Preterm Birth and Low Birth Weight after In Utero Exposure to Antiretrovirals Initiated during Pregnancy in Yaoundé, Cameroon.

BACKGROUND: Effects of antiretroviral therapy (ART) on birth outcomes remain controversial. OBJECTIVE: To assess the impact of antenatal exposure to ART on the occurrence of preterm birth (PTB) and low birth weight (LBW). METHODS: A cross-sectional study conducted at the Essos Hospital Center in Yaounde from 2008 to 2011 among HIV vertically exposed infants with two distinct maternal antiretroviral experiences: monotherapy group (Zidovudine, ZDV) and the combination ART group (cART). Mothers already receiving cART before pregnancy were ineligible. In both groups, events of PTB (<37 weeks) and LBW (<2,500g) were analyzed using univariate and multivariate logistic regression; with p<0.05 considered statistically significant. RESULTS: Of the 760 infants, 481 were born from cART-exposed mothers against 279 from maternal-ZDV. Median maternal CD4 count was 378 [interquartile range (IQR): 253-535] cells/mm3. Median duration of ART at onset of delivery was 13 [IQR: 10-17] weeks. In the cART-group, 64.9% (312/481) of mothers were exposed to Zidovudine/Lamuvidine/Nevirapine and only 2% (9/481) were on protease inhibitor-based regimens. Events of PTB were not significantly higher in the cART-group compared to the ZDV-group (10.2% vs. 6.4% respectively, p = 0.08), while onsets of LBW were significantly found in the cART-group compared to ZDV-group (11.6% vs. 7.2% respectively, p = 0.05). Other factors (parity, maternal age at delivery or CD4 cell count) were not associated with PTB. CONCLUSION: cART, initiated during pregnancy, would be an independent factor of LBW. In the era of option B+ (lifelong ART to all HIV-pregnant women), further studies would guide towards measures limiting onsets of LBW.

[Transfer and transport of newborn babies in vital distress in Yaoundé, Cameroon: situational analysis conducted in a reference hospital]. / Transfert et transport des nouveau-nés en situation de détresse vitale à Yaoundé, Cameroun: analyse situationnelle dans un hôpital de référence.

INTRODUCTION: This study aims to describe transfer modalities of newborn babies in vital distress to the ESSOS Hospital Center in Yaoundé, Cameroon. METHODS: We conducted a prospective cross-sectional study from October 2014 to January 2015. Data were collected using a short questionnaire from the transfer operator. Main parameters: means of transport, reason for transfer, transfer delay, number of detours (itinerary before admission) prevalence for hypothermia, neonatal mortality rate. RESULTS: We recorded 73 transfers during the study period. Nearly 1/5 (22%) of infants were born within the health district of the reference structure. 24/73 newborns were referred for tertiary care centers (33%). The main reason for transfer was prematurity (40%) followed by neonatal asphyxia (26%). Medical transfer was performed in 5/73 (7%) cases, inter-hospital transfer effected through a nurse was performed in 10/73 (13.6%) cases. The average transfer time was 17 hours, 60% of babies were transferred within the first 6 hours of life, 22% (16/73) within the first two hours of life. For more than half of newborns, a transfer to another hospital was done before admission. Hypothermia (central temperature less than 36° C) on arrival was found in 20% of cases. 15/73 (20.5%) of transferred newborns died. The mean temperature in the dead infants upon their arrival to the hospital was 35.5° C versus 37° C in the non-deceased (p = 0.006). The percentage of newborns who underwent =2 tranfers was 57% in the deceased infants versus 30% in the non-deceased ones (p=0,02). CONCLUSION: In Yaoundé, transfers conditions of newborns in precarious conditions of life hinder early neonatal prognosis because of an erratic itinerary, which increases the risk of hypothermia and death. This reinforces the need for a perinatal network.