Causes of Preterm Birth. Lancet, 371, 75-84.
[11] Pennell, C.E., Jacobsson, B., Williams, S.M., Buus, R.M., Muglia, L.J. and Dolan, SM. (2007) Genetic Epidemiologic Studies of Preterm Birth: Guidelines for Research. American Journal of Obstetrics & Gynecology, 196, 107-118. http://dx.doi.org/10.1016/j.ajog.2006.03.109
[12] Baron, L., Hodgaman, J.E. and Pavlova, Z. (1999) Causes of Death in the Extremely Low Birth Weight Infant. Pediatrics, 103, 446-451. http://dx.doi.org/10.1542/peds.103.2.446
[13] Brewster, D. (1989) Neonatology in the developing world. Part 2. Tropical Doctor, 19, 147-151.
[14] Etuk, S.J., Etuk, I.S. and Oyo Ita, A.E. (2005) Factors Influencing the Incidence of Preterm Birth in Calabar, Nigeria. The Journal of Physiological Sciences, 20, 63-68.
[15] Abbasi, K.A. (1995) Neonatal Disease Profile in Larkana before and after Establishment of Neonatal Ward. Journal Pakistan Medical Association, 45, 235-236.
[16] McGil Ugwu, G.I. (2010) Prematurity in Central Hospital and GN Children’s Clinic in Warri Niger Delta. Nigerian Medical Journal, 51, 10-13.
[17] Kuti, O. and Owa, J.A. (2003) Gestational Age Specific Neonatal Mortality among Preterm Singletons in a Nigerian Tertiary Institution. International Journal of Gynecology & Obstetrics, 8, 319-320.
[18] Omole-Ohonsi, A. and Attah, RA. (2012) Risk Factors of Preterm Deliveries at Aminu Kano Teaching Hospital, Kano, Nigeria. South Asian Journal of Management Sciences, 1, 3-10.
[19] Oyedeji, G.A. (1985) Socioeconomic and Cultural Background of Hospitalized Patients in Ilesa. Nigerian Journal of Paediatrics, 12, 111-117.
[20] Filley, R.A. and Hadock, F.P. (2000) Sonographic Determination of Gestational Age. In: Callen, P.W., Ed., Ultrasongraphy in Obstetrics and Gynecology. 4th Edition, WB Saunders, Philadelphia, 146-170.
[21] Laing, F.C. and Frates, M.C. (2000) Ultrasound Evaluation during the First Trimester of Pregnancy. In: Callen, P.W., Ed., Ultrasonography in Obstetrica and Gynacology, 4th Edition, WB Saunders, Philadelphia, 105-144.
[22] Lumley, J. (2003) Defining the Problem: The Epidemiology of Preterm Birth. BJOG: An International Journal of Obstetrics & Gynaecology, 110, 3-7. http://dx.doi.org/10.1046/j.1471-0528.2003.00011.x
[23] Lawn, J.E., Cousens, S. and Zupan, J. (2005) Lancet Neonatal Survival Steering Team. 4 Million Neonatal Deaths: When? Where? Why? Lancet, 365, 891-900. http://dx.doi.org/10.1016/S0140-6736(05)71048-5
[24] McGil Ugwu, G.I. (2012) Pattern of Morbidity and Mortality in the Newborn Special Care Unit in a Tertiary Institution in the Niger Delta Region of Nigeria: A Two Year Prospective Study. Global Advanced Research Journal of Medicine and Medical Sciences, 1, 133-138.
[25] Onwuanaku, C.A., Okolo, S.N., Ige, K.O., Okpe, S.E. and Toma, B.O. (2011) The Effects of Birth Weight and Gender on Neonatal Mortality in North Central Nigeria. BMC Research Notes, 4, 562. http://dx.doi.org/10.1186/1756-0500-4-562
[26] Zeleke, B.M., Zelalem, M. and Mohammed, N. (2012) Incidence and Correlates of Low Birth Weight at a Referral Hospital in North-West Ethiopia. The Pan African Medical Journal, 12, 4.
[27] Shrestha, S., Dangol Singh, S., Shrestha, M. and Shrestha, R.P.B. (2010) Outcome of Preterm Babies and Associated Risk Factors in a Hospital. Journal of Nepal Medical Association, 49, 286-290.
[28] Onyiriuka, A.N. (2011) Twin Delivery: Incidence and Perinatal Outcome in a Nigerian Mission Hospital. Bangladesh Journal of Medical Science, 10, 45-51.
[29] Lee, Y.M., Cleary-Goldman, J. and D’Alton, M.E. (2006) The Impact of Multiple Gestations on Late Preterm (Near-term) Births. Clinics in Perinatology, 33, 777-792. http://dx.doi.org/10.1016/j.clp. 2006.09.008
[30] Wood, N.S., Marlow, N., Costeloe, K., Gibson, A.T. and Wilkinson, A.R. (2000) Neurological and Developmental Disability after Extreme Preterm Birth. EPICure Study Group. The New England Journal of Medicine, 343, 378-384. http://dx.doi.org/10.1056/NEJM200008103430601
[31] Gyetvai, K., Hannah, M.E., Hodnett, E.D. and Ohisson, A. (1999) Tocolysis for Preterm Labour: A Systematic Review. Obstetrics & Gynecology, 94, 869-877. http://dx.doi.org/10.1016/S0029-7844 (99)00329-4
[32] Charearnsutsiri, R. (2004) Outcomes of Very Low Birth Weight Infants at Prapokklao Hospital in the First Four Years of the New Millennium. The Journal of Prapokklao Hospital Clinical Medical Education Center, 21, 175-183.
[33] Onyiriuka, A.N. and Okolo, A.A. (2007) Neonatal Morbidity Pattern in Infants Born in Benin City to Nigerian Mothers with Hypertensive Disorders in Pregnancy. Nigerian Journal of Clinical Practice, 10, 294-299.
[34] Ferrer, R.L., Sibai, B.M., Mulrow, C.D., Chiquette, E., Stevens, K.R. and Cornell, J. (2000) Management of Mild Chronic Hypertension during Pregnancy: A Review. Obstetrics & Gynecology, 96, 849-860. http://dx.doi.org/10.1016/S0029-7844(00)00938-8
[35] Igberase, G.O. (2012) Harmful Cultural Practices and Reproductive Health in Nigeria. Continental Journal of Tropical Medicine, 6, 27-33.
[36] Igberase, G.O. (2012) Maternal and Foetal Deaths from Ruptured Spleen as a Result of Abdominal Massage by Traditional Birth Attendants in the Niger Delta, Nigeria. Afrimedic Journal, 3, 34-36.
[37] Khan, M.R., Maheshwari, P.K., Shamim, H., Ahmed, S. and Ali, S.R. (2012) Morbidity Pattern of Sick Hospitalized Preterm Infants in Karachi, Pakistan. Journal of Pakistan Medical Association, 62, 386-388.
[38] Onalo, R. and Olateju, K.E. (2013) Trend and Seasonality in Admissions and Outcome of Low Birth Weight Infants in Gwagalada Abuja, Nigeria. International Journal of TROPICAL DISEASE & Health, 3, 190-198. www.sciencedomain.org
[39] McGuire, W., Clerihew, L. and Fowlie, P.W. (2004) Infection in the Preterm Infant. British Medical Journal, 329, 1277-1280.
[40] Trotman, H. and Lord, C. (2007) Outcome of Extremely Low Birth Weight Infants at the University Hospital of the West Indies, Jamaica. West Indian Medical Journal, 56, 409-413.
[41] Naeye, R.L., Burt, I.S. and Wright, D.I. (1971) Neonatal Mortality, the Male Advantage. Pediatrics, 48, 902-906.
[42] Khoury, M.J., Marks, J.S. and McCarthy, B.J. (1985) Factors Affecting the Sex Differential in Neonatal Mortality. American Journal of Obstetrics & Gynecology, 151, 777-782. http://dx.doi.org/10.1016/ 0002-9378(85)90518-6
[43] Escobar, G.J., Greene, J.D. and Hulac, P. (2005) Rehospitalization after Birth Hospitalization: Pattern among Infants of All Gestations. Archives of Disease in Childhood, 90, 125-131. http://dx.doi.org/10. 1136/adc.2003.039974
[44] Kalimba, E.M. and Ballot, D.E. (2013) Survival of Extremely Low Birth Weight Infants. South African Journal of Child Health, 7, 13-16.
[45] Owa, J.A., Al-Dabbous, I. and Owoeye, A.A. (2004) Weight Specific Morbidity and Mortality Rates among Low Birth Weight Infants in Developing Countries. Nigerian Journal of Paediatrics, 31, 19-25.

  
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