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Neonatal survival of infants less than 2000 grams born at Kenyatta National Hospital
F N Were1, B O Mukhwana, R N Musoke
1Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi.
Insights
Neonatal survival for low birth weight infants at Kenyatta National Hospital is low, with no survival for extremely low birth weight infants. Lack of neonatal intensive care facilities contributes to high early mortality rates.
Area of Science:
- Neonatalogy
- Public Health
- Perinatology
Background:
- Institutional survival rates are key indicators of medical care quality.
- Neonatal services at Kenyatta National Hospital have a long history, but recent survival data for low birth weight infants is lacking.
- Previous survival data for low birth weight infants at this institution dates back to 1978.
Purpose of the Study:
- To assess birth weight-specific neonatal survival rates for infants under 2000 grams.
- To provide updated survival data for low birth weight infants at Kenyatta National Hospital.
Main Methods:
- A cross-sectional survey design was employed.
- Data was collected from the Newborn Unit at Kenyatta National Hospital in Nairobi.
- Survival was analyzed for infants in specific birth weight categories: below 1000g (extremely low), 1000-1499g (very low), and 1500-1999g (low).
Main Results:
- The overall neonatal survival rate for infants under 2000g was 62.6%.
- Infants weighing less than 1000g had a 0% survival rate, while survival rates were 68% for 1000-1499g and 78% for 1500-1999g groups.
- Higher survival rates were observed for infants born between 32-35 weeks gestation (69%) compared to those with earlier gestations (27% for 28-31 weeks, 9% for <28 weeks).
- Over 70% of deaths occurred within the first week of life, with infection and respiratory distress being the most common clinical syndromes.
Conclusions:
- Neonatal survival rates for low birth weight infants remain significantly lower than those reported in developed countries decades ago.
- The high proportion of early neonatal deaths, particularly within the first 24 hours, highlights critical deficiencies.
- Inadequate neonatal intensive care facilities and suboptimal obstetric services are identified as primary contributors to the low survival rates.
Background:
Survival of patients is regularly used as a measure of the level and appropriateness of medical care provided by institutions. Newborn services have been evaluated in this manner since the 1960s. Though Kenyatta National Hospital has provided neonatal services for over 25 years, no survival data for the low birth weight infants has been published since 1978.
Objective:
To determine the birthweight specific neonatal survival of infants born weighing less than 2000 grams at Kenyatta National Hospital.
Design:
A cross sectional survey.
Setting:
Newborn Unit, Kenyatta National Hospital, Nairobi.
Main Outcome Measures:
The proportion of infants surviving the first 28 days of life grouped in the following birthweight categories; below 1000 grams (extremely low birthweight), 1000-1499 grams (very low birthweight) and 1500-1999 grams (low birthweight).
Results:
The overall neonatal survival of 163 infants born below 2000 grams was 62.6%. None of the 23 infants born less than 1000 grams survived the neonatal period. Bigger infants fared much better with 68% (n=73) of the 1000-1499 and 78% (n=67) of the 1500-1999 gram groups surviving. Survival based on gestational age was also determined. Sixty nine per cent of infants born between 32 and 35 weeks survived while only 27% and 9% of the 28-31 weeks and those less than 28 weeks survived respectively. When the patients were analysed for age at death, it was found that over 28% of the deaths occurred within the first day and by the seventh day, more than 70% had died. Less than 30% of the deaths occurred after the first week. The commonest clinical syndromes seen were infection (41%) and respiratory distress (43%).
Conclusion:
Neonatal survival rates of low birthweight infants are still much lower than those observed in developed countries as far back as the early 1970's. The big proportion of deaths occurring during the first week, and in particular the first day, is due to lack of neonatal intensive care facilities and inadequate obstetric services.
