Time to discharge and its predictors among preterm neonates admitted to the neonatal unit of Kawempe National Referral Hospital

Abstract

Background: Preterm babies are physiologically immature with poor temperature stability, respiratory distress and intracranial hemorrhages which may compromise their survival. Admission for special newborn care is essential to avert and minimize the short-term complications. The support offered is dependent on the characteristics of the neonate, the specialty of the staff and availability of equipment and other requirements to provide specialized care. The time to discharge, an important measure of the short-term outcomes in healthcare becomes a measure of the effectiveness of care as it may represent a better clinical course and improved quality of life. This makes it relevant as both a clinical and an economic outcome measure. As Uganda makes strides towards achieving the sustainable development goal in 2030, describing the length of hospital stay becomes important as a measure of the outcomes of investments made to improve neonatal care. Objective: To describe the time to discharge and its predictors among preterm neonates at 28 to 33 weeks of gestation admitted to the neonatal unit of Kawempe National Referral Hospital. Methods: A prospective cohort study design was used. A total of 223 eligible preterm neonates were systematically recruited at admission, after stabilisation. Neonates were assessed for level of maturity using the Ballard score. A questionnaire was used to obtain mother’s sociodemographic and pregnancy information. At enrolment, the neonate’s data was collected from the medical records using a checklist. The neonates were then followed up daily, taking note of the duration of hospitalisation, the clinical events as they occurred as well as interventions provided. The period of observation was from admission to discharge, death, referral to another facility or escape during observation and the 28th day of life whichever occurred first. The collected data was entered using Epi-data version 3.1 and later exported to Stata version 14 for analysis. Data from patients who did not achieve discharge was censored. The median time to discharge was determined using the Kaplan Meier estimates. Predictors of time to discharge was determined using Cox proportional regression model, p-value of 0.05 and corresponding 95%CI were used to determine significance. Results: A total of 223 preterm neonates were enrolled and their characteristics analysed in the study. A total of 125 (56.1%) neonates were discharged. The overall median time to discharge of neonates was 7 days (IQR 5-9). Time taken on oxygen therapy [aHR = 0.15, 95%CI (0.092-0.229), p<0.001] and gestation age [aHR = 1.66, 95%CI (1.117-2.453), p=0.012] were significant predictors of time to discharge at multivariate analysis after assessing and adjusting for potential confounders. Conclusion: The overall median time to discharge of the preterm neonates was 7 days. Gestation age and duration of oxygen therapy are the two most important factors which significantly influenced the time to discharge. There was high mortality of 43% among the neonates and hypothermia was the most prevalent cause of death. Recommendations: Proactive monitoring and management of hypothermia and emphasis on the use of low-cost thermal protection methods. Revision of the discharge protocol to prevent premature discharges. Strengthen the implementation of the national strategy to end child marriage and teenage pregnancy. Support young mothers in the care of their neonates while in admission and post discharge.