Survival of Preterm Neonates and its Determinants in Teaching Hospitals of Addis Ababa University

Abstract

Background: Practicing in a setting where survival of preterm labor is unknown and at best a guess is usually challenging particularly in counseling patients about the outcome of the preterm neonate. The objective of this study was to determine gestational age specific survival of preterm deliveries and its determinants in three teaching hospitals of Addis Ababa University College of health science. Methods: A prospective cross sectional descriptive study was conducted on newborns delivered from January 1 to June 30, 2017 before gestational age of 37 completed weeks at the three teaching hospitals. Results: Among 9927 neonates delivered during the study period, 415 (4.2%) were preterm. Of the preterm neonates 407 fulfill the inclusion criteria and analyzed. The cumulative survival rate for preterm babies at the three teaching hospitals is 74.4%. The survival rate of preterm neonates is zero %, 9.1%, 31.8%, 55.2%, 57.6%, 77.4%, 90.4%, 98.6% and 98.8% for GA of 28, 29, 30, 31, 32, 33, 34, 35, and 36 weeks respectively. Majority of neonatal deaths occurs with in the first 2 days (52.5%) and two third (67.1%) of the deaths occurs with in the first 3 days. Birth weight of 1500 grams or above (AOR 3.5, 95% CI 1.5-8.1, P <0.01), GA increment by one week (AOR 2.4, 95% CI 1.9-3.2, P<0.001) and married mother (AOR 3.9, 95% CI 1.2- 12 P< 0.05) are associated with a better chance of neonatal survival in this study. Neonates who required resuscitation after delivery have lower probability of survival (AOR 0.3, 95% CI 0.12-0.64, P< 0.01). Significant association were not found between neonatal outcome and sex of the neonate, parity, duration of labor, duration of ROM, preeclampsia, IUGR, administration of dexamethasone and other maternal socio demographic factors when adjusted for other confounding factors. Conclusion: Preterm neonates delivered prior to 31 weeks of GA have very low survival rate. So instead of iatrogenically delivering newborn prior to this GA, especially for fetal indication, efforts to push pregnancy at least till 31 weeks should be encouraged for better neonatal outcome. Critical attention should be paid on resuscitative intervention and the first 3 days of life to mitigate factors contributing to high preterm babies’ loss at this particular time. A study to assess the quality of care and cause of very low survival rate of preterm infants is recommended.