The prevalence, sonographic patterns and factors associated with brain injury in premature infants at Mulago hospital.

Abstract

Background: Preterm babies worldwide are estimated to be 11.1% of all live births with a rise noted every year, especially in developing nations. In low-resource settings and developing nations, prematurity is a leading cause of neonatal infant mortality and morbidity which has long-term adverse consequences for health. Brain injury in premature infants is a significant public health concern of noncommunicable disease in children due in part to a large number of such infants who survive with serious neurodevelopmental disability. This includes both major cognitive deficits and motor disability. Higher rates of cerebral palsy, sensory deficits, learning disabilities and respiratory illnesses are reported compared with children born at term.

Objectives: The objectives of this study were to determine the prevalence, describe the sonographic patterns of brain injury and delineate the associated risk factors among preterm infants who were admitted to Mulago Hospital Methodology: This was a cross-sectional analytical study performed at Mulago National Hospital. The study population was 384 preterm neonates. A Cranial scan was performed for each child and a questionnaire was used to collect maternal and neonatal clinical data. Results: Three hundred and eighty-four infants were included. The prevalence of brain injury among the preterm infants was 28.39 per cent (109 out of 384 preterm infants) At bivariate analysis, the neonatal predisposing factors that were statistically significant included evidence of febrile illness, low APGAR score (less than 5 at 5 minutes), seizures and presence of respiratory distress. The maternal factor that carried the most statistical significance for risk of preterm brain injury was twin gestation. Conclusion: In our setting, the prevalence of brain injury in preterm infants is significant and shows a rise in prevalence compared to earlier studies. A low APGAR score, evidence of respiratory distress and mechanical ventilation all represent the most important risk factors for detecting brain lesions giving an indication to perform a cranial ultrasound. Similar to other studies, mothers with twin pregnancy represents a risk factor. Recommendation: Cranial ultrasound scans should be routinely done for all premature infants at Mulago hospital and especially those with established risk factors like respiratory distress.