Department of Paediatrics, Port Vila General Hospital, Port Vila, Vanuatu.
Health Clinic, Leomala Medical, Luganville, Vanuatu.
J Paediatr Child Health. 2023 May;59(5):753-759. doi: 10.1111/jpc.16388. Epub 2023 Mar 30.
Medical care and technology have increased the survival of low birthweight babies (LBW), but especially in low- and middle-income settings the longer term thriving of such babies is not assured because of their fragility, limited services and difficult access after discharge from hospital. In Vanuatu, a Pacific nation of dispersed islands, improving LBW outcomes and survival remains a significant challenge. In this study, we prospectively document the survival, developmental and nutritional outcomes of a cohort of LBW over the first year of life. We also explored the mother's experiences of caring for an LBW baby in hospital and at home.
A prospective descriptive cohort study of 49 newborns weighing less than 2.5 kg, born between April and August 2019. Data were recorded on their hospital stay, and they were followed up at 6 and 12 months post-discharge and outcomes recorded. Developmental milestones were assessed using the Denver Developmental Screening Test, using milestones appropriate for corrected age. Qualitative interviews were conducted to identify experiences and challenges the mothers faced in caring for their LBW baby.
The mean birthweight was 1800 g at 35 weeks gestation (between 2nd and 9th centile). At 6 months of age the median weight was 6.5 kg (9th centile) and at 12 months it was 7.8 kg (9th centile). Three infants died in the first 6 months post-discharge. By 12 months of age, the proportion of infants who had achieved milestones of social and emotional (90%), language and communication (97%), cognition (85%) and motor (69%) development. One had evidence of retinopathy, and 19 had clinical anaemia. Mothers identified several stressors that they attributed as risk factors for premature delivery and outlined the difficulties and isolation of caring for an LBW baby.
It is vital that all LBW babies are followed up in the years after discharge: nutritional, developmental and general health outcomes were generally good; however, post-discharge deaths are more common in this group than in the general population. Equally important is the support for mothers of LBW babies to achieve better outcomes.
医疗保健和技术的进步提高了低出生体重儿（LBW）的存活率，但在中低收入国家，由于这些婴儿的脆弱性、有限的服务以及出院后难以获得医疗资源，他们能否长期茁壮成长仍未得到保障。在瓦努阿图，这个太平洋岛国由分散的岛屿组成，改善 LBW 的结局和存活率仍然是一个重大挑战。在这项研究中，我们前瞻性地记录了一个 LBW 队列在生命的第一年的生存、发育和营养结局。我们还探讨了母亲在医院和家中照顾 LBW 婴儿的经历。
这是一项前瞻性描述性队列研究，纳入了 2019 年 4 月至 8 月期间出生、体重不足 2.5kg 的 49 名新生儿。记录他们在医院的住院情况，并在出院后 6 个月和 12 个月进行随访，记录结局。使用适合矫正年龄的丹佛发育筛查测试评估发育里程碑。进行定性访谈以确定母亲在照顾 LBW 婴儿时面临的经验和挑战。
平均出生体重为 1800g，胎龄为 35 周（第 2-9 百分位数）。6 个月时的中位数体重为 6.5kg（第 9 百分位数），12 个月时为 7.8kg（第 9 百分位数）。有 3 名婴儿在出院后 6 个月内死亡。12 个月时，有社交和情感（90%）、语言和交流（97%）、认知（85%）和运动（69%）发育里程碑的婴儿比例。1 例有视网膜病变证据，19 例有临床贫血。母亲确定了几个压力源，他们认为这些压力源是早产的危险因素，并概述了照顾 LBW 婴儿的困难和孤立感。
所有 LBW 婴儿在出院后都需要进行随访：营养、发育和一般健康结局总体良好；然而，该组的出院后死亡率高于一般人群。同样重要的是，为 LBW 婴儿的母亲提供支持，以实现更好的结局。
