Abstract
BackgroundPreterm delivery is among the major public health problems worldwide and the leading cause of morbidity and mortality among neonates. Postnatal poor weight gain, which can contribute to mortality, can be influenced by feeding practices, medical complications and quality of care that is provided to these high-risk neonates. This study aimed to investigate the proportion and predictors of poor weight gain among preterm neonates at Muhimbili National Hospital (MNH), from September 2018 to February 2019.MethodsA hospital-based prospective cohort study involving preterm neonates with Gestation age (GA) < 37 weeks receiving care at MNH. Eligible preterm, were consecutively recruited at admission and followed up until discharge, death or end of neonatal period. Poor weight gain was defined as weight gain less than 15 g per kg per day. The risk factors associated with poor weight gain were evaluated. Predictors of poor weight gain were evaluated using a multivariate analysis. Results were considered statistically significant if P -value was < 0.05 and 95% confidence interval (CI) did not include 1.ResultsA total of 227 preterm neonates < 37 weeks GA, with male to female ratio of 1:1.2 were enrolled in the study. The overall proportion of preterm with poor weight gain was 197/227 (86.8%). Proportion of poor weight gain among the early and late preterm babies, were 100/113 (88.5%) and 97/114 (85.1%) respectively. Predictors of poor weight gain were low level of maternal education (AOR = 2.58; 95%Cl: 1.02–6.53), cup feeding as the initial method of feeding (AOR = 8.65; 95%Cl: 1.59–16.24) and delayed initiation of the first feed more than 48 h (AOR = 10.06; 95%Cl: 4.14–24.43). A previous history of preterm delivery was protective against poor weight gain (AOR = 0.33; 95% Cl: 0.11–0.79).Conclusion and recommendationPoor weight gain was a significant problem among preterm neonates receiving care at MNH. This can be addressed by emphasizing on early initiation of feed and tube feeding for neonates who are not able to breastfeed. Health education and counselling to mothers focusing on feeding practices as well as close supervision of feeding especially for mothers experiencing difficulties in feeding their preterm will potentially minimize risk of growth failure.
Highlights
Preterm delivery is among the major public health problems worldwide and the leading cause of morbidity and mortality among neonates
The spread of weight amongst preterm were more on Low birth weight (LBW) (56.8%) than extremely low birth weight (ELBW)
Two-thirds of preterm (63.4%) were delivered by spontaneous vaginal delivery and higher proportion were born at Muhimbili National Hospital (MNH) (74.9%)
Summary
Preterm delivery is among the major public health problems worldwide and the leading cause of morbidity and mortality among neonates. The prevalence of preterm deliveries worldwide is higher especially in developing countries. This is associated with increased risk of low birth weight and poor health outcomes including poor growth and development. According to WHO 2018 report [1] preterm birth remains a significant public health concern, and it is the leading cause of neonatal mortality and morbidity. Studies in Tanzania have reported a high prevalence of preterm birth between 10 and 16.7% [2]. Postnatal growth pattern in preterm and LBW neonates is often characterized by initial physiological weight loss in the first 7 days of life of approximately 7–15% of their birth weight. Differences in weight trends have been observed with respect to the age of the preterm, being more marked amongst early and extreme preterm as compared to late preterm [5]
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