Mortality among Preterm Babies in a Resource-poor Setting: What Time is Crucial?

Abstract

Background: Preterm babies contribute the bulk of neonatal deaths globally. Neonatal deaths constitute about 46% of childhood deaths. Therefore, reduction of mortality among preterm babies is desired for reduction of childhood mortality. Objective: To examine the pattern of mortality among preterm babies in a resource-poor tertiary facility setting and relate it to the place of birth and duration of admission when the deaths occurred. Methods: A retrospective study of the hospital records of all preterm babies who died between 2011 and 2015 in a tertiary hospital in southwest Nigeria. Factors associated with death within 24 hours and 72 hours of admission were statistically determined. Results: Out of a total of 1936 neonatal admission, 648 (33.5%) were preterm babies out of which 142 (21.9%) died. The preterm deaths formed 45.6% of all neonatal deaths during this period. The 142 preterm deaths comprised 59 (41.5%) out-born and 83 (58.5%) in-born babies. Death within 72 hours of admission occurred among 36% of in-born babies compared to 71.2% of out-born babies. A significantly higher proportion of babies who died within 24 hours were out-born (p < 0.0001) and less than 32 weeks of gestation (p = 0.025). Death occurring within 72 hours of admission was associated with out-born status (p < 0.0001) and presence of severe asphyxia (p = 0.045). Conclusion: Most of the deaths within the first 72 hours of admission occurred among out-born preterm babies suggesting worse clinical state, especially with severe asphyxia. Special interventions required to minimise the delivery of preterm babies outside the hospital are desired.