Outcomes of Premature Neonates Less Than 35 Weeks in Low Income Countries, Case of Democratic Republic of Congo

Abstract

Background: Prematurity is cause of perinatal mortality and morbidity. Mortality is higher in newborns under 32 weeks in almost sub-Saharan African countries.Aim of work: To determine factors associated with preterm mortality less than 35 weeks of gestational age.Patients and methods: A retrospective study was conducted at Monkole Hospital on date base of preterm babies, born during the period from January 1, 2018 to December 31, 2021. Results: The study included 398 hospitalised preterms. The prevalence of prematurity was 8.3%, 220 (55.6%) were female preterms and 176 (44.4%) were males, with a sex ratio of 1.25. Their average weight was 1482 + 434 g. Caesarean sections were induced in 47% of cases (186). Central cyanosis was present in 32.1% (127), the majority was less than 28 weeks. The rate of antenatal steroid use was 45% (75/167).  Mortality rate was higher in preterm infants less than 28 weeks. The rate was 80.1% at 26 weeks,  69.1% at 27 weeks and 56.5% at 28 weeks. A multivariate logistic regression analysis noted that the mortality of preterm infants decreased with increasing gestational age (OR= 0.544, 95% CI: 0.450-0.659, p=0.000). Morbidity was associated with the absence of antenatal corticosteroid therapy (OR = 2.768, 95% CI: 1.071-7154, p=0.036), absence of Continuous Positive Airway Pressure CPAP use (OR= 0.259, 95% CI: 0.109-0.619, p=0.002) and with transfer (OR = 0.338, 95% CI: 1.470-5.534, p = 0.002).Conclusions: Prematurity is one of the major causes of neonatal mortality especially in developing countries. The absence of antenatal corticosteroid therapy and non-use of CPAP increases the mortality of premature babies in this study.