Profile of Babies Born before Arrival at Hospital in a Peri-Uban Setting

ABSTRACT

Background. Babies born before arrival (BBAs) at hospital constitute a special group at risk of high morbidity and mortality.Objective. We conducted a 12-month retrospective review to describe maternal and neonatal characteristics of BBAs; and their outcomes compared with babies born in the state health sector.Methods. Using case-control sampling; all babies born outside a health facility and who presented to hospital within 24 hours of life were included and compared to the next in-hospital delivery occurring immediately after each BBA presented. Results. During the period reviewed; 135 BBAs (prevalence 1.8) presented; 71 after hours with most deliveries occurring at home (73.8). There was no birth attendant present at 70.5 of deliveries. Average birth weights were similar (2.86 kg in the BBA group; 95 confidence interval (CI) 2.73 - 2.95; 2.94 kg in the control group; 95 CI 2.78 - 3.02); but significantly more preterm babies were found in the BBA group (23 v. 9; respectively; p0.0001). Admitted BBAs had significantly lower average weights than those who were not admitted (2.19 kg v. 2.96 kg; respectively; p0.0001). No significant differences were found when maternal age; parity; co-morbidities and distance from the hospital were compared. There were significantly more unbooked mothers in the BBA group (23.0 v. 6.7; respectively;p0.0001). Only 54.40 of the admitted BBAs' mothers had booked antenatally; compared with 78.89 of mothers whose babies were discharged. Admission and complication rates were similar between the groups; but average length of stay was longer in admitted BBAs compared with controls. Conclusion. The prevalence of BBAs in this study is comparable to that in other developing countries; and is associated with poor antenatal attendance; prematurity; delay in presentation to hospital and lengthier hospital stays. These factors have implications for prehospital care of newborns and access to maternal and child healthcare in general