Early neonatal deaths among preterm and term Neonates: A comparative study at the University Teaching Hospital, Lusaka

Abstract

Background: Globally, 15 million babies are born preterm (<37 weeks gestation) each year, and more than 1 million of those do not survive their first month of life. (Lawn, 2006). Preterm birth accounts for 75% of all perinatal mortality in some series. Causes of deaths and antecedent pregnancy and delivery factors are different in deaths of preterm and term neonates. This study aimed to establish factors associated with preterm deaths at the University Teaching Hospital (UTH) compared to those of term neonatal deaths. Objective: To compare how early neonatal deaths among preterm infants differ from term neonatal deaths. Methods: A case-control study was conducted among 208 neonates that were early neonatal deaths (eNND) (within 7 days) in neonatal intensive care unit (NICU) at UTH in 2015. Antenatal and intrapartum details (parity, multiple pregnancy, birthweight, antenatal steroid exposure, antibiotic exposure, and the indication of admission to NICU) were obtained from 104 neonates that were preterm (between 24-36 completed weeks gestation) and had died and of a further 104 term neonates (>37 weeks gestation) that died around the same time. The data was collected by interviewer-administered structured questionnaire and analyzed by SPSS v21. Bivariate analysis was used to identify variables for multivariate logistic regression model to identify obstetric determinants amongst deaths in neonates that were preterm compared to those born at term. Results: There was few difference between the two groups. More preterm neonates that died had received steroids compared to term neonates that had died (P<0.001) and had received antibiotics (p=0.004). By contrast, more term neonates that died were male (P=0.0031) and had a very poor Apgar score (1-3) (P=0.0048). Both the indications for admission to NICU and cause of death were different in the two groups (P<0.0001 and P=0.0309 respectively). On multivariate regression analysis, poor Apgar score was associated with a six-fold odds of RDS. None of the other factors reached statistical significance (adjOR 6.0, 95% CI 3.03-11.92, p<0.0001). Poor Apgar score was also the only factor associated with sepsis, though it was a neonate with a good Apgar score that had higher odds of dying due to sepsis. Primiparity was associated with a 2.6-fold odds (95% CI 1.03 to 6.68, p=0.04) of hypoxic ischaemic encephalopathy. Conclusions: Hypoxic ischaemic encephalopathy as a cause of early neonatal death is commoner in term neonates but also common in preterm. Sepsis is commoner in preterm neonates as a cause of early neonatal death. Comparing different causes of death, poor Apgar score featured in all cases calling for improved resuscitation.