Risk factors for mortality in low birth weight infants at Harare hospital (maternity unit)

Abstract

Background: Research evidence highlights that in low income countries half the infants born before 32 weeks gestation continue to die. More than 75% preterm infant deaths can be prevented without ICU care as these infants die from preventable causes such as hypothermia and hypoglycemia. According to WHO estimates, Zimbabwe is one of the 11 countries with a high preterm birth rate of over 15%. Methods: In the current prospective cohort study, the researchers followed up infants less than 2000g at birth through the first 28 days of life to determine the mortality rate and age related risk factors for mortality in the follow up period. Results: The overall mortality rate in the first 28 days was 51.2%. Mortality in the ELBW was 91.1%, VLBW – 54.4% and LBW – 28.8%. More than half the deaths (53%) happened in the first 48 hours of life predominantly in the first 12 hours. The independent risk factors for mortality in the first 12 hours of life were Respiratory Distress Syndrome (RDS), (RR 1.58 (95% CI 1.039 - 2.405) and infants born to mothers with Diabetes Mellitus (RR 2.31 (95 % CI 1.46 - 3.65). The late preterm infant had a significant risk of dying between day 3 and end of first week of life compared to other time periods (RR 3.14; 95% CI 1-18 - 4.30). Conclusion: Our study demonstrates that neonatal mortality rate in this cohort was very high. The majority of the deaths occurred within 12 hours of birth and were largely due to extremely low birth weight. Use of life support mechanisms is very low at this unit due to resource constraints and shortage of nurses. Interventions to reduce mortality should address these issues in particular to improve treatment and monitoring during the initial critical 12 hours of life.

1