Mocking Martina, Adu-Bonsaffoh Kwame, Osman Kwabena A, Tamma Evelyn, Ruiz Alexa M, van Asperen Ruth, Oppong Samuel A, Kleinhout Mirjam Y, Gyamfi-Bannerman Cynthia, Browne Joyce L
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana.
Front Glob Womens Health. 2023 Feb 2;3:989020. doi: 10.3389/fgwh.2022.989020. eCollection 2022.
Prematurity is the most important cause of death among children under the age of five years. Globally, most preterm births occur in Sub-Saharan Africa. Subsequent prematurity leads to significant neonatal morbidity, mortality and long-term disabilities. This study aimed to determine the causes, survival rates and outcomes of preterm births up to six weeks of corrected age in Ghana.
An observational prospective cohort study of infants born preterm was conducted in a tertiary hospital in Accra, Ghana from August 2019 to March 2020. Inclusion was performed within 48 h after birth of surviving infants; multiple pregnancies and stillbirths were excluded. Causes of preterm birth were categorized as spontaneous (including preterm pre-labour rupture of membranes) or provider-initiated (medically indicated birth based on maternal or fetal indications). Survival rates and adverse outcomes were assessed at six weeks of corrected age. Recruitment and follow-up were suspended due to the COVID-19 outbreak. Descriptive statistics and differences between determinants were calculated using Chi-squared tests or Kruskal-Wallis test.
Of the 758 preterm deliveries, 654 (86.3%) infants were born alive. 179 were enrolled in the cohort and were analyzed. Nine (5%) were extremely preterm [gestational age (GA) < 28 weeks], 40 (22%) very preterm (GA 28-31 weeks), and 130 (73%) moderate to late preterm (GA 32-37 weeks) births. Most deliveries ( = 116, 65%) were provider-initiated, often due to hypertensive disorders in pregnancy ( = 79, 44.1%). Sixty-two infants were followed-up out of which fifty-two survived, presenting a survival rate of 84% ( = 52/62) at six weeks corrected age in this group. Most infants (90%, = 47/52) experienced complications, predominantly consisted of NICU admission (92%) and interval illnesses (21%) including jaundice and sepsis.
The incidence of adverse outcomes associated with preterm birth in a tertiary facility with NICU capacity is high. Larger longitudinal studies are needed for an in-depth understanding of the causes and longer-term outcomes of preterm birth, and to identify effective strategies to improve outcomes in resource constrained settings.
早产是五岁以下儿童死亡的最重要原因。在全球范围内，大多数早产发生在撒哈拉以南非洲地区。随后的早产会导致严重的新生儿发病、死亡和长期残疾。本研究旨在确定加纳校正年龄达六周的早产原因、存活率及结局。
2019年8月至2020年3月在加纳阿克拉的一家三级医院对早产婴儿进行了一项观察性前瞻性队列研究。纳入出生后48小时内存活的婴儿；排除多胎妊娠和死产。早产原因分为自发性（包括早产胎膜早破）或医疗人员引发（基于母体或胎儿指征的医学指征性分娩）。在校正年龄六周时评估存活率和不良结局。由于新冠疫情爆发，招募和随访暂停。使用卡方检验或克鲁斯卡尔-沃利斯检验计算描述性统计数据和决定因素之间的差异。
在758例早产分娩中，654例（86.3%）婴儿存活。179例纳入队列并进行分析。9例（5%）为极早早产儿[胎龄（GA）<28周]，40例（22%）为非常早早产儿（GA 28 - 31周），130例（73%）为中度至晚期早产儿（GA 32 - 37周）。大多数分娩（n = 116，65%）是由医疗人员引发的，通常是由于妊娠期高血压疾病（n = 79，44.1%）。62例婴儿接受了随访，其中52例存活，该组校正年龄六周时的存活率为84%（n = 52/62）。大多数婴儿（90%，n = 47/52）出现并发症，主要包括入住新生儿重症监护病房（92%）和间歇性疾病（21%），如黄疸和败血症。
在具备新生儿重症监护病房能力的三级医疗机构中，与早产相关的不良结局发生率很高。需要开展更大规模的纵向研究，以深入了解早产的原因和长期结局，并确定在资源有限环境中改善结局的有效策略。
