Evaluation of preterm and low birth weight morbidity, mortality and standards of care in Lao PDR / Lao Medical Journal

ABSTRACT

@#Objective: we aimed to investigate the possible causes of death among preterm and LBW infants admitted to the post-delivery ward and/or NICU at Mahosot Hospital, Lao PDR, and the possible factors that influence preterm and LBW infants’ survival. Methods: A retrospective cross-sectional study was conducted between by reviewing the treatment and outcomes for preterm and LBW infants admitted July - November 2017 to Mahosot Hospital in Vientiane, Lao PDR. Results: Of 3,500 births in 2017, 224 (6.4%) were preterm, 350 (9.4%) were LBW and 106 (30.2%) were term LBW; 98 preterm births (43.8%) and 21 (19.8%) term LBW babies were admitted to the NICU. Enrolment included 93 cases including 86 (92.5%) preterms and 7 term LBW neonates, of whom 47 (54.7%) and 2 were admitted to NICU, respectively. Enrollees were mostly male, Lao Loum, born vaginally at Mahosot Hospital; 3.2% were extreme preterm, 15.1% were very preterm, 74.2% moderate to late preterm and 7.5% term LBW; 2.2% were extremely LBW, 16.1% very LBW, 63.4% LBW and 18.3% normal birth weight. All 44 (47.3%) preterm or LBW babies admitted to the postnatal ward survived. Of the 49 (52.7%) admitted to the ICU, 18.4% died. All neonates who died were preterm of gestational age ranging 25-36 weeks and birth weight 730-2220g. Babies admitted to the NICU were mostly diagnosed with respiratory distress syndrome (RDS, 39.7%), neonatal infections (31.7%), asphyxia (9.5%) and congenital malformations (4.8%). Patient care. Antenatal 5.9% of preterm births <32 weeks received magnesium sulfate, and 27% of births 24-34 weeks gestational age received antenatal steroids. Postnatal 37.6% received skin-to-skin contact (SSC), and 15% maintained SCC until breastfeed completed, 68.8% received exclusive breastmilk as first feed and 24.5% kangaroo mother care. Only 7.5% were monitored for hypoxemia and 24.7% for hypothermia. Weights were not checked prior to discharge. Case management Around two-thirds of babies with risk factors for sepsis received prophylactic antibiotics. Most (77.6%) babies during the NICU admission received antibiotics, all of whom had a CBC and blood culture; but half without a diagnosis of sepsis or risk factors. Most (79.6%) preterm and LBW babies admitted to the NICU were given oxygen. About one-quarter of babies with RDS died. Very LBW infants rarely received supplementation with vitamin D, phosphate, iron and calcium. Conclusions: Most study participants were late preterm and LBW. Just under 10% died. Care can be improved, including antenatal administration of magnesium sulfate and antenatal steroids that needs to be vastly increased for eligible mother in preterm labor. Respiratory management needs further investigation for gaps. Feeding with breastmilk and checking vital signs appear to be strengths.