PREVALENCE AND DETERMINANTS OF OUTCOME OF PRETERM DELIVERIES IN UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN

Abstract

One of the millennium development goals is the reduction of under five
mortality rate by two-thirds from 1990 to 2015. In Nigeria, of the over 900,000
children under the age of five years that die every year, early neonatal death is
responsible for a little over 20%. Prematurity remains a significant cause of these
early neonatal deaths and in some series is said to be responsible for 60-70% of all
perinatal deaths. With this background, a prospective case control study to determine
the prevalence and determinants of outcome of preterm deliveries at the University of
Ilorin Teaching Hospital, Ilorin was undertaken. Out of the 2489 deliveries that took
place over a 9 month period, 293 were preterm giving a preterm delivery rate of 120
per 1000 deliveries. Of these, 1522 singleton deliveries that satisfied certain defined
criteria were recruited; 185 of them were preterm deliveries giving a case:control ratio
of 1:7. Significant determinants of preterm delivery identified were previous preterm
delivery (p=0.000; OR=3.55; 95%CI=1.71-7.30), antepartum haemorrhage (p=0.000;
OR=8.95; 95%CI=4.06-19.78), premature rupture of the membranes (p=0.000;
OR=6.48; 95%CI=4.33-9.67), maternal urinary tract infection (p=0.000; OR=5.89;
95%CI=1.16-27.57), pregnancy induced hypertension (p=0.000; OR=3.23;
95%CI=2.09-4.99), type of labour (p=0.000; OR=6.44; 95%CI=4.42-9.38) and
booking status (p=0.000; OR=4.67; 95%CI=3.33-6.56). Out of the 185 preterm babies
studied, 22 (11.9%) died. This was significantly higher than the mortality figures of
1.3% observed among term babies (Fisher’s’s Exact Test= 0.000 OR= 10.48; 95%
CI= 5.22-21.14). Mortality rates at gestational ages <28 weeks, 28-33 weeks and 34
36 weeks were 75%, 32.6% and 3% respectively. Similarly, mortality rates at
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birthweight below 1000g, 1000-1499g and 1500-2499g were 75%, 52.6% and 6%
respectively. Over two-thirds (72.7%) of all the mortalities among these preterm
babies took place within 72 hours of delivery. The mean duration of stay in hospital
among preterm infants (8.5 ± 7.5 days) was statistically significantly longer than that
observed among term babies (Mann-Whitney U test=0.000). The difference in mean
duration of stay in hospital before death among preterm and term babies was not
statistically significant (Mann-Whitney U test = 0.954). Significant morbidities
encountered among these preterm babies were severe perinatal asphyxia (p=0.000;
OR=4.74; 95%CI=2.67-8.40), sepsis (p=0.000; OR=7.19; 95%CI= 3.62-14.27),
apnoea (p=0.000; OR=13.21; 95%CI= 4.76-37.63), respiratory distress (p=0.000;
OR=9.65; 95%CI= 6.46-14.40), neonatal jaundice (p=0.000; OR=18.48; 95%CI=
9.41-36.68) and necrotizing entero-colitis (p=0.006; OR=22.06; 95%CI= 1.75-
1158.93). Factors identified as significant determinants of mortality were severe
perinatal asphyxia (p=0.000; OR=71.31; 95%CI= 17.63-308.24), apnoea (p=0.000;
OR=178.20; 95%CI= 20.64- 7709.02), necrotizing entero-colitis (p=0.001) and
resuscitation duration (p=0.003; OR=5.33; 95%CI= 1.62- 19.02). With these findings,
there is an urgent need to increase capacity and facilities for the management of this
category of babies while also using the knowledge of the determinants to reduce their
incidence where possible.

PREVALENCE AND DETERMINANTS OF OUTCOME OF PRETERM DELIVERIES IN UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN