Short term survival of premature infants admitted to the new born unit at Moi Teaching and Referral Hospital, Kenya
Background: Short and long term survival rates of premature infants have been well documented in developed countries. However, there are few data in low resource settings describing the survival of preterm infants. Data on short term survival rates of preterm infants may inform clinicians in a resource limited setting when counseling families on expected outcomes of care.
Objective: To determine survival to hospital discharge of preterm infants in a public tertiary hospital in Kenya.
Design: Prospective hospital cohort study design was used.
Setting: Moi Teaching and Referral Hospital New Born Unit, Kenya.
Participants: Premature Infants and their mothers
Interventions: No study specific interventions were performed. We prospectively evaluated survival from admission until discharge from the hospital of 175 premature infants admitted to the newborn unit at Moi Teaching and Referral Hospital, a tertiary public hospital, between December 2012 and August 2013. We determined the overall survival rate and gestational age and birth weight category survival rates.
Main outcome measures and Analysis: Death or discharge was the main outcomes of interest. Cox Proportional Hazards model was used to determine factors associated with survival and Kaplan-Meier survival curves drawn.
Results: Of the 175 infants, 53.1% were female, mean birth weight was 1342g (± 355.5) and 37% were born before arrival. There were 15.4% neonates born less than 28 weeks, 30.9% aged 28- 31 weeks and 53.7% above 32-37 weeks. The overall survival to hospital discharge was 60.6% (95% CI 0.53-0.68). The survival rate was 29.6% for infants born less than 28 weeks’ gestation, 50% for those born at 28-31 weeks and 75.5% for those born at or above 32 weeks. Gestation age of ≥ 32 weeks (HR 0.39, 95% CI 0.18-0.8), birth weight >1000g (HR 0.27, 95% CI 0.20-0.78) and maternal antenatal care attendance (HR 0.52, 95% CI 0.3-0.9) were associated with better survival. Caesarian section delivery was associated with increased risk of death (HR 4.26, 95% CI 1.88-9.66). Most of deaths (81%) occurred within the first seven days.
Conclusions: Sixty percent of premature infants admitted to MTRH new born unit survived to hospital discharge. The survival limit defined as the gestation at which a prematurely born infant has a 50% chance of survival was at the gestational age category of 28-32 weeks.