Research Article ISSN 2689-1085

Research Article Journal of Pediatrics & Neonatology

Hospital Outcome of Preterm Babies at the Regional Hospital Limbe: A

4-Year Retrospective Study
Yolande Djike Puepi F1*, Naiza Monono1, Charlotte Eposse2, Bela Ode3, Yanelle Wandji1, Wilfried Ganni
Wele3, and Evelyn Mah Mungyeh4

Department of Internal Medicine and Paediatrics, Faculty of

1

Health Sciences, University of Buea, Cameroon.

*
Correspondence:
Department of Paediatrics, Faculty of Medicine and
2
Yolande Fokam Djike Puepi, Faculty of Health sciences, University
Biomedical sciences, University of Douala, Cameroon. of Buea, Tel: (237) 677836217, Cameroon.
3
Faculty of Health Sciences, University of Buea, Cameroon. Received: 28 Jul 2022; Accepted: 02 Sep 2022; Published: 08 Sep 2022

Department of Paediatrics, Faculty of Medicine and

4

Biomedical Sciences, University of Yaounde I, Cameroon.

Citation: Puepi YDF, Monono N, Eposse C, et al. Hospital Outcome of Preterm Babies at the Regional Hospital Limbe: A 4-Year
Retrospective Study. J Pediatr Neonatal. 2022; 4(4): 1-8.

ABSTRACT
Background: Globally, preterm birth and its complications have become major public health problems as it is
a major determinant of neonatal morbidity and mortality with long-term adverse health consequences. It is the
leading cause of neonatal and under-5 mortality globally. In Cameroon, especially in the South West Region, there
is a paucity of data as concerns preterm birth and its related morbidities and outcome.

Objectives: Our objective was to determine the prevalence and hospital outcome of preterm babies at the Regional
Hospital Limbe.

Methods: A hospital-based cross-sectional study with a retrospective review of files of preterm babies admitted
in the neonatology unit from the 1st January 2017 to 31st December 2020. A structured data collection sheet
was used to collect information from the files. Information obtained included independent variables (gestational
age at birth, gender, birth weight, hospital complications during admission, treatment received and duration
of admission) and dependent variables (dead or discharge). Relationship between dependent and independent
variables was tested using Pearson Chi-square. Multivariate logistic regression was used to identify factors and
independent associations.

Result: Preterm admissions constituted 16.5% of the total admissions with a male to female ratio of 1:1.2.
The common morbidities were respiratory distress 132(49.1%), hypothermia 72(26.8%), anaemia 70(26.0%),
infection 65(24.2%) and jaundice 63(23.4%). The mortality rate was 31.8%. Preterm babies who had congenital
malformation (AOR: 25.39;95%CI:1.80-356.38), apnoea (AOR:6.36;95%CI:1.49-27.09), respiratory distress
(AOR:6.15;2.75-13.77) and anaemia (AOR:2.19;95%CI:1.07-4.50) were more likely to die compared to those
who did not have these morbidities. Also, male preterm babies (AOR:2.72;95%CI:1.35-5.48) were more likely to
die than their female counterparts.

Conclusion: Preterm babies constituted a significant percentage of neonatal admissions at the Regional Hospital
Limbe with the most frequent complications being respiratory distress, hypothermia, anaemia, infection and
jaundice. The mortality rate was high, with more preterm babies dying from congenital malformation, apnoea,
respiratory distress, and anaemia were strongly associated with mortality.

J Pediatr Neonatal, 2022 Volume 4 | Issue 4 | 1 of 8

Keywords zone two-health area of the Limbe Health District. It is the
Preterm, prevalence, morbidity, mortality, principal secondary referral Hospital in the region and serves
as one of centres for clinical training of medical students. There
Introduction is a neonatology unit, which is being headed by a Paediatrician
Preterm birth (PTB) is defined by the World Health Organisation who follows up with the children daily and closely assisted by a
(WHO) as any viable birth before 37 completed weeks of gestation general practitioner and 10 nurses. It has 10 cots, 5 incubators, 2
or less than 259 days since the first day of a woman’s last menstrual phototherapy lamps and 2 oxygen concentrators. These babies are
period. It is classified as being extremely preterm (less than 28 either being transferred from the maternity ward or are referred
weeks), very preterm (28 to less than 32 weeks), and moderate to from other health facilities around.
late preterm (32 to less than 37 weeks) [1].

According to the WHO, nearly 15 million premature babies are born Study Design
annually worldwide of whom one million do not survive beyond This was a hospital-based cross-sectional study with the
the neonatal period [2,3]. Preterm birth-related complications have retrospective review of files of preterm babies admitted at the
replaced pneumonia as the leading cause of mortality, not only in neonatology unit of the Regional Hospital Limbe from 1st January
the neonatal period but also in the global under-5 mortality [4]. 2017 to 31st December 2020.
The rate of preterm birth among 184 countries ranges from 5 to
18% of newborns [2,5]. In Europe, the prevalence of preterm birth Inclusion Criteria
is 5% to 10%. India, China, Nigeria, Pakistan, Indonesia, and the We included files of all preterm neonates admitted into the
United States account for 50% of the total preterm births in the neonatology unit within the study period.
world [6].
Exclusion Criteria
Africa and South Asia account for 60% of preterm births [7- We excluded files of preterm babies that were incomplete and
9]. Prematurity is one of the leading causes of neonatal deaths missing during the study period.
in Africa with a prevalence of about 11.9% [1]. In Africa, the
frequency of prematurity is estimated to be above 15%. According Data Collection and Procedure
to the United Nations Children’s Fund (UNICEF) data for After having gained access to the register of admission of neonates
prematurity in Cameroon, the preterm birth rate is estimated to be at the neonatology unit, the total number of neonates and preterm
13% [10]. The survival of these preterm infants greatly depends babies admitted during the study period was obtained. The available
on their biological maturity and technological advancement [11]. files were sorted from the archives. Files of Preterm babies with
Factors such as level of prenatal care, gestational age at birth, sex, missing information were removed. The files which were left
availability of resources, adequate and well-trained personnel also were those that met up with the inclusion criteria. Structured
influence management success of prematurity [12]. data collection sheets were used to collect information from the
files of the preterm babies that met up the inclusion criteria. The
Preterm birth remains an important public health priority information such as maternal sociodemographic characteristics
worldwide. There is a need for evidence-based strategies to prevent (age, occupation, and area), gestational age of the preterm at birth,
prematurity from occurring, as well as mitigating its effects on weight at birth, gender, hospital complications, treatment received,
preterm newborns particularly in low-resource settings [13]. With source of feeding, duration of hospitalization and outcome
the understanding that innovative solutions are needed to decrease (discharged or died) were recorded in the data collection sheets.
mortality from preterm birth, the World Health Organization
(WHO) published recommendations in 2015 on interventions to Data analysis
improve quality of care and outcomes surrounding preterm birth Data collected were coded and entered into excel sheet and
[14]. The issue of preterm birth is of paramount significance for exported into Statistical Package for Social Sciences version
achieving United Nations Sustainable Development Goal 3, which 26.0 for analysis. Birth weight and gestational age at birth were
aims to end all preventable deaths of newborns and children categorized using WHO standards. The independent variables were
aged under 5 years by 2030 [6,15]. Thus an urgent need for the maternal age, occupation, marital status, area, gestational age at
establishment of neonatal intensive care units with adequate birth, gender, birth weight, place of birth, hospital complications,
manpower as well as appropriate diagnostic and management treatment, source of feeding, duration of hospitalization, while
facilities to improve the survival rates of this vulnerable group of the dependent variables included outcome (discharged, died).
patients[12]. The first part of the analysis dealt with descriptive statistics to
ascertain the frequency of the variables with categorical variables
Materials and methods were presented as frequencies and percentages while continuous
Study setting variables were presented as means and standard deviations. The
This study took place in the neonatology unit of the Regional Chi-square test and Fisher’s exact test were used to establish if
Hospital Limbe of the Fako Division of the South West Region there was a relationship between independent and dependent
of Cameroon. The Limbe Regional Hospital is located in the variables. All independent variables with p-values less than 0.05
J Pediatr Neonatal, 2022 Volume 4 | Issue 4 | 2 of 8
in the chi-squared analysis were included in the final logistic Marital status (n=266) *
regression model. Statistical significance was set at a p-value Single 130 48.9
<0.05 at a 95% confidence interval. Married 136 50.6
Area (n=269)
Ethical considerations Rural area 82 30.5
Ethical clearance was obtained from the Institutional review Urban area 187 69.5
Board of the Faculty of Health Sciences, University of Buea (Ref. *= missing information
No. 2021/1296-02UB/SG/IRB/FHS). Administrative approval
was obtained from the Dean of the Faculty of Health Sciences, Profile of preterm babies
University of Buea (Ref. No. 2021/950/UB/VD/RC/FHS), and the The gestational age of the preterm babies ranged from 21 to 36
Regional Delegate of Public Health in the South West Region (Ref. weeks with a mean age of 32.4 weeks ± 2.8 weeks. Most of the
No. R11/MINSANTE/SWR/RDPH/PS/514/784). Information preterm babies were late preterm 109 (40.5%), with 3 (4.8%)
collected from the files was used exclusively for this study. being extremely preterm, as shown in figure 2 below.

Results
Trend of preterm admission over four years
A total of 1968 babies were admitted at the neonatology of which
324 were preterm and 1644 were born at term. There were 52
missing files of preterm babies with 3 incomplete files. Thus, we
worked with 269 files. The prevalence of preterm babies admitted
was 16.5%. There has been an increase in preterm admission with
the highest recorded 97 (29.9%) in 2019, as depicted in figure 1
below.

Figure 2: Gestational age groups distribution of preterm babies.

Females dominated with most weighing 1500g to <2500g and

born at the Regional Hospital Limbe, as depicted in table 2 below.

Table 2: Profile of preterm babies at presentation to the neonatology unit

(n=269).
Characteristics Frequency (n) Percentage (%)
Gender
Male 123 45.7
Figure 1: Admission of preterm babies with respective years.
Female 146 54.3
Sociodemographic characteristics of mothers Place of birth
The age, occupation, and marital status of 5,6 and 3 mothers Regional Hospital Limbe (RHL) 238 88.5
respectively were not recorded in the files of their preterm babies. Out of Regional Hospital Limbe 31 11.5
The age of the mothers ranged from 15 to 45 years with a mean Gestational age groups (weeks)
age of 27.1±5.3 years. Most of the mothers were aged 20 to less <28 (21-27) 13 4.8
than 35 years 221 (83.7%). Majority of the were unemployed 28 - <32 73 27.1
116 (44.1%), married 122 (45.4%) and lived in urban areas 187 32 - <34 74 27.5
(69.5%), as depicted in table 1 below. 34 - <37 109 40.5
Birth weight groups (g)
Table 1: Maternal sociodemographic characteristics (n=269).
<1000 (500-<1000) 11 4.1
Variable Frequency (n) Percentages (%)
1000-<1500 55 20.4
Age groups (years) (n=264) *
<20 (15-19) 17 6.4 1500-<2500 195 72.5
20-<35 221 83.7 ≥2500g (2500-2700) 8 3.0
≥35 (35-45) 26 9.8
Occupation (n=263) * Hospital complications of preterm babies
Employed 37 14.1 Ten complications were assessed. The majority 216 (80.3%) of
Self-employed 110 41.8 the preterm babies had one or more hospital complications. The
Unemployed 116 44.1 most common hospital complications were respiratory distress
J Pediatr Neonatal, 2022 Volume 4 | Issue 4 | 3 of 8
132 (49.1%), followed by hypothermia 72 (26.8%), anaemia Table 5: Association between of gestational age groups and complications
70 (26.0%), infection 65 (24.2%), and jaundice 63 (23.4%) as (n=269).
depicted in table 4 below.
Gestational age groups (weeks)
Variable <28 (%) 28-<32 (%) 32-<34 (%) 34-<37 p-value
Table 4: Hospital complications of preterm babies at the neonatology unit (%)
(n=269). Respiratory distress
Yes 12 (92.3) 48 (65.8) 31 (41.9) 41 (37.6) 0.000
No 1 (7.7) 25 (34.2) 43 (58.1) 68 (62.4)
Variable Frequency (n) Percentage (%)
Hypothermia
Hospital complications
Yes 9 (69.2) 29 (39.7) 16 (21.6) 18 (16.5) 0.000
Yes 216 80.3
No 4 (30.8) 44 (60.3) 58 (78.4) 91 (83.5)
No 53 19.7 Anaemia
Respiratory distress Yes 5 (38.5) 23 (31.5) 22 (29.7) 20 (18.3) 0.109
Yes 132 49.1 No 8 (61.5) 50 (68.5) 52 (70.3) 89 (81.7)
No 137 50.9 Infection
Hypothermia Yes 1 (7.7) 18 (24.7) 22 (29.7) 24(22.0) 0.326
Yes 72 26.8 No 12 (92.3) 55 (75.3) 52 (70.3) 85 (78)
No 197 73.2 Jaundice
Yes 0 (0) 15 (20.5) 15 (20.3) 33 (30.3) 0.056
Anaemia
No 13 (0) 58 (79.5) 59 (79.7) 76 (69.7)
Yes 70 26.0
Feeding difficulties
No 199 74.0
Yes 1 (7.7) 9 (12.3) 16 (76.2) 5 (4.6) 0.005
Infection
No 12 (92.3) 64 (87.7) 5 (23.8) 104 (95.4)
Yes 65 24.2 Necrotizing enterocolitis
No 204 75.8 (NEC)
Jaundice Yes 0 (0) 3 (4.1) 10 (13.5) 3 (2.8) 0.013
Yes 63 23.4 No 13 (100) 70 (95.9) 64 (86.5) 106 (97.2)
No 206 76.6 Apnoea
Feeding difficulties Yes 0 (0) 3 (4.1) 4 (5.4) 4 0.818
Yes 31 11.5 No 13 (100) 70 (95.9) 70 (94.6) 105
Seizure
No 238 88.5
Yes 0 (0) 1 (1.4) 4 (5.4) 2 (1.8) 0.343
Necrotizing enterocolitis
No 13 (100) 72 (98.6) 70 (94.6) 107 (98.2)
(NEC)
Congenital malformation
Yes 16 5.9
Yes 1 (7.7) 1 (1.4) 2 (2.7) 0 (0) 0.121
No 253 94.1
No 12 (92.3) 72 (98.6) 72 (97.3) 109 (100)
Apnoea
Yes 11 4.1 Treatment given to preterm babies
No 258 95.9 The treatment received by preterm babies included; oxygen,
Seizure antibiotics, caffeine citrate, aminophylline, cimetidine,
Yes 7 2.6 phototherapy, glucose, phenobarbital, blood transfusion,
No 262 97.4 metronidazole, and gastric lavage. The three most frequently used
Congenital malformation treatments were the first line anti biotherapy 269 (100%) followed
Yes 4 1.5 by cimetidine 148 (55.0%) and oxygen 139 (51.7%), as depicted
No 265 98.5 in table 6 below.

Association between gestational age groups and complications Table 6: Treatment given to preterm babies (n=269)
The bivariate analysis revealed gestational age groups of preterm
Variable Frequency (n) Percentage (%)
babies and how they influenced the complications. Specifically, Oxygen therapy
respiratory distress (p=0.000), hypothermia (0.000), necrotising Yes 139 51.7
enterocolitis (p=0.013) and feeding difficulties (p=0.005) were No 130 48.3
statistically significant to complications of the preterm babies. First-line anti biotherapy
This analysis shows that there is a decreased vulnerability to Yes 269 100.0
complications with increase gestational age as depicted in table No 0 0
5 below. Second-line anti biotherapy
Yes 53 19.7
No 216 80.3

J Pediatr Neonatal, 2022 Volume 4 | Issue 4 | 4 of 8

Third line anti biotherapy Mortality rate of hospitalized preterm babies
Yes 1 0.4 Out of the 324 preterm babies hospitalized at the neonatology unit,
No 168 99.6 103 of them died giving a mortality rate of 31.8%. Majority of the
Caffeine citrate deaths 33 (32.0%) were recorded in 2019 following by 29 (28.2%)
Yes 94 34.9 in 2020, 24 (23.3%) in 2018 and 17 (16.5%) in 2017 as shown in
No 175 65.1 figure 3 below.
Aminophylline
Yes 52 19.3
No 217 80.7
Cimetidine
Yes 148 55.0
No 121 45.0
Phototherapy
Yes 63 23.4
No 206 76.6
Phenobarbital
Yes 6 2.2
No 263 97.8
Blood transfusion
Yes 60 22.3 Figure 3: Distribution in the proportion of mortality with the respective
No 209 77.7 years.
Metronidazole plus lavage
Yes 18 6.7 Factors associated with hospital outcome of preterm
No 251 93.3 babies (bivariate analysis)
Association between preterm profile and hospital outcome
Nutrition, duration of hospitalisation, and hospital outcome of The bivariate analysis revealed the characteristics of preterm babies
preterm babies and how they influenced the outcome. Specifically, gestational age
Majority 190 (70.6%) of the preterm babies began feeding on (p=0.000), gender (p=0.012), and birth weight (p=0.000) of the
day 2 of hospitalization. Most of the them were started on breast preterm babies were significantly associated with mortality. In
milk 257 (95.5%). The majority 198 (73.6%) of the babies were addition, temperature (p=0.001) and oxygen saturation (p=0.000)
hospitalized for less than 14 days. A greater proportion of preterm on admission significantly influenced the outcome as shown below
babies 205 (76.2%) were discharged, as depicted in table 7 below. a depicted in table 8 below.
Table 7: Nutrition, duration of hospitalisation, and hospital outcome of Table 8: Factors associated with mortality.
preterm babies (n=269).
Outcome
Variable Frequency (n) Percentage (%) Variable p-value
Died (%) Discharged (%)
Started nutrition (n=269) Gestational age groups (weeks)
Yes 260 96.7 <28 9 (69.2) 4 (30.8) 0.000
No 9 3.3 28-<32 24 (32.9) 49 (67.1)
Onset of nutrition (n=260*) 32-<34 20 (27.0) 54 (73.0)
Day 1 31 11.9 34-<37 11 (10.1) 98 (89.9)
Day 2 190 73.1 Gender
Day 3 38 14.6 Male 38 (30.9) 85 (69.1) 0.012
Day 4 1 0.4 Female 26 (17.8) 120 (82.1)
Breast milk (n=260*) Birth weight groups (g)
Yes 257 98.8 <1000 8 (72.7) 3 (27.3) 0.000
No 3 1.2 1000g-<1500 23 (41.8) 32 (58.2)
Artificial milk (n=260*) 1500-<2500 33 (16.9) 162 (83.1)
Yes 11 4.2 >2500 0(0) 8 (100)
No 249 95.8 Place of birth
Duration of hospitalization (days) (n=269) RHL 55 (23.1) 183 (76.9) 0.466
<14 198 73.6 Out of RHL 9 (29.0) 22 (71.0)
14 to <30 61 22.7 Temperature groups (0C)
≥30 10 3.7 <36.5 29 (39.2) 45 (60.8) 0.001
Outcome (n=269) 36.5-37.5 32 (19.2) 135 (80.8)
Discharged 205 76.2 >37.5 3 (10.7) 25 (89.3)
Died 64 23.8 Saturation groups
*= missing information <90 52 (40) 78 (60) 0.000
≥90 12 (8.6) 127 (91.4)

J Pediatr Neonatal, 2022 Volume 4 | Issue 4 | 5 of 8

Association between complications and outcome of preterm Preterm babies born at 28 to less than 32 weeks
babies (AOR:0.24;95%CI:0.05-0.96) and at 34 to less than 37 weeks
The hospital complications that were statistically significant to (AOR:0.09;95%CI:0.02-0.41) of gestation had lesser chances of
the outcome of preterm babies were respiratory distress (0.000), dying as compared to their counterparts born before 28 weeks of
hypothermia (0.001), apnoea (0.002), anaemia (0.006), jaundice gestation.
(0.018), congenital malformation (0.015), as depicted in table 9
below. Male preterm babies were about 3 times
(AOR:2.72;95%CI:1.35-5.48) more likely to die than their female
Table 9: Association between complications and outcome of preterm counterparts. Preterm babies who had an oxygen saturation of
babies. 90% and above (AOR:0.16; 95%CI:0.08-0.32) had lesser chances
Variable Outcome Died (%) Discharged (%) p-value of dying as compared to those with oxygen saturation of less than
Complication 90% as depicted in table 10 below.
Yes 63 (29.2) 153 (70.8) 0.000
No 1 (1.9) 52 (98.1)
Table 10: Factors associated with mortality of preterm babies (Multivariate
Respiratory distress
analysis).
Yes 53 (40.2) 79 (59.8) 0.000
Variable Adjusted OR (95% CI) p-value
No 11(8.0) 126 (92.0)
Gestational age groups (weeks)
Hypothermia
<28 1
Yes 29 (40.3) 43 (59.7) 0.001 28-<32 0.24 (0.05-0.96) 0.044
No 35 (17.9) 161 (82.1) 34-<37 0.09 (0.02-0.41) 0.001
Apnoea Gender
Yes 7 (63.6) 4 (36.4) 0.002 Male 2.72 (1.35-5.48) 0.005
No 57 (22.1) 201(77.9) Female 1
Necrotizing enterocolitis Temperature groups (0C)
(NEC) <36.5 1.23 (0.07-21.87) 0.888
Yes 7 (43.8) 9 (56.2) 0.053 36.5-37.5 1.18 (0.28-4.89) 0.824
No 57 (22.5) 196 (77.5) >37.5 1
Anaemia Oxygen saturation (%)
Yes 25 (35.7) 45 (64.3) 0.006 <90 1
No 39 (19.6) 160 (80.4) ≥90 0.16 (0.08-0.32) 0.000
Feeding difficulties Respiratory distress
Yes 10 (32.3) 21 (67.7) 0.239 Yes 6.15 (2.75-13.77) 0.000
No 54 (22.7) 184 (77.3) No 1
Apnoea
Infection
No 1
Yes 16 (24.6) 49 (75.4) 0.858
Yes 6.36 (1.49-27.09) 0.012
No 48 (23.5) 156 (76.5)
Anaemia
Seizure
No 1
Yes 1 (14.3) 6 (85.7) 0.55 Yes 2.19 (1.07-4.50) 0.032
No 63 (24.0) 199 (76.0) Congenital malformation
Jaundice No 1
Yes 8 (12.7) 55 (87.3) 0.018 Yes 25.39 (1.80-356.38) 0.016
No 56 (27.2) 150 (72.8) Hypothermia
Congenital malformation No 1
Yes 3 (75) 1 (25) 0.015 Yes 1.38 (0.11-17.24) 0.803
No 61 (23.0) 204 (77.0)
Discussion
Factors associated with mortality of preterm babies Neonatal and under-5 mortality attributable to preterm birth and
(multivariate analysis) complications remains a huge challenge globally and in low- and
Following multivariate analysis, gestational age, gender, oxygen middle-income countries like Cameroon. Despite improvement
saturation, congenital malformation, respiratory distress, in postnatal care provided in delivery rooms like warmth,
apnoea, and anaemia were statistically significant. Preterm breastfeeding support and neonatal intensive care units, preterm
babies with congenital malformation were 25 times (AOR: babies remain vulnerable to a wide array of complications in the
25.39;95%CI:1.80-356.38) more likely to die than those without neonatal period and beyond.
congenital malformation. Furthermore, preterm babies who had
apnoea (AOR:6.36;95%CI:1.49-27.09) and respiratory distress Few studies have been done in the South West Region of Cameroon
(AOR:6.15;2.75-13.77) were 6 times more likely to die than on the outcome of preterm babies admitted to the neonatology unit.
their counterpart without apnoea and respiratory distress. Preterm This hospital-based retrospective cross-sectional study was carried
babies with anaemia were 2 times (AOR:2.19;95%CI:1.07-4.50) out to determine the prevalence of the preterm babies admitted
were two times more likely to die than their counterparts without at the neonatology unit, assess frequent hospital complications,
anaemia. mortality rate and complications associated with mortality.
J Pediatr Neonatal, 2022 Volume 4 | Issue 4 | 6 of 8
Characteristics of preterm babies and Kunle-Olowu et al in Nigeria [12] who observed respiratory
We found out that preterm babies born at 32 to 36 weeks of problems, jaundice and sepsis as the most frequent complications.
gestation predominated (68.0%) while those born at less than 28
weeks of gestation were the least (4.8%). A similar trend was Mortality rate of preterm babies
found in retrospective studies carried out by Abdul-Mumin et al The current study had a mortality rate of 31.8% of the total number of
in Ghana [16] and Paudel et al in Nepal [17]. This was however in preterm babies admitted during the study period. The high mortality
line with the global report on prematurity in which preterm babies rate can be attributed to the complications of preterm babies which
born at 32 to 36 weeks of gestation accounted for about 84.3% arises from their immature systems that are not yet prepared to
of cases whereas preterm babies born at less than 28 weeks of support life in the extrauterine environment, thus causing them to
gestation accounted for only 5.3%. The very low prevalence of die Moreover, our study was carried out in a neonatal unit with
extremely preterm babies can be explained by the high stillbirth in inadequate infrastructure and limited trained health professionals,
this group [18]. this could be the reason for the high mortality rate recorded in our
study. Contrary to our study, Khan et al in Pakistan had a much
In our study population, there was female predominance with a lower mortality rate of 16% [22]. The reason could be that their
female to male ratio of 1.2:1. This finding was similar to those study was conducted in a neonatal intensive unit with well-equipped
observed by Abdul-Mumin et al in Ghana [16] and Gupta et al in infrastructure and adequately trained health professionals.
India [19]. However, our finding was contrary to those obtained in
studies conducted by Chiabi et al in Cameroon [7] and Ayele et al Factors independently associated with mortality
in Ethiopia [20] who had a male predominance. Respiratory distress, apnoea, anaemia, and congenital malformation
were independently associated with the mortality of preterm
Prevalence of preterm babies admitted babies. Preterm babies who had congenital malformation 25 times
According to the study, the prevalence of preterm babies admitted more likely to die compared to those who did not congenital
at the neonatology unit of the Regional Hospital Limbe (RHL) malformation. The problem of insufficient material resources, a
was 16.5% of the total number of neonates hospitalised during the standby team to operate, inadequate postoperative care, and the
study period. This high rate could be explained by the fact that absence of a neonatal intensive care unit can explain why preterm
RHL is one of the main centres in the South West Region and infants with congenital malformation have high mortality.
serves as a referral centre for the management of preterm babies
in the area. The prevalence is similar to that reported by Ugwu in Preterm neonates who had apnoea and respiratory distress were
Nigeria [21] and Paudel et al in Nepal [17] who both reported a both 6 times more likely to die than those who did not have these
prevalence of 16.4%. complications. This could be explained by the fact that there is the
unavailability of exogenous surfactant, lack of respiratory support
Our study had a lower prevalence than the 26.5% reported by machines, insufficient trained Staff, higher rates of infections,
Chiabi et al. in Cameroon [7] who carried out a retrospective hypoglycemia and the absence of a kangaroo mother care (KMC)
cross-sectional study at the neonatology unit of the Yaounde unit. Preterm infants who had anaemia were 2 times more likely to
Gynaeco-Obstetric and Paediatric Hospital (YGOPH). This could die than their counterparts without anaemia.
be explained by the difference in the long duration of the study
with the hospital being one of the main referral centres in the Our results were similar to the findings obtained by Chiabi et al
Country where very complicated cases are referred. On the other in Cameroon [7] who found out that there were more deaths in
hand, Awoala et al in Nigeria recorded a higher prevalence rate preterm babies who had congenital malformation. Also, Paudel
(46.4%) of preterm admissions [21]. This can be explained by the et al in Nepal [17] observed more deaths in preterm babies with
difference in the level of the neonatology unit. They did their study respiratory distress syndrome.
in a tertiary unit in an overpopulated town.
Gestational age, gender and oxygen saturation on admission were
Hospital complications of preterm babies independently associated with mortality.
We found out that the frequent hospital complications were
respiratory distress, hypothermia, anaemia infection and jaundice. Males were about 3 times more likely to die than females. This is
This lack of knowledge and practice of correct methods of finding consistent with a study done by Ayele et al in Ethiopia,
transportation for these preterm babies like the Kangaroo mother 2019. This could be explained by the fact that the female fetus
care (KMC) method to prevent hypothermia, is not yet being has a more favourable hormonal milieu leading to accelerated lung
implemented by most health care professionals in our setting. maturation compared to the male fetus. Furthermore, male fetuses
are exposed to higher levels of androgen and Mullerian inhibiting
A lot of pregnant women are already anaemic despite the iron substances, which adversely affect surfactant production [20]
supplement during pregnancy, this could also favour severe Preterm babies born at 28 to less than 32 weeks and 34 to less than
anaemia in our context. Our results were similar to the findings 37 weeks had lesser chances of dying than those born less than
of Ayele et al in Ethiopia [19] where hypothermia, respiratory 28weeks gestation. It is well known that the survival of preterm
problems and jaundice were the most common complications babies increases with each additional gestational week they spend
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in utero. Preterm babies are able to adapt to the extra-uterine life associated with preterm birth at kenyatta national hospital. BMC
as increasing gestational age is associated with better respiratory Pregnancy Childbirth. 2018; 18: 107.
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nal+and+new+born+health+disparities+unicef+data+cam-
Limitation eroon&oq=&aqs=chrome.0.69i59i450l8.121502795j0j7&-
Due to the retrospective nature of this study, we were unable to get sourceid=chrome&ie=UTF-8
information of some preterm babies which would have been useful 11. Mokuolu OA, Suleiman B, Adesiyun O, et al. Prevalence and
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preterm babies. The mortality rate of preterm babies admitted at the 14. Griffin JB, Jobe AH, Rouse D, et al. Evaluating WHO-
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