Determinants of the Outcomes of Preterm Infants at the Korle Bu Teaching Hospital Neonatal Intensive Care Unit.

Abstract

Introduction: Preterm births are deliveries that occur before 37 completed gestational weeks with its lower cut off limit of viability varying based on the geographic location. Preterm births may be as a consequence of obstetric interventions from fetal or maternal indications or spontaneous preterm labor with no apparent precursors. This study sought to determine the outcomes of preterm infants managed at the Korle Bu Teaching Hospital Neonatal Intensive Care Unit (NICU) and the factors affecting the outcomes. Method: A retrospective analysis of data from all medical records of preterm infants admitted to the Korle Bu Teaching Hospital NICU between January 2017 and May 2019. A data extraction form was used to extract relevant available information on both mother and infant, characteristics, health status and infant outcome at discharge. Univariate analyses of categorical variables were expressed as frequencies and proportions. Chi square analysis and logistic regression were used to determine factors associated with outcomes of preterm births. P-values less than 0.05 were considered to be statistically significant. Results: Out of the 1274 preterm neonate’s data reviewed in this study, 70.3% survived and were discharged from the NICU. Reasons for admission to NICU included being preterm only (87.5%), being preterm with asphyxia (8.7%) and being preterm with respiratory distress (2.4%). Less than half (43.5%) of the neonates were resuscitated prior to admission at NICU. More than a third (36.3%) were very low birth weight (<1.5kg to 1kg), almost half (45.3%) were low birth weight (<2.5kg to 1.5kg) with 8.4% being normal weight babies (2.5kg and above). With respect to gestational age, almost half (48.9%) were born moderate to late preterm with only 7.1% born extremely preterm. Increasing trend in preterm infant admissions had corresponding increased trend in preterm deaths. Factors influencing outcome of preterm deliveries include being an extremely low birth weight infant <1kg (AOR=22.03, 95%CI: 9.23-52.57, p<0.001), being a very low birth weight infant (AOR=3.24, 95%CI: 1.64-6.39, p<0.001), being low birth weight (AOR=1.21, 95%CI: 0.63-2.37, p<0.001), being born extremely preterm (AOR=12.02, 95%CI: 5.47-26.44, p<0.001), and being born very preterm (AOR=1.85, 95%CI: 1.33-2.59, p<0.001). Non-resuscitated babies (AOR=0.53; 95%CI: 0.40-0.71; p<0.001) and absence of congenital anomalies (AOR=0.18; 95%CI: 0.09-0.34; p<0.001) were also predictors of outcomes of preterm infants. Conclusion: Preterm babies admitted to the Korle Bu Teaching Hospital NICU have high chances of survival. Low birth weight, low gestational ages, congenital anomalies as well as need for resuscitation remain major factors influencing death or survival of preterm babies.