[Variables determining the amount of care for very preterm neonates: the concept of medical stance]

[Trends in neonatal mortality of very-low-birth-weight infants between 1998 and 2013 in Essos Hospital, Yaoundé, Cameroon]

OBJECTIVE

To measure the mortality rate and the survival of very-low-birth-weight (VLBW) infants at two given periods.

METHOD

Descriptive retrospective study. Data were extracted from activity reports and pediatric registries during the years 1998, 1999, and 2004 for the first period and from 2010 to 2013 from the second period. This population study comprised all VLBW infants admitted to the unit weighing <1500g irrespective of gestational age. The main outcome measurement was the percentage of VLBW infants discharged alive during each period.

RESULTS

During the cumulated period, we included a total of 5250 newborn babies, of whom 315 were VLBW, giving a prevalence of 6% (7.1% in period 1 vs 5.5% in period 2, P≤0.05). The overall survival rate of VLNW infants was 52%, corresponding to a mortality rate of 48%. The death rate was 53% during the first period vs 46% in period 2 (P=0.9). In infants weighing between 1000 and 1500g, the mortality rate ranged from 47% in period 1 to 37% in period 2 (P≤0.05). Below 1000g, the rate of survival was consistently below 5%, significantly lower than for infants born above 1000g (P<0.001). In period 2, the caesarian section rate was 7% (20/217), 11% between 1000 and 1500g, 0% below 1000g. The mortality rate was higher with vaginal delivery (47%; 93/196) versus 20% caesarian section (4/20) (OR 3, 61 [1.17-11], P≤0.02).

CONCLUSION

In this center, the hospital mortality rate of VLBW infants seems to have improved, notably in those weighing more than 1000g. Significant efforts are needed to prevent VLBW births and improve management of both delivery and newborn care.