Survival and Risk Factors for Late Preterm and Early Term Neonates Compared to Full-Term Infants at Garissa County Referral Hospital, Kenya

https://doi.org/10.51867/ajernet.5.4.46

Authors

  • Tom Amolo (MSc) Department of Public Health, Masinde Muliro University of Science and Technology P. O. Box P.O BOX 190- 50100, Kakamega, Kenya https://orcid.org/0000-0002-2034-7250
  • Evans Raballah (PhD) Department of Medical Laboratory Science, Masinde Muliro University of Science and Technology P. O. Box P.O BOX 190- 50100, Kakamega, Kenya https://orcid.org/0000-0002-3304-6836
  • Rose Olayo (PhD) Department of Public Health, Masinde Muliro University of Science and Technology P. O. Box P.O BOX 190- 50100, Kakamega, Kenya https://orcid.org/0000-0002-8125-9625
  • Gladys C. Esendi (MSc) Department of Medical Laboratory Science, Masinde Muliro University of Science and Technology P. O. Box P.O BOX 190- 50100, Kakamega, Kenya
  • Walter Otieno (PhD) Department of Paediatrics and Child Health, School of Medicine, Maseno University, Private Bag, Maseno, Kenya

Keywords:

Late Preterm Neonate, Early Term Neonate, Maternal-Related, Fetal-Related, Risk Factor, Birth, Garissa

Abstract

Preterm birth constitutes a significant health burden in Kenya, yet there is hardly any targeted research looking at the survival and specific risk factors associated with birth of late preterm neonates (LPNs) and early term neonates (ETNs), particularly in Garissa County. While studies on preterm birth determinants have been done in Kenya, factors specifically influencing LPNs and ETNs births and their survival relative to their full-term counterparts remain understudied. Studies done on preterm in general have identified maternal age, history of preterm birth, pregnancy-induced hypertension, and prolonged premature rapture of the membrane among others as significant risk factors, but their relevance to LPNs and ETNs specifically has not been fully investigated. This study aimed to address these gaps by determining maternal as well as fetal risk factors associated with LPN and ETN births compared to full-term neonates (FTNs) born at Garissa County Referral Hospital. Further, it sought to identify predictors of survival across these neonatal groups. The study conducted at Garissa County Referral Hospital employed a prospective cohort design.  Mother-neonate dyads were enrolled using convenience sampling method until the required sample was achieved. Data was collected using pretested and validated questionnaires.  STATA version 17 was used for analysis. Multinomial logistic regression analysis was performed to determine Relative Risk Ratio. The P-value was set α=0.05 and P<0.05 was considered statistically significant. Survival rates were estimated using Kaplan-Meier survival analysis. Bivariate Cox regression analysis was employed to identify independent predictors at p<0.20. However, since all variables had p-values >0.02, multivariate Cox regression was not conducted. The study revealed that maternal age (P=0.042), occupation (P=0.024), ethnicity (P=0.021), religion (P=0.016) and absence of previous abortion/still birth/premature deliveries (P=0.015) were maternal related factors associated with birth of LPN, ETN and FTN. Birth weight was associated with LPN (P<0.001), while FTN had higher likelihood of delayed initiation of breastfeeding (P=0.038) but were less likely to have feeding difficulties compared to LPN and ETN (P=0.012). A comparison of fit model with the complete set of predictors with an intercept-only, or null model revealed that P-values for maternal (P=0.0175) and fetal (P<0.001) related risk factors were less than Fisher’s value of 0.05, hence the null hypothesis was rejected. The Kaplan-Meier survival analysis revealed high survival rates across all gestational age categories, with 100% survival among LPNs. In conclusion, the study showed that maternal- and fetal-related risk factors associated with LPNs and ETNs are distinct from those of FTNs.

Dimensions

Algameel, A., Elhawary, M., Amin, S., & Abd Elmenem, M. (2020). Outcome of late preterm newborns in Upper Egypt. Egyptian Pediatric Association Gazette, 68(1), 11. https://doi.org/10.1186/s43054-020-00023-1 DOI: https://doi.org/10.1186/s43054-020-00023-1

Ananth, C. V., Ananth, C. V., & Vintzileos, A. M. (2006). Epidemiology of preterm birth and its clinical subtypes. The Journal of Maternal-Fetal & Neonatal Medicine, 19(12), 773-782. https://doi.org/10.1080/14767050600965882 DOI: https://doi.org/10.1080/14767050600965882

Bérard, A., Le Tiec, M., & De Vera, M. A. (2012). Study of the costs and morbidities of late-preterm birth. Archives of Disease in Childhood - Fetal and Neonatal Edition, 97(5), F329-F334. https://doi.org/10.1136/fetalneonatal-2011-300969 DOI: https://doi.org/10.1136/fetalneonatal-2011-300969

Brown, H., Speechley, K., Macnab, J., Natale, R., & Campbell, M. (2015). Biological determinants of spontaneous late preterm and early term birth: a retrospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 122(4), 491-499. https://doi.org/10.1111/1471-0528.13191 DOI: https://doi.org/10.1111/1471-0528.13191

Brown, H., Speechley, K., Macnab, J., Natale, R., & Campbell, M. (2016). Maternal, fetal, and placental conditions associated with medically indicated late preterm and early term delivery: a retrospective study. BJOG: An International Journal of Obstetrics & Gynaecology, 123(5), 763-770. https://doi.org/10.1111/1471-0528.13428 DOI: https://doi.org/10.1111/1471-0528.13428

Chawanpaiboon, S., Vogel, J. P., Moller, A.-B., Lumbiganon, P., Petzold, M., Hogan, D., Landoulsi, S., Jampathong, N., Kongwattanakul, K., Laopaiboon, M., Lewis, C., Rattanakanokchai, S., Teng, D. N., Thinkhamrop, J., Watananirun, K., Zhang, J., Zhou, W., & Gülmezoglu, A. M. (2019). Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. The Lancet Global Health, 7(1), e37-e46. https://doi.org/10.1016/S2214-109X(18)30451-0 DOI: https://doi.org/10.1016/S2214-109X(18)30451-0

Davidoff, M. J., Dias, T., Damus, K., Russell, R., Bettegowda, V. R., Dolan, S., Schwarz, R. H., Green, N. S., & Petrini, J. (2006). Changes in the Gestational Age Distribution among U.S. Singleton Births: Impact on Rates of Late Preterm Birth, 1992 to 2002. Seminars in Perinatology, 30(1), 8-15. https://doi.org/10.1053/j.semperi.2006.01.009 DOI: https://doi.org/10.1053/j.semperi.2006.01.009

Delnord, M., & Zeitlin, J. (2019). Epidemiology of late preterm and early term births - An international perspective. Seminars in Fetal and Neonatal Medicine, 24(1), 3-10. https://doi.org/10.1016/j.siny.2018.09.001 DOI: https://doi.org/10.1016/j.siny.2018.09.001

Engle, W. A., Tomashek, K. M., & Wallman, C. (2007). "Late-Preterm" Infants: A Population at Risk. Pediatrics, 120(6), 1390-1401. https://doi.org/10.1542/peds.2007-2952 DOI: https://doi.org/10.1542/peds.2007-2952

Eşki, A., Ceylan, G., & Zenciroğlu, A. (2023). Risk Factors and Morbidity in Late-preterm Infants: A Comparison with Early-term and Full-term Infants. Anatolian Journal of Medicine, 33(3), 349-356. https://doi.org/10.4274/anatoljmed.2023.40799 DOI: https://doi.org/10.4274/anatoljmed.2023.40799

Etil, T., Opio, B., Odur, B., Lwanga, C., & Atuhaire, L. (2023). Risk factors associated with preterm birth among mothers delivered at Lira Regional Referral Hospital. BMC Pregnancy and Childbirth, 23(1), 814. https://doi.org/10.1186/s12884-023-06120-4 DOI: https://doi.org/10.1186/s12884-023-06120-4

Goldenberg, R. L., Culhane, J. F., Iams, J. D., & Romero, R. (2008). Epidemiology and causes of preterm birth. The Lancet, 371(9606), 75-84.

https://doi.org/10.1016/S0140-6736(08)60074-4 DOI: https://doi.org/10.1016/S0140-6736(08)60074-4

Hankins, G. D. V., & Longo, M. (2006). The Role of Stillbirth Prevention and Late Preterm (Near-Term) Births. Seminars in Perinatology, 30(1), 20-23. https://doi.org/10.1053/j.semperi.2006.01.011 DOI: https://doi.org/10.1053/j.semperi.2006.01.011

Karnati, S., Kollikonda, S., & Abu-Shaweesh, J. (2020). Late preterm infants - Changing trends and continuing challenges. International Journal of Pediatrics & Adolescent Medicine, 7(1), 36-44. https://doi.org/10.1016/j.ijpam.2020.02.006 DOI: https://doi.org/10.1016/j.ijpam.2020.02.006

Linhart, Y., Bashiri, A., Maymon, E., Shoham-Vardi, I., Furman, B., Vardi, H., & Mazor, M. (2000). Congenital anomalies are an independent risk factor for neonatal morbidity and perinatal mortality in preterm birth. European Journal of Obstetrics & Gynecology and Reproductive Biology, 90(1), 43-49. https://doi.org/10.1016/S0301-2115(99)00196-7 DOI: https://doi.org/10.1016/S0301-2115(99)00196-7

Mengesha, H. G., Wuneh, A. D., Lerebo, W. T., & Tekle, T. H. (2016). Survival of neonates and predictors of their mortality in Tigray region, Northern Ethiopia: prospective cohort study. BMC Pregnancy and Childbirth, 16(1), 202. https://doi.org/10.1186/s12884-016-0994-9 DOI: https://doi.org/10.1186/s12884-016-0994-9

Okube, O. T., & Sambu, L. M. (2017). Determinants of Preterm Birth at the Postnatal Ward of Kenyatta National Hospital, Nairobi, Kenya. Open Journal of Obstetrics and Gynecology, 07(09), 973-988. https://doi.org/10.4236/ojog.2017.79099 DOI: https://doi.org/10.4236/ojog.2017.79099

Pusdekar, Y. V., Patel, A. B., Kurhe, K. G., Bhargav, S. R., Thorsten, V., Garces, A., Goldenberg, R. L., Goudar, S. S., Saleem, S., Esamai, F., Chomba, E., Bauserman, M., Bose, C. L., Liechty, E. A., Krebs, N. F., Derman, R. J., Carlo, W. A., Koso-Thomas, M., Nolen, T. L., … Hibberd, P. L. (2020). Rates and risk factors for preterm birth and low birthweight in the global network sites in six low- and low middle-income countries. Reproductive Health, 17(S3), 187. https://doi.org/10.1186/s12978-020-01029-z DOI: https://doi.org/10.1186/s12978-020-01029-z

Reddy, U. M., Ko, C.-W., Raju, T. N. K., & Willinger, M. (2009). Delivery Indications at Late-Preterm Gestations and Infant Mortality Rates in the United States. Pediatrics, 124(1), 234-240. https://doi.org/10.1542/peds.2008-3232 DOI: https://doi.org/10.1542/peds.2008-3232

Shapiro-Mendoza, C. K., & Lackritz, E. M. (2012). Epidemiology of late and moderate preterm birth. Seminars in Fetal and Neonatal Medicine, 17(3), 120-125. https://doi.org/10.1016/j.siny.2012.01.007 DOI: https://doi.org/10.1016/j.siny.2012.01.007

Tamene, A., Abeje, G., & Addis, Z. (2020). Survival and associated factors of mortality of preterm neonates admitted to Felege Hiwot specialized hospital, Bahir Dar, Ethiopia. SAGE Open Medicine, 8. https://doi.org/10.1177/2050312120953646 DOI: https://doi.org/10.1177/2050312120953646

Tan, J. H. T., Poon, W. B., Lian, W. Bin, & Ho, S. K. Y. (2014). A Comparison of the Short-term Morbidity and Mortality Between Late Preterm and Term Newborns. Annals of the Academy of Medicine, Singapore, 43(7), 346-354. https://doi.org/10.47102/annals-acadmedsg.V43N7p346 DOI: https://doi.org/10.47102/annals-acadmedsg.V43N7p346

Torres-Muñoz, J., Jiménez-Fernandez, C. A., Ortega, R. R., Cuero, D. J. M., & Mendoza, D. M. (2020). Factors Associated With Late Prematurity in the University Hospital of Valle Cali, Colombia During 2013-2014. Frontiers in Public Health, 8. https://doi.org/10.3389/fpubh.2020.00200 DOI: https://doi.org/10.3389/fpubh.2020.00200

van den Broek, N. R., Jean-Baptiste, R., & Neilson, J. P. (2014). Factors Associated with Preterm, Early Preterm and Late Preterm Birth in Malawi. PLoS ONE, 9(3), e90128. https://doi.org/10.1371/journal.pone.0090128 DOI: https://doi.org/10.1371/journal.pone.0090128

Vanin, L. K., Zatti, H., Soncini, T., Nunes, R. D., & Siqueira, L. B. S. de. (2020). MATERNAL AND FETAL RISK FACTORS ASSOCIATED WITH LATE PRETERM INFANTS. Revista Paulista de Pediatria : Orgao Oficial Da Sociedade de Pediatria de Sao Paulo, 38, e2018136. https://doi.org/10.1590/1984-0462/2020/38/2018136 DOI: https://doi.org/10.1590/1984-0462/2020/38/2018136

Wagura, P., Wasunna, A., Laving, A., Wamalwa, D., & Ng'ang'a, P. (2018). Prevalence and factors associated with preterm birth at kenyatta national hospital. BMC Pregnancy and Childbirth, 18(1), 107. https://doi.org/10.1186/s12884-018-1740-2 DOI: https://doi.org/10.1186/s12884-018-1740-2

Wang, M. L., Dorer, D. J., Fleming, M. P., & Catlin, E. A. (2004). Clinical Outcomes of Near-Term Infants. Pediatrics, 114(2), 372-376. https://doi.org/10.1542/peds.114.2.372 DOI: https://doi.org/10.1542/peds.114.2.372

Published

2024-10-31

How to Cite

Amolo, T., Raballah, E., Olayo, R., Esendi, G. C., & Otieno, W. (2024). Survival and Risk Factors for Late Preterm and Early Term Neonates Compared to Full-Term Infants at Garissa County Referral Hospital, Kenya. African Journal of Empirical Research, 5(4), 569–582. https://doi.org/10.51867/ajernet.5.4.46

Issue

Vol. 5 No. 4 (2024): Oct-Dec 2024

Section

Articles
Copyright & Licensing

Copyright (c) 2024 Tom Amolo (MSc), Evans Raballah (PhD), Rose Olayo (PhD), Gladys C. Esendi (MSc), Walter Otieno (PhD)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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