Abstract
IntroductionThe level of clinical care and facilities to support the often more viable full-term newborns with normal birth weight compared with preterm/low birth weight newborns that require special care at birth are likely to be attainable in many resource-poor settings. However, the nature of the required care is not evident in current literature. This study therefore set out to determine maternal and perinatal profile of surviving full-term newborns with normal birth weight in a poorly-resourced setting.MethodsA retrospective cohort study of newborns with gestational age ≥37 weeks and birth weight ≥2500g recruited in an inner-city maternity hospital in Lagos, Nigeria. Primary factors/outcomes were determined by multivariate logistic regression analyses and population attributable risk (PAR).ResultsOf the 2687 full-term newborns with normal birth weight studied, 242 (9.0%) were admitted into special care baby unit (SCBU) representing 53.6% of all SCBU admissions. Fetal distress, low 5-minute Apgar scores, neonatal sepsis and hyperbilirubinemia as well as maternal factors such as primiparity, type of employment, lack of antenatal care and emergency cesarean delivery were predictive of SCBU admission. The leading contributors to SCBU admission were neonatal sepsis (PAR=96.8%), and hyperbilirubinemia (PAR=58.7%).ConclusionA significant proportion of newborns requiring special care are full-term with normal birth weight and are associated with modifiable risk factors that can be effectively addressed at appropriately equipped secondary-level hospitals. Prenatal maternal education on avoidable risk factors is warranted.
Highlights
The level of clinical care and facilities to support the often more viable full-term newborns with normal birth weight compared with preterm/low birth weight newborns that require special care at birth are likely to be attainable in many resource-poor settings
Infant factors significantly associated with special care baby unit (SCBU) admission were fetal distress, low Apgar scores at 1 and 5 minutes, neonatal sepsis and hyperbilirubinemia
Mothers of newborns admitted into SCBU were significantly likely to be primiparous (OR:1.56; 95% confidence intervals (CI):1.10-2.21), self-employed (OR:2.63; 95% CI:1.57-4.40) or in regular employment (OR:1.82; 95% CI:1.05-3.16), lacking antenatal care (OR:2.00; 95% CI:1.41-2.82) and delivered by emergency cesarean section (OR:2.39; 95% CI:1.12-5.08)
Summary
The level of clinical care and facilities to support the often more viable full-term newborns with normal birth weight compared with preterm/low birth weight newborns that require special care at birth are likely to be attainable in many resource-poor settings. The constraints imposed by the widespread lack of NICU facilities required more frequently by preterm and low birth weight newborns have prompted suggestions for a higher priority in providing effective services for the more viable full-term newborns requiring special care in order to optimize the limited human and financial resources in these countries [14,15]. This retrospective study set out to determine the maternal and perinatal profile of full-term newborns that are likely to graduate from NICU/SCBU in a resourcepoor setting to facilitate improved services and better outcomes for such infants
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