The incidence of, and factors associated with extra uterine growth restriction among preterm infants in Kiwoko Hospital, Uganda

Abstract

Background: Premature birth is the leading cause of under 5 mortality globally and is frequently associated with Extrauterine growth restriction (EUGR).Although the vast majority of mortality due to preterm birth occurs in low resource settings, little is known about their postnatal growth in Uganda.We therefore determined the incidence of and factors associated with EUGR among preterms managed at Kiwoko hospital, a rural hospital in Uganda. Methods: This was a 12 months retrospective cohort study of preterms managed and discharged from Kiwoko hospital from July 2017 to June 2018. Clinical progress notes of preterm infants less than 37 weeks of gestation with no major congenital anomalies and spent at least 7 days in hospital were reviewed and entered into a data collection tool.Gestational age was determined by recorded last normal menstruation period (LNMP) and where available early obstetric ultrasound scans. Admission and discharge weights for each preterm were plotted on Fenton 2013 growth charts. EUGR diagnosed if discharge weight was < 10th percentile for estimated gestational age. Logistic regression was used to explore factors associated with EUGR. Statistical significance was considered when p value was ≤ 0.05. Results: This study recruited 349 preterms and average gestational age was 31weeks (range 26 to 36 weeks).The incidence proportion of EUGR was 254/349 (73%).The incidence was highest among preterms that were small for Gestation age at birth 35/36(97%), those with extremely low birth weight, 16/18 (89%) and the moderate to late preterm neonates 132/167 (79%). Factors significantly associated with EUGR in this population were; male gender (AOR = 1.71 95% CI 1.01 to 2.91), multiple gestation (aOR=1.81, 95% CI 1.01 to 3.24), sepsis during hospitalization (aOR=6.76, 95% CI 2.15 to 21.2) while initiating enteral feeds within 48 hours of life was protective (aOR=0.26, 95% CI 0.11 to 0.58). Conclusion: Extrauterine growth restriction is high in this population at 73% by weight. Male gender, multiple gestation and having sepsis during hospitalization increased the odds of EUGR whereas initialing enteral feeds before 48 hours of life was protective against EUGR.