Mortality rate and associated risk factors among premature neonates admitted at Muhimbili National Hospital, Dar es Salaam, a Prospective Cohort Study

Abstract

BSTRACT Background Globally, it is estimated that 15 million (11.5%) babies are born before term each year, and of these, 1.1 million die within the first 28 days of life. Prematurity and its complications is an important cause of death during the first month of life, contributing to 35% of all neonatal death worldwide. In Tanzania, 27% of such deaths are secondary to complications of prematurity. According to World Health Organization (WHO) report of 2015, those who survive face a lifetime of disability, including learning disabilities, chronic lung disease (40%) visual problems (25%) and may have hearing problems (5-10%). There is little understanding of the rate and predictors of deaths among neonates who are born prematurely at Muhimbili National Hospital in Dar es Salaam. Aim: To determine the mortality rate and associated factors among preterm neonates admitted at Muhimbili National Hospital. Methods: A hospital based prospective cohort study was conducted from October 2018 and January 2019 where preterm neonates were recruited and followed up until 28 days of life. Information collected from mothers, patient records and physical examination of the preterm neonates was recorded in a data collection form. Univariate and multivariate analyses were used to determine and quantify the relationship between predictors associated with preterm mortality. Results: A total of three hundred premature neonates of mean birth weight 1850gram ±670gram and gestational age 32 weeks ± 9.4 were recruited; 114 (27.7%) died giving an overall mortality rate of 10 deaths per1000 live preterm births. The leading causes of death were respiratory distress syndrome 59 (52%), septicaemia 25(47.2%), hemorrhagic disease of the new born and intraventricular haemorrhages 15(28.3%), aspiration pneumonia 14(12.3%), and metabolic disturbances6 (11.3%). Predictors for mortality were found to be presence of intracranial hemorrhage Hazard ratio (HR); 1.9, 95% CI (1.12, 3.25), respiratory distress syndrome, HR; 4.4, 95% CI (1.59, 12.6). vii Neonates who needed suction HR; 4.2, 95% CI (2.29, 7.45) and presence of necrotising enterocolitis (NEC) HR; 4.7, 95% CI (1.75, 12.6) a raised CRP, HR; 2.5, 95% CI (1.3, 6.6) and an elevated serum creatinine HR; 4.3, 95% CI (1.3, 11.4),. On the other hand undergoing caesarean section delivery and receiving antenatal corticosteroid prior to delivery were associated with a 46% and a 43% reduced risk of mortality, HR; 0.54, 95% CI (0.32, 0.92), p=0.024 and HR; 0.57, 95% CI (0.36, 0.91), p=0.017, respectively Conclusion: Preterm neonatal mortality rate is 10/1000 live preterm birth. Risk factors for preterm neonatal mortality include: presence of RDS and IVH; whilst caesarean section and ACS were found to be protective. Recommendations: Stakeholders should ensure all mothers with impeding preterm delivery to receive antenatal corticosteroids and to undergo timely caesarean when indicated. Similarly, early screening and appropriate management of IVH and RDS in neonates should be done to reduce the risk of neonatal mortality