Socio-demographic and obstetric characteristics of mothers
There were 346 participants in this study and a 100% response rate. 346 pre-existing neurological data were included in the analysis. 58.67% of the mothers in the city. Two-thirds (63%) of the mothers were between the age of 29 and 34 years. More than 90% of neonates delivered from the health facility. More than 252(72%) mothers have more than 4 times the regular maternity care (Table 1).
Table 1 Sociodemographic and obstetric characteristics of mothers of preterm neonates admitted in NICU at Aksum university comprehensive specialized Hospital from June 2008 to May 2011 E.C (n = 346)
Serial no
|
Characteristics
|
Frequency
|
Percentage (%)
|
Remark
|
1
|
Maternal age
|
<20 year
|
72
|
20.8
|
|
20-34 year
|
218
|
63
|
|
>=35
|
56
|
16.2
|
|
2
|
Residence
|
Urban
|
203
|
58.67
|
|
Rural
|
143
|
41.33
|
|
3
|
Place of delivery
|
Home
|
34
|
9.83
|
|
Health center
|
150
|
43.35
|
|
Hospital
|
162
|
46.82
|
|
4
|
Type of pregnancy
|
Singleton
|
329
|
95.09
|
|
Multiple
|
17
|
4.91
|
|
5
|
Frequency of ANC visit
|
<4 times
|
94
|
27.17
|
|
>=4 times
|
252
|
72.83
|
|
6
|
Parity (number of births)
|
I
|
52
|
15.03
|
|
II-IV
|
272
|
78.61
|
|
≥ V
|
22
|
6.36
|
|
7
|
Previous bad obstetrics history
|
Yes
|
34
|
9.83
|
|
No
|
312
|
90.17
|
|
8
|
Onset of labor
|
Spontaneous
|
325
|
93.93
|
|
Induced
|
21
|
6.07
|
|
9
|
Mode of delivery
|
SVD
|
332
|
95.95
|
|
CS
|
7
|
2.02
|
|
INSTRUMENTAL
|
7
|
2.02
|
|
10
|
Cause of labor
|
Spontaneous
|
325
|
93.94
|
|
Induced
|
21
|
6.06
|
|
11
|
History of PROM
|
Yes
|
54
|
15.61
|
|
No
|
292
|
84.39
|
|
12
|
History of PIH
|
Yes
|
21
|
6.07
|
|
No
|
325
|
93.93
|
|
Characteristics of the preterm neonates
Of the 346 preterm infants, 180(52%) were female and 6(1.73%) were less than 1 kg. Approximately 21(6.06%) were employed and 110(31.8%) seniors were cared for by the kangaroo mother. Of the 276 (79.8%) who started breastfeeding immediately. 56(16.18%) had an APGAR score of less than or equal to 6 (Table 2).
Table 2: Characteristics of preterm neonates admitted in NICU at Aksum University comprehensive specialized Hospital from June 2008 to May 2011 E.C (n = 346).
Serial no
|
Characteristics
|
Frequency
|
Percentage (%)
|
Remark
|
1
|
Sex of the neonate
|
Male
|
166
|
47.98
|
Female
|
180
|
52.02
|
2
|
Weight for gestational age at birth
|
1.5-2.5
|
270
|
78.03
|
1-1.5
|
70
|
20.23
|
<1
|
6
|
1.73
|
3
|
Gestational age (weeks)
|
< 32
|
42
|
12.14
|
32–35
|
116
|
33.53
|
35–37
|
188
|
54.34
|
4
|
Was the newborn develop low oxygen saturation
|
Yes
|
74
|
21.39
|
No
|
272
|
78.61
|
5
|
First minute APGAR score
|
<=6
|
56
|
16.18
|
>=7
|
290
|
83.22
|
6
|
Fifth minute APGAR score
|
<=6
|
7
|
2.02
|
>=7
|
339
|
97.98
|
7
|
Was the baby start breastfeed
|
Yes
|
276
|
79.77
|
No
|
70
|
20.23
|
8
|
Treatment for hypoglycemia
|
Yes
|
28
|
8.09
|
No
|
318
|
91.91
|
9
|
Maternal fever during labor
|
<36.5
|
104
|
30.06
|
36.5-37.5
|
235
|
67.92
|
>37.5
|
7
|
2.02
|
10
|
Newborn received kangaroo mother care
|
Yes
|
110
|
31.79
|
No
|
236
|
68.21
|
The proportion of preterm neonatal death
In my study, the overall mortality rate was 22.2%, with 95% confidence interval (17.9-26.9), of which 18 (23.4%) died within the first 48 hours and 59(76.6%) died the first 7 days of life(newborn death). The median survival time was 2o days. The causes of death are numerous, but the majority causes are complications prematurity 54%, PNA 22.1%, sepsis 14.3% and other 9.1% (figure 1).
Associated factors of proportions of death for preterm neonates
In binary logistic regression: preterm neonates who were delivered from mothers above 35 years, neonates who were delivered at home, neonates who were delivered from mothers had a history of PROM and PIH, neonates delivered from mothers having less than 4 ANC follow up, neonates whose birth weight was between 1 to 1.5kg, neonates who were not received KMC, neonates who were treated for hypoglycemia, neonates who were not initiated breastfeed following delivery, neonates who were delivered from mothers who undergo induction and neonates whose APGAR score less than or equal to six were significantly associated with the death of preterm neonates
However, in the multi-variable analysis neonates whose birth weight was between 1 to 1.5kg, neonates who were not received KMC, neonates who were treated for hypoglycemia, neonates whose APGAR score was less than or equal to six, preterm neonates who have not started breastfeeding, neonates who were delivered at home and neonates who were delivered from mothers above 35 years have remained statistically significant factors.
The odds of death among preterm neonates whose birth weight was between 1 to 1.5kg was Five times [AOR = 4.69; 95% CI (2.29-9.63)] more likely as compared to neonates whose birth weight was between 1.5-2.5k.g.
The risk of death among neonates who were delivered from mothers above the of 35 years 4 times [AOR = 4.19, 95% CI (2.86, 12.46)] more vulnerable than neonates who were delivered from mothers in the age group of between 20-34 years.
The odds of death for preterm neonates who had < 7 APGAR score at birth was nine times [AOR = 8.63; 95% CI (3.52 - 21.17))] risk than those who had >=7 APGAR score at birth
Providing KMC for all preterm neonates reduces the odds of death by 96.5% as compared to neonates who do not provide KMC [AOR = 2.71; 95% CI (1.20 - 6.11)].
The odds of death for preterm neonates who were delivered at home were five times [AOR = 5.13, 95% CI (3.46, 10.04)] risk than neonates who were delivered at the hospital.
The risk of death for preterm neonates who was not started breastfeeding was six times [AOR = 6.35, 95% CI (4.62, 11.98)]risk than their counterparts.
The odds of death for preterm neonates who were treated for hypoglycemia was 2 times [AOR = 2.47; 95% CI (1.30- 4.715)] more vulnerable than those who were not treated (Table 3).
Table 3 Bivariate and Multivariate analysis of neonatal and obstetric factors predicting preterm birth outcomes.
Variables
|
Status
|
COR (CI)
|
AOR(CI)
|
Survived
|
Died
|
Age
|
<20
|
55(76.4%)
|
17(23.6%)
|
2.56(1.35-4.86)
|
1.31(0.43-3.94)
|
20-34
|
197(90.4%)
|
21(9.6%)
|
1
|
1
|
>35
|
17(30.4%)
|
39(69.6%)
|
11.04(6.47-18.85)
|
4.19(2.86-12.46)*
|
Place of delivery
|
home
|
7(16.3%)
|
36(83.7%)
|
7.05(4.17-11.92)*
|
5.13(3.46-10.04)*
|
HC
|
128(90.8%)
|
13(9.2%)
|
0.7(0.41-1.29)
|
0.84(0.75-1.64)
|
Hospital
|
134(82.7%)
|
28(17.3%)
|
1
|
1
|
PROM
|
Yes
|
19(35.2%)
|
35(64.8%)
|
6.496(4.13-10.21)
|
1.17 (0.67-2.01)
|
No
|
250(85.6%)
|
42(14.4%)
|
1
|
1
|
PIH
|
Yes
|
10(47.6%)
|
11(52.4%)
|
4.25(2.112-7.60)
|
1.38 (0.77, 2.47)
|
No
|
259(79.7%)
|
66(20.3%)
|
1
|
1
|
Frequency of ANC
|
<4
|
59(62.8%)
|
35(37.2%)
|
2.40(1.53-3.76)
|
1.13(0.65-1.99)
|
>=4
|
210(83.3%)
|
42(16.7%)
|
1
|
1
|
Birth weight
|
1.5-2.5
|
240(88.6%)
|
31(11.4%)
|
1
|
1
|
1-1.5
|
29(38.7%)
|
46(61.3%)
|
7.1(4.48-11.19)
|
4.69 (2.29-9.63)**
|
KMC
|
Yes
|
75(68.2%)
|
35(31.8%)
|
1
|
1
|
No
|
194(82.2%)
|
42(17.8%)
|
3.52(1.33-7.81)
|
2.71 (1.20 - 6.11)*
|
Hypoglycemia
|
Yes
|
7(25%)
|
21(75%)
|
5.58(3.37-9.25)
|
2.47 (1.30- 4.72)*
|
No
|
262(82.4%)
|
56(17.6%)
|
1
|
1
|
Breastfeeding initiated
|
Yes
|
248(89.9%)
|
28(10.1%)
|
1
|
1
|
No
|
21(30%)
|
49(70%)
|
9.22(5.78-14.71)
|
6.35(4.62-11.98)*
|
Cause of labor
|
Spontaneous
|
262(80.6%)
|
63(19.4%)
|
1
|
1
|
Induced
|
7(33.3%)
|
14(66.7%)
|
4.69(2.62-8.41)
|
3.08(0.83-11.52)
|
1stminute APGAR score
|
<7
|
28(50%)
|
28(50%)
|
3.26(2.05-5.21)
|
8.63 (3.52 - 21.17)**
|
>=7
|
241(83.1%)
|
49(16.9%)
|
1
|
1
|
5thminute APGAR score
|
<7
|
0(0%)
|
7(100%)
|
4.8 ( 2.2 - 10.48)
|
1.28(0.55-3.06)
|
>=7
|
269(79.4%)
|
70(20.6%)
|
1
|
1
|
*P-value <0.05, ** P-value <0.001, COR- crude odds ratio, AOR- Adjusted odds ratio