Time to discharge and associated predictors among preterm neonates admitted in Kiwoko hospital, Nakaseke district, Uganda

Abstract

Background; Every year an estimated 13.4 million babies are born preterm. Due to their complications, they contribute to about 35% of neonatal deaths globally. Assessing the time to discharge and the associated predictors among preterm neonates hospitalized in the Neonatal Intensive Care Unit (NICU) can enhance health care course and plan effective interventions to maximize early preterm neonatal discharges while alive and as well contribute to achieving SDG 3.2 target. Methods; A prospective cohort study based on secondary data was carried out from Kiwoko hospital with a sample of 847 preterm neonates analyzed. Cumulative incidence function was used to estimate the probability of preterm neonates completing the 28 days of follow-up in the NICU while a sub distribution hazard regression model of competing risk events was used to assess the associated predictors of time to discharge. Results; Of the 847 preterm admissions, 594 were discharged within 28 days, 165 were not and 88 of them died during follow-up. The probability of completing the 28 days was 68% and overall, 70.1% of the preterm neonates were discharged alive within the period. The 14th day from admission was the median discharge time. With the sub distribution hazard analysis, factors including place of delivery (SHR: 0.62; 95% CI: 0.53, 0.73), very preterm (SHR: 0.18; 95% CI: 0.14, 0.22), moderate preterm (SHR:0.59; 95% CI: 0.46, 0.76), extreme preterm (SHR: 0.05; 95% CI: 0.32, 0.93), triplets (SHR: 0.40; 95% CI: 0.23, 0.68), 2-4 ANC visits (SHR: 0.70; 95% CI: 0.56, 0.87), ≤1 ANC visits (SHR:0.64; 95% CI:0.49, 0.85), positive preterm respiratory distress syndrome status (SHR: 0.60; 95% CI: 0.48, 0.74), and preterm trauma status (SHR: 2.62; 95% CI: 1.60, 4.9) were associated with time to discharge. Conclusion and recommendations; There was reduced likelihood of early discharge among preterm neonates diagnosed with RDS, those whose mothers had ≤1 ANC visits, those from other hospitals and places of residence. It was hence recommended that mothers attend at least 5 ANC visits to help identify probable complications of both the mother and baby for safe delivery and the government to establish NICU departments in several other health centers.