Survival rate and determinants among extremely low birth weight Preterms at Kawempe National Referral Hospital

Abstract

Introduction: The magnitude of extremely low birth weight (ELBW) preterm survival is unknown in Uganda and yet preterm related complications are a major contributor to neonatal mortality in the country. The neonatal period greatly determines the survival of a child during their first 28 days of life. Sub-Saharan Africa and South Asia registered the highest rates of neonatal mortality in the world in 2020. Understanding the determinants of extremely low birth weight preterm survival is pivotal in the improvement of neonatal care and reduction of both short- and long-term complications. Previous studies have indicated that birth weight, gestational age, mode and place of delivery are some of the factors that influence survival of preterm babies within their first 28 days of life. Objectives: This study aimed at determining the survival rate, median time at death and associated factors among preterm babies with extremely low birth weight at Kawempe National Referral Hospital at 28 days of life. Methods: This was a prospective cohort study conducted among 200 preterm neonates with extremely low birth weight at Kawempe National Referral Hospital from November 2023 to March 2024. They were followed up to 28 days of life and the data collected was entered into KOBO collect while data analysis was done using Stata Version 16. Study results: A total of 200 ELBW preterm babies were enrolled into this study of whom 124 (62%) were girls. The median weight of the babies was 820 grams (IQR 750, 900). Only 5 of the 200 preterm neonates were still alive by their 28th day of life thus 2.5 survive per 100 live births. Their median time at death was 3 days (IQR 2,4). Hypothermia on the last day of observation of the neonates (aHR 1.66 CI [1.17 - 2.36], pvalue 0.007) and medication for Apnea (aHR 0.54 CI [0.33 - 0.90], pvalue 0.019) influenced survival of the preterm neonates with ELBW. Conclusion: This study denotes that the survival of ELBW preterm babies is extremely low at KNRH with an estimated 50% dying by day 3 of life. Not having hypothermia at the time of death and being on Medication for Apnea treatment and prophylaxis were crucial factors for survival. Recommendation: temperature monitoring, use of medication for Apnea and incubator use.