Assessing Neonatal survival and associated factors among extreme preterm deliveries at Mulago specialized women’s and neonatal hospital and Kawempe national referral hospital -a retrospective-study

Abstract

Background: Uganda has high preterm birthrates of 14 per 1000 live births which are responsible for 8/27 neonatal deaths per 1000 live births and therefore remains among the top three leading causes of death during neonatal period. The increasing incidents of preterm follow the lowering of viability gestation age from 28 to 26weeks, hence a need for more research so as to comprehend the contributing elements for this rising trend and therefore provide focused intervention, and develop protocols so as to improve on the survival rates of extreme preterm. Objective: To assess the neonatal survival of extreme preterm births and factors associated with their survival. Methods: This was a retrospective chart review study on a sample of 376 mothers who had extreme preterm delivery and those of extreme preterm babies admitted in NICU. Baseline characteristics were described using descriptive statistics presented in, means and percentages as appropriate Logistic regression was used to assess association between extreme preterm birth and fetal outcomes. Results: The neonatal survival was 16%. Various factors were found to be significantly associated with neonatal survival. Neonatal survival was 4.4 times higher among neonates whose mothers were aged between 25 to 34 years (AOR=4.4; 95% CI: 2.3-11.8, P=0.0001) and 3.7 times higher among neonates whose mothers were aged 35 to 45 years (AOR=3.7; 95% CI: 1.9-8.2, P=0.0020). Survival was 8.9 times higher among neonates whose mothers were formally employed (AOR=8.9, 95% CI: 4.2-24.8, P<0.00001), 12.7 times higher among neonates whose mothers attended ANC (AOR=12.7, 95% CI: 4.3-22.6, P=0.0003), 15.3 times higher among mother who had C-section and 15.6 times among those who received Antenatal corticosteroids (AOR=15.6, 95% CI: 6.8-30.6, P<0.00001). Neonates who had APGAR score at 1 minute of <4 were 95% less likely to survive than those who scored 7-10 respectively (AOR=0.07, 95% CI: 0.02-0.35, P<0.00001). Recommendations: There is need to continuously monitor the pregnancy and better management of the delivery. There is need for sensitization and awareness creation to pregnant mother to always utilize the ANC services to enable early detection of any complications that can affect neonatal survival.