Ahlsén Anna Karin, Spong Elinor, Kafumba Nomsa, Kamwendo Francis, Wolff Kerstin
Department of Obstetrics and Gynaecology, Södertälje Sjukhus, Södertälje, Sweden Department of Obstetrics and Gynaecology, Kamuzu Central Hospital, Lilongwe, Malawi Department of International Collaborations, Oslo University Hospital, Oslo, Norway.
Motala Hospital, Motala, Sweden.
Arch Dis Child Fetal Neonatal Ed. 2015 Mar;100(2):F150-4. doi: 10.1136/archdischild-2013-305877. Epub 2014 Dec 16.
Malawi has the highest estimated preterm birth rate in the world. The survival rate of these babies is not known. The main objective of this study was to demonstrate the short-term survival of infants with birth weight below 2500 g nursed in Bwaila Hospital, a district hospital, and the tertiary level Kamuzu Central Hospital (KCH) in Lilongwe. The specific objectives were to calculate birth weight specific survival rates, compare the two hospitals regarding the chances of survival and review the use of antenatal corticosteroids.
1496 babies were included prospectively in the study between June and November 2012. Survival was defined as discharge from the nursery or postnatal ward.
Survival was 7% for extremely low birth weight infants, 52% for very low birth weight and 90% for low birth weight (1500-2499 g). There was a marked increase in survival from 1100 g. Survival was significantly higher in KCH only for babies weighing below 1200 g. The majority of deaths occurred within the first 3 days of life. Only 98 of the babies had a mother who had received antenatal corticosteroids.
With the current resources, we suggest focusing efforts on preventing early neonatal deaths in low birth weight infants above 1100 g in the hospitals in Lilongwe. The coverage of antenatal steroids for mothers at risk of preterm delivery can be improved. Further studies are needed on the quality of the obstetric and neonatal care at the hospitals and how to reduce the high rate of preterm birth in Malawi.
马拉维的早产率估计为全球最高。这些婴儿的存活率尚不清楚。本研究的主要目的是证明在利隆圭的一家区级医院——布瓦伊拉医院以及三级医疗机构卡穆祖中央医院（KCH）护理的出生体重低于2500克的婴儿的短期存活率。具体目标是计算特定出生体重的存活率，比较两家医院的存活几率，并审查产前皮质类固醇的使用情况。
2012年6月至11月期间，前瞻性纳入1496名婴儿进行研究。存活定义为从新生儿病房或产后病房出院。
极低出生体重婴儿的存活率为7%，超低出生体重婴儿为52%，低出生体重（1500 - 2499克）婴儿为90%。从1100克起存活率显著上升。仅在KCH，体重低于1200克的婴儿存活率显著更高。大多数死亡发生在出生后的前3天。只有98名婴儿的母亲接受了产前皮质类固醇治疗。
基于目前的资源，我们建议集中精力预防利隆圭各医院中出生体重超过1100克的低出生体重婴儿的早期新生儿死亡。可提高有早产风险的母亲产前类固醇的覆盖率。需要进一步研究各医院产科和新生儿护理的质量以及如何降低马拉维的高早产率。
