Region-specific burden of late preterm birth during the first week of life
Date
2020-03
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
Introduction: International data indicate that the number of late-premature babies (34-36.6
weeks) are on the increase.1,2,3,4 Late preterm newborns also account for the largest subset of
all preterm births (74%). With regard to South Africa, no information exists on the potential
disease burden associated with a late preterm birth. Determining the disease burden related
to late premature births is especially important since gestation is often inaccurate and weight
criteria rather than gestation is used for discharge.
Aim: The primary objective was to document morbidity and mortality within the first week of
life of late premature births at a tertiary hospital in the Western Cape, South Africa. Methods: A prospective descriptive study of late-premature babies born at Tygerberg
Hospital between 1 March and 31 May 2018 was performed. Babies admitted to both the
neonatal and postnatal wards were included. Data was collected on day 1, 3 and 7 of life, with
telephonic interview of the mother in the case of discharge. Obstetric data as well as
demographic data, morbidity and mortality data was collected on the neonate. Specific
interventions including need for admission, length of stay, respiratory support, surfactant
administration, antibiotic prescription, poor feeding and jaundice were recorded.3 Neonatal
data was stratified according to gestation 34.0-34.6 vs 35.0-36.6 weeks, as the former is
routinely admitted if neonatal capacity allows.
Results: 117 babies were enrolled, 63 in the 34-34.6 week group and 54 in the 35.0-36.6 weeks
group. The primary obstetric reason for delivery was pre-eclampsia/eclampsia followed by
spontaneous preterm labour. The median maternal age was 27.5 years in the younger
gestational group and 29 years in the older group. There was a large variation in weight in
both groups of babies, with the median weight in the 34-34.6 group being 1895g (Range
1428g-3695g), and in the older gestation being 2140g (Range 1030g- 5000g).
A total of 98 babies required admission to the neonatal service. In the younger gestation
group, 62 babies (98.4%) were admitted, while 36 (66.7%) of the 35-36.6 week group required
admission to the neonatal ward. The majority of the babies in both groups had respiratory
distress, requiring nasal continuous positive airway pressure (nCPAP). None of the babies
required surfactant treatment or invasive ventilation. Antibiotics were initiated in 46 of the
admitted babies, 29 of them continuing by day 3. Ten (10.8%) babies developed jaundice on
day 1 and 11 (11.9%) had documented hypoglycaemia. By day 3, 50% of the babies were not
able to satisfactorily breastfeed. On day three of life, only 5 of the 117 infants were discharged
home. Fifteen of the infants were still admitted only for maternal reasons, while 96 babies
still required medical attention. By day 7, 54 babies (63.2% of original cohort) were still
admitted for medical care and another 8 were only in hospital due to maternal reasons. None
of the babies during the study period demised, however possible late neonatal death was
outside the scope of this study.
Conclusion: There was a high burden of morbidity amongst the late-preterm group. In this
specific group of babies, discharge policies should be reviewed.
Description
Thesis (MMed)--Stellenbosch University, 2020.
Keywords
Premature babies -- Mortality, Preterm-born children, Birth weight, Low, Premature babies -- Morbidity