Morbidity and mortality of low birth weight infants in the new born unit of Kenyatta National Hospital, Nairobi

Abstract

Background: Morbidity and mortality of low birth weight (LBW) infants at Kenyatta National Hospital (KNH) has previously been found to be high. Other centres have shown that even with lack of neonatal intensive care facilities, selective interventions can be implemented that improve neonatal survival rates. It is important to identify those factors at KNH that when selectively modified, will improve the quality of care hence survival rates. Objective: To quantify the morbidity and mortality of LBW infants in KNH. To audit the quality of care and identify factors that can be selectively modified to improve the quality of care and improve the currently low survival rates. Design: Retrospective study utilising case notes. Setting: New born unit, Kenyatta National Hospital, Nairobi. Subjects: All LBW infants admitted to the NBU at KNH from January to December 2000. Results: Out of an expected 694 files, 533 (77%) were studied. The male to female ratio and LBW to VLBW ratio was 1:1 respectively. Small for gestational age (SGA) accounted for 11.6%. Overall mortality was 57.4% (574/1000 admissions) while mortality for SGA was 37%. Infants born out of KNH had significantly higher mortality (p=0.0047). Compared to Caeserian delivery infants born via spontaneous vertex delivery had higher mortality (p=0.0087). The leading diagnoses on admission or death were respiratory distress(69%), apnoeic attacks (42%) suspected sepsis and jaundice (37% each), hypothermia(27%) and anaemia(17%). By time of death or discharge, 43% had no laboratory investigations done. While 37% had suspected sepsis, only 14% had blood culture done. Antibiotics were started in 460 (86%) of infants yet only 37% had diagnosis of suspected sepsis. Change of antibiotics was guided by culture and sensitivity reports in only 62(13.5%). Apnoeic spells were managed with rectal aminophyline in 156(29%) infants of whom 19(12%) survived. The terminal events for the dead infants included recurrent apnoeic spells. The only mode of nutrition was enteric feeding in 59% with breast milk, formula or pasteurized cows milk by nasogastric tube, breast feeding or cup feeding. Except for dextrose water, parenteral nutrition was not utilised. Of 63 infants dying with associated anaemia, 43(68%) were not transfused due to lack of reliable blood supply. Conclusion: Compared to previous studies, mortality of LBW infants in KNH- NBU has increased over the years. Improvement in supportive care as regards nutrition, temperature regulation, laboratory back up and respiratory support is recommended. There is a place for trial of kangaroo mother care and simple continous positive airways pressure administration methods. There is a need to ascertain the efficacy of the method of aminophyline administration.