Survival of Extremely Preterm Neonates in a Resource-limited Setting

Background: Preterm birth is a major contributor to neonatal and under-five mortality, and births at lower gestational ages (GA) contribute more to these statistics. Most developed countries have succeeded in improving survival at extremes of GA, while most developing countries like Nigeria still lag behind. The objective of this retrospective study was to document the survival rates among extremely preterm neonates and factors associated with mortality in a tertiary center in Nigeria. Methods: The labor ward delivery and neonatal unit admission records were reviewed from January 2010 to December 2017. The GA, gender, mode of delivery, birth weight, duration of admission, and outcomes for babies delivered at 24 to 27 weeks + 6 days of gestation were recorded. The survival rates and factors associated with mortality were analyzed. Results: During this period, there were 11,607 live births with 1,685 (14.5%) preterm deliveries. There were 4,523 admissions to the neonatal unit; overall, 736 (16.3%) cases were preterm neonates out of which 152 (3.4%) subjects were extremely preterm. The overall survival rate was 24.3%, and the survival rate increased with increasing GA and birth weight (BW). Most deaths occurred in the first week of life. The means of BW and GA were significantly lower in babies that died, compared to those who survived. The median duration of admission was also lower for those that died, compared to those that survived. The most common causes of death were respiratory distress, sepsis, and intracranial hemorrhage. Conclusion: The survival rate of extremely preterm neonates is low in this study. Facilities to improve care, especially for respiratory support should be put in place to reduce mortality.