Short-term Outcomes of Asphyxia in Preterm Neonates Receiving Care at Newborn Unit, Kenyatta National Hospital

Abstract

Background: Neonatal resuscitation plays a major role in preventing neonatal death due to asphyxia. Globally, it is estimated that out of 2.5 million neonatal deaths that occur annually, 28% of which is attributed to preterm delivery and 24% result from perinatal asphyxia. However, despite Kenyatta National Hospital being a teaching and referral hospital providing specialty neonatal care, there is paucity of data on short term outcomes of asphyxia in pre-term neonates hence the need this study. Objective: This study aimed at determining short-term outcomes of birth asphyxia in preterm neonates receiving care at Kenyatta National Hospital Newborn Unit. Methods: A hospital-based descriptive cross-sectional study was conducted between the month of June and July 2019 involving mother-infant pair of preterm neonates with asphyxia (n=36) selected purposively and Nurses working in the newborn unit (n=52) selected via systematic random technique. Maternal socio-demographic characteristics and nurses‟ characteristics were collected using semi-structured questionnaire and a separate checklist used to capture daily neurological assessment for infant in the first seven days of life. Data collected were analyzed using STATA version 14, descriptive and inferential statistics calculated using Odds Ratio with bivariate and multinomial logistic regression applied to independent variables with level of significance set at 95% Confidence Interval and p value = ≤ 0.05. Results: Out of 34 infant mothers that took part in the study, advanced maternal age (AOR =3.3, 95% CI [-1571.4-1577.9]), distance from medical facility (AOR = -32, 95% CI [-20829.8- 20765.5]), low income status (AOR = -23, 95% CI [-25.8-21,4]) and anemia in pregnancy (AOR=12.8, 95% CI[-18048.2-18073.7]) was shown to increase the risk for adverse neonatal outcome. By the end of day seven of life, 55.8% of neonates (n=19) had recovered and got discharged, 35.2 % (n=12) continued treatment and 9% (n=3) had expired. Neonatal characteristics such as decreased birth weight (AOR= 0.17, 95% CI [-1054957-1054958]), low APGAR score (AOR= -91.01, 95% CI [0.23-8.1]) and poor monitoring of vital signs (AOR= - 1.17, 95% CI [-8.04-8.0]) in neonates was found to influence neonatal outcome. There was no significant statistical association between knowledge of nurses on preterm asphyxia and its management in relation to neonatal outcome (p=0.635). Similarly, no significant statistical association was found to exist between nurses‟ practice regarding immediate care of asphyxiated neonate and neonatal outcome (p=0.512). Conclusion: In Kenyatta National Hospital, the mortality rate of asphyxia in preterm neonates was found to be 9 % with morbidity rate of 35% on day seven of life and this was largely determined by maternal and neonatal risk factors rather nurse‟s knowledge and practice on management of asphyxia. Recommendations: There is need to strengthen prevention of anemia in pregnancy and identification of risk factors associated with preterm asphyxia. Nurses should practice strict observation of vital signs in high risk neonates to improve outcome. Prompt treatment of hypoglycemia and sepsis in preterm neonate can help prevent neonatal morbidity and mortality in early neonatal period.