Mortality among very low birth weight infants after hospital discharge in a low resource setting

Abstract

BackgroundEarly discharge of very low birth weight infant (VLBW) in low resource settings is inevitable but to minimize mortality of these infants after discharge we need to identify the death attributes.MethodA prospective cohort was conducted among 190 VLBW infants discharged from Mulago Special Care Baby Unit (SCBU) with discharge weight of < 1500 g over an 8 months period. These infants were followed up with the aims of determining the proportion dead 3 months after discharge, identifying factors associated and possible causes of death.Relevant data were captured, transferred in to STATA and imported to SPSS 12.0.1 for analysis. To determine factors associated with mortality bi-variable and multivariable regressions were conducted. A p-value of < 0.05 was considered significant and 95% confidence interval was used.ResultsOf the enrolled infants 164 (86.3%) completed follow up. The median gestational age of study participants was 32 weeks (range 26-35 weeks), the mean discharge weight was 1119 g (range 760-1470 g), and 59.8% were small for gestational age (SGA). During follow up 32 (19.5%) infants died. Infants discharged with weight of < 1200 g accounted for 81.2% of the deaths. Majority of the deaths (68.7%) occurred in the first month after discharge. Factors independently associated with mortality were discharge weight < 1000 g (OR 3.10, p 0.015) and not being SGA (OR 3.54, p 0.019). The main causes of death were presumed sepsis 50.0% and suspected cot death (25.0%).ConclusionMortality after hospital discharge among VLBW infants is high. Discharge at weight < 1200 g may not be a safe practice. Measures to prevent sepsis and suspected cot death should be addressed prior to considering early discharge of these infants.

Relative impact of pre-eclampsia on birth weight in a low resource setting: A prospective cohort study

“…This is a clinically significant finding, particularly in a setting where survival to hospital discharge at 28–30 weeks’ gestation is by no means assured [22] . The elevated mortality risk for these babies persists even after leaving hospital, as a discharge weight of ≤1500 g in urban Uganda is associated with a 20% risk of death within three months [23] . We also found a significantly greater proportion of LGA (≥90 th centile) babies in the pre-eclampsia group than in the normotensive group.…”

Early inadequate or excessive weight loss: A potential contributor to mortality in premature newborns in resource-scarce settings?

“…More specifically, 7% of neonates had birth weights of <1000g, and 24% had weights <1000 g at discharge, highlighting the potential for early EWL loss during hospitalization and association between significant weight loss and neonatal mortality in LMICs. 7 The timing and etiology was not clearly detailed; however, we hypothesize that the etiology of such weight loss in the Ugandan cohort may be a combination of both EWL and/or insufficient caloric intake with the discharge average age of only 12 days. 7 Preterm infants with EWL may also carry the risk for long-term disabilities.…”

“…7 The timing and etiology was not clearly detailed; however, we hypothesize that the etiology of such weight loss in the Ugandan cohort may be a combination of both EWL and/or insufficient caloric intake with the discharge average age of only 12 days. 7 Preterm infants with EWL may also carry the risk for long-term disabilities. Hypernatremia secondary to EWL has associated short-and long-term implications for preterm neonates including an increased risk of severe intraventricular hemorrhage, which is itself associated with poor neurodevelopmental outcomes in early childhood.…”

The Combined Effects of Fine Particulate Matter and Temperature on Preterm Birth in Seoul, 2010–2016

“…The high risk of morbidity and mortality among premature infants is partly attributable to growth restrictions associated with premature birth. In the long term, these conditions increase the risk of a variety of health hazards [ 2 ]. In Korea, birth outcomes among women of childbearing age are generally deteriorating [ 3 ].…”