Survival Determinants of Preterm Infants in a Neonatal Care Unit at a Tertiary Hospital in Kenya

Abstract

Preterm birth presents a significant challenge, particularly in developing nations like Kenya. The survival of preterm infants in neonatal care units is influenced by a complex array of factors, encompassing maternal health, neonatal characteristics, and institutional practices. Understanding these factors is imperative for enhancing preterm infant care. In this study, we investigated survival determinants among preterm infants at a Kenyan tertiary hospital to improve neonatal care practices and outcomes. Employing a mixed-methods approach, we integrated retrospective data analysis of preterm baby files with a nursing staff survey. Statistical analysis was utilized to correlate factors with preterm birth. Antenatal care (ANC) attendance emerged as a crucial factor, with the risk of preterm birth reduced by 68% for those attending four or more ANC visits (X2=6.47, p=0.01). Cesarean section,
which accounted for 45% of deliveries, showed a significant association with maternal age (X2=3.93, p=0.04). The implementation of Kangaroo Mother Care resulted in a notable 45% reduction in neonatal mortality (p<0.001, 95% CI [0.36, 0.55]). Mortality risk was highest among extremely preterm infants (20%) and decreased progressively, reaching 95% for those born at 28-32 weeks’ gestation. Moreover, 44% of infants had very low birth weight (1000-1500 grams), and females exhibited a lower survival rate (81%) compared to males (92%). All infants initiated breastfeeding within an hour, promoting health and survival. Additionally, corticosteroid administration significantly reduced neonatal morbidity (p<0.001, 95% CI [0.25, 0.44]). However, inadequate staffing levels were noted, underscoring the need for improvement. Proper humidification was found to enhance respiratory care, while the utilization of medical advances improved outcomes. This research emphasizes the importance of neonatal care considerations in reducing preterm infant mortality, thereby informing interventions at healthcare facilities.