Causes, survival rates, and short-term outcomes of preterm births in a tertiary hospital in a low resource setting: An observational cohort study

Very low birth weight infant outcomes in a resource-limited setting: a five-year follow-up study

Background

Preterm birth and very low birth weight (VLBW) remain major contributors to neonatal morbidity and mortality, particularly in low-income settings such as Indonesia, where healthcare resources are limited. In response, the Ministry of Health introduced mentoring programs in 2014, followed by intensive neonatal training initiatives in 2015. These interventions substantially improved survival rates for LBW infants however, they face significant growth and developmental challenges. This study aims to investigate the growth and development of VLBW infants in remote area at five years of age.

Method

Data were collected retrospectively between September 2021 and May 2022 from children born between 2016 and 2017 with VLBW (<1,500 grams) at Biak Regional Hospital, Indonesia. Growth parameters, including stunting and wasting and developmental outcomes such as cerebral palsy, blindness, and developmental impairment or delays were assessed after 5 years of age for follow up assessment.

Results

Among 78 identified infants with VLBW, 54 infants (69.2%) with a gestational age of <34 weeks were discharged alive between 2016 and 2017. Their gestational ages ranged from 27 to 33 weeks, with birth weights between 625 and 1,400 grams. Overall, 12 infants died before reaching one year of age while five died after one year. The 1-year survival rate was 77.8%, while 5-year survival rate was 68.5%. The incidences of stunting, wasting, cerebral palsy, and blindness were 32.1%, 46.4%, 21.4%, and 10.7%, respectively.

Conclusion

The high prevalence of growth and developmental impairments highlights the need for sustained multidisciplinary efforts to improve long-term outcomes for VLBW infants. In resource-limited settings, the focus should extend beyond survival to ensure optimal growth and development of the children.

Preterm delivery in Ghana: challenges and implications for maternal mental health trajectories

PURPOSE

The present study examined mothers' experiences with preterm infants in Accra, Ghana, at a time when the COVID-19 pandemic, existing poverty, and global economic depressions severely challenged access to communal, familial, and individual resources. We argue that, in a family crisis, contextual and external institutional resources, such as access to quality healthcare resources, play crucial roles in mothers' risk exposure and adaptation.

STUDY DESIGN/METHODOLOGY/APPROACH

Using a qualitative approach with an immersive exploratory-descriptive design, the study interviewed twenty-five (25) mothers whose preterm infants were discharged from the Neonatal Intensive Care Unit (NICU) of Korle Bu Teaching Hospital in Accra, Ghana.

FINDINGS

The study showed that mothers of preterm infants experienced varying range of challenges, including diminished appetite, decreased productivity, and feelings of hopelessness, both during and following their infants' hospitalization. Having access to adequate income, information, medication, and experienced medical practitioners remains critical to the management of stressful situations associated with the care of preterm children.

CONCLUSION FOR PRACTICE

Access to funding, preterm information, quality medication, and qualified health professionals can help mothers of preterm infants' better deal with negative experiences than those who do not have adequate amounts of these resources. Access to critical resources can safeguard mothers' mental health and the survival of preterm infants within the first year of delivery. A policy on the existing national health insurance scheme can be enacted to expand coverage and absorb the cost of care for the mother and child within the first eighteen months after delivery.

Perinatal loss in Tanzania: Perspectives of maternal-child healthcare providers

Over 98% of stillbirths and neonatal deaths occur in Low- and Middle-Income Countries, such as Tanzania. Despite the profound burden of perinatal loss in these regions, access to facility or community-based palliative and psychosocial care is poor and understudied. In this study we explore perinatal loss through the lens of front-line healthcare providers, to better understand the knowledge and beliefs that guide their engagement with bereaved families. A Knowledge Attitudes and Practices survey addressing perinatal loss in Tanzania was developed, translated into Swahili, and administered over a 4-month period to healthcare professionals working at the Kilimanjaro Christian Medical Center (KCMC). Results were entered into REDCap and analyzed in R Studio. 74 providers completed the survey. Pediatric providers saw a yearly average of 5 stillbirths and 32.7 neonatal deaths. Obstetric providers saw an average of 11.5 stillbirths and 13.12 neonatal deaths. Most providers would provide resuscitation beginning at 28 weeks gestational age. Respondents estimated that a 50% chance of survival for a newborn occurred at 28 weeks both nationally and at KCMC. Most providers felt that stillbirth and neonatal mortality were not the mother's fault (78.4% and 81.1%). However, nearly half (44.6%) felt that stillbirth reflects negatively on the woman and 62.2% agreed that women are at higher risk of abuse or abandonment after stillbirth. A majority perceived that women wanted hold their child after stillbirth (63.0%) or neonatal death (70.3%). Overall, this study found that providers at KCMC perceived that women are at greater risk of psychosocial or physical harm following perinatal loss. How women can best be supported by both the health system and their community remains unclear. More research on perinatal loss and bereavement in LMICs is needed to inform patient-level and health-systems interventions addressing care gaps unique to resource-limited or non-western settings.

Impact of Genital Infections and Antibiotic Use on Incidence of Preterm Birth: A Retrospective Observational Study

This study investigates the complex interplay among genital infections, antibiotic usage, and preterm birth. This study aims to identify common genital pathogens associated with preterm births, assess the impact of various antibiotic treatments on pregnancy outcomes, and understand antibiotic resistance patterns among these pathogens. This study included 71 pregnant women who experienced preterm birth and 94 women with genital infections who delivered at term. Various maternal characteristics, medical history, signs and symptoms, gestational weight, gestational age, type of birth, vaginal pH, Nugent scores, and vaginal flora were analyzed. Antibiotic resistance patterns of isolated microorganisms were also examined. The prevalence of sexually transmitted diseases (STDs) and genital herpes was significantly higher in the preterm group. Preterm births were associated with fever, pelvic pain, vaginal spotting, and fatigue. Vaginal pH levels and Nugent scores were significantly higher in the preterm group, indicating disturbed vaginal flora. The presence of Extended-Spectrum Beta-Lactamases (ESBLs) was a particularly strong risk factor, increasing by more than four times the odds of preterm birth (OR = 4.45, p = 0.001). Vancomycin-Resistant Enterococci (VRE) presence was another critical factor, with a four-fold increase in the odds of preterm birth (OR = 4.01, p = 0.034). The overall presence of Multidrug-Resistant (MDR) organisms significantly increased the odds of preterm birth (OR = 3.73, p = 0.001). Specific pathogens like Chlamydia trachomatis (OR = 3.12, p = 0.020) and Mycoplasma hominis (OR = 3.64, p = 0.006) were also identified as significant risk factors. Ureaplasma urealyticum also showed a significantly higher risk of preterm birth (OR = 2.76, p = 0.009). This study highlights the importance of screening for and treating genital infections during pregnancy, especially STDs and genital herpes, as they can significantly increase the risk of preterm birth. Additionally, the presence of specific microorganisms and antibiotic resistance patterns plays an essential role in preterm birth risk. Early detection and targeted antibiotic treatment may help mitigate this risk and improve pregnancy outcomes.