Introduction: Prematurity is a real public health problem in developing countries. The objective of this study was to investigate the risk factors for death in premature newborns in a pediatric ward.
Methods: This was a retrospective cross-sectional study with descriptive and analytical aims that took place over a period of 12 months. It involved all hospitalized newborns. The data were entered and analyzed using Epi info 7.2.3.1 2019 software and exported to Excel 2016.
Results: The hospital prevalence of prematurity was 20.75%. The average age of the mothers was 24 years (range 15-41). 89.59% of the mothers were housewives. 253 women (94.05%) had at least one prenatal consultation during the pregnancy.
The mortality rate was 44.37%. Among deceased newborns, mortality was significantly related to gestational age, birth weight, score, and the presence of a complication.
There was a statistically significant relationship between neonatal mortality and certain maternal characteristics: pregnancy monitoring, place and mode of delivery.
Conclusion: Improving the management of prematurity should be based on better consideration of the risk factors associated with mortality.
Newborn, Prematurity, Mortality, Burkina Faso
According to the World Health Organization (WHO), each year, nearly 15 million babies are born prematurely worldwide, and more than one million will die due to complications related to prematurity [1].
The morbidity and mortality rate associated with prematurity is said to be very alarming in many countries around the world. Every 30 seconds, a newborn dies worldwide due to prematurity. This mortality rate is even higher in low-income countries where premature newborns have only a 10% chance of survival [1].
Sub-Saharan Africa and Asia alone accounted for 60% of premature births worldwide. According to a study published in 2019, these two regions accounted for 81.1% of premature births [1].
In Burkina Faso, prematurity accounted for 10.9% of live births. According to statistics from the Burkinabe Ministry of Health, the national prematurity rate was 2.3‰. Prematurity is the second leading cause of death among children under 5 years of age [2].
In the pediatric unit of Ouahigouya Regional Teaching Hospital, prematurity is one of the leading causes of death among children under one year of age, with an estimated proportion of 8.5% [3]. This study aimed to research the factors of death of premature newborns in the department in order to contribute to improving their care.
This was a cross-sectional study with a descriptive and analytical design, with retrospective data collection over a one-year period (January 1 to December 31, 2022).
Our study included all newborns hospitalized during the study period in the pediatric unit of Ouahigouya Regional Teaching Hospital.
The sampling was exhaustive and included all patients meeting the study inclusion criteria. All newborns with a gestational age strictly less than 37 completed weeks of amenorrhea and greater than 22 weeks of amenorrhea, hospitalized in the pediatric department for any reason, with a complete clinical record, were included in the study.
The study did not include premature infants who died upon arrival, or those admitted to the unit but not hospitalized.
Data were collected using an individual form based on admission forms, the newborns' hospitalization medical records, obstetrical and gynecological records, and information gathered during the interview.
Data were entered and analyzed using Epi info 7.2.3.1 2019 software and exported to Excel 2016.Mann-Whitney (quantitative variables), Pearsonchi-square, Fisher (qualitative variables) statistical tests were used for comparisons of proportions and means.
Comparisons were made using the Chi-square test at the 5% significance level and the calculation of odds ratios (OR) with their 95% confidence intervals (CI) for the association measures. The influence of the different relevant covariates was analyzed by univariate and multivariate logistic regression.
This study consisted of a retrospective collection of hospitalization data routinely collected in healthcare practice. Anonymity was maintained throughout the data collection, processing, and dissemination process. We obtained the consent of the relevant authorities to conduct this study.
During the study period, 1,455 newborns were hospitalized in the neonatology unit of the pediatrics department of the CHUR-OHG, including 302 premature babies, representing a hospital prevalence of 20.75%.
The average age of the mothers was 24 years +/- 06 years with extremes of 15 years and 41 years. The mothers were housewives in 89.59%. The pregnancy benefited from at least one pregnancy monitoring in 253 women or 94.05%.And 15 (5.57%) pregnancies did not benefit from any pregnancy monitoring.
The average gestational age was 32+/-2 weeks with extremes of 22 weeks and 36 weeks + 6 days. The evolution was marked by death in 134 premature babies, or 44.37%.
In newborns who died, mortality was significantly related to gestational age, birth weight, APGAR score less than7 in the first minute, and the presence of a complication. The presence of respiratory signs, particularly respiratory distress, is a significant risk factor, as is the presence of neurological signs (Table 1).
Table 1: Association of mortality risk factors and parameters of premature newborns. View Table 1
Furthermore, there is a statistically significant relationship between neonatal mortality and certain maternal characteristics: pregnancy monitoring, place and mode of delivery (Table 2).
Table 2: Association of mortality risk factors and maternal obstetric characteristics. View Table 2
When the pregnancy had benefited from less than 3 CPN, the prognosis of death was multiplied by 2.20 and 1.72 and when the delivery had taken place outside the CHUR of OHG. This link was very significant for the incorrect monitoring of CPN (p = 0.003) and less significant for delivery outside the CHUR (p = 0.040).
Vaginal delivery exposed the patient to a 1.15-fold risk of mortality. This factor was not significant for the prognosis of mortality (p = 0.14) (Table 3).
Table 3: Prognosis of mortality of premature newborns according to risk factors identified in the mother. View Table 3
Table 4 shows the mortality prognosis of premature newborns according to certain neonatal factors. The proportion of deaths was multiplied by 3.56 and 1.47 respectively when the birth weight was less than 1500 g and between 1500 and 1999 g.
Table 4: Mortality prognosis of premature newborns according to their risk factors. View Table 4
APGAR score less than 7 increased the risk of death by 1.91 times. These factors were significant for mortality risk. There was no significant risk of mortality with gestational ageless than 32 weeks and the presence of a complication.
In our series, we found a hospital prevalence of prematurity at 20.75%. This result is close to that of Kedy Koum, et al. [4] in Cameroon and Dainguy, et al. [5] in Ivory Coast who each reported a rate of 20%.
On the other hand, it is higher than that of Diouf, et al. [6] in Senegal(15%), Butalo, et al. [7] in Nigeria (16.8%) and Hounkponou, et al. [8] (17.89%) in Benin.
Sow, et al. in Senegal [9] and Minko [10] in Gabon had found rates of 28.1% and 50.30% respectively; higher than that of our study.
Similarly, the studies of Ouédraogo/Yugbaré [11] and Nagalo [12] in Burkina Faso noted higher prevalences than ours with 33.6% and 60.8% respectively.
The prevalence of prematurity varies according to the authors and the study setting. Overall, the rate of prematurity remains very high in Sub-Saharan Africa compared to Western and North African countries [13].
According to the World Health Organization (WHO), there are on average 12% premature births in poor countries compared to 9% in higher-income countries [14]. This high rate in sub- Saharan Africa could be explained by insufficient monitoring of pregnant women.
This makes it difficult to prevent prematurity. In this region of the world, food insecurity could also be implicated in the occurrence of premature births. Indeed, the insufficiency or lack of a healthy and varied diet can negatively influence the development of a pregnancy until term.
We recorded a mortality rate of 44.37% in our series. This rate is lower than that of Minko (50.2%) [105] and Diouf (50.3%) [6].
However, it is significantly higher than that of Naja (7.5%) [109], Dainguy (25.6%) [5] and Njom Nlend (31.5%) [15].
Generally speaking, the mortality rate linked to prematurity is very alarming in Africa (especially in WestAfrica) [16]. This could be due to the conditions of care from childbirth to hospitalization in neonatology units. Indeed, many units lack efficient materials and equipment. Similarly, failure to maintain the heat chain and poor environmental hygiene are thought to increase morbidity and mortality.
Furthermore, the lack or inadequacy of qualified personnel to care for premature babies (pediatricians, neonatologists, nurses, midwives) is thought to hamper the adequate care of these highly vulnerable newborns.
In our study, the risk factors significantly associated with neonatal death identified were:
• For the mother: poor pregnancy monitoring, delivery outside the university hospital, and vaginal delivery.
The risk of mortality was significantly associated with poor pregnancy monitoring (p = 0.003 and OR = 2.20) and delivery outside the university hospital (p = 0.040 and OR = 1.72).
• In premature babies: GA less than 32 weeks (p = 0.000), birth weight less than 1500 g (p = 0.000), an APGAR score < 7 at the 1 st minute (p = 0.0027), the occurrence of a complication during hospitalization (p = 0.000), the presence of respiratory distress (p = 0.000), neurological signs (p = 0.000) and hypothermia (p = 0.009) on admission.
However, the mortality prognosis was only significant for birth weight less than1500 g (p = 0.03 and OR = 3.56) and an APGAR score less than 7 at the 1 st minute (p = 0.02 and OR = 1.91).
Prematurity thus appears to be a nightmare for families and medical staff. In addition to the organic, physiological, and immune immaturity they present, they are subject to numerous pathologies, causing death and serious disabilities, particularly at the limit of viability.
Prematurity is a major concern at the Ouahigouya Teaching Hospital, and mortality is relatively high. The risk of death was primarily related to gestational age, birth weight, APGAR score, and the presence of a complication.
A multifactorial approach that takes into account the mother-child couple is essential to improve their care and reduce the mortality rate. This involves the implementation of a preventive policy focused on family planning, education for adolescent girls on sexual and reproductive health, and rigorous and high-quality monitoring of high-risk pregnancies in our region.