Mortality and Short-Term Outcomes of Very Low Birth Weight Infants at a Tertiary Care Center in Jordan: Comparison with Other Countries

Al-lawama, Manar; Abdelghani, Tariq; Badran, Eman

doi:10.4172/2161-0665.1000311

Cited by 5 publications

(8 citation statements)

References 12 publications

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“…A birth weight of ≤ 1200 g and Thompson HIE score of ≥ 15 were independent predictors of mortality among neonates with very low birth weight and perinatal asphyxia respectively. The high mortality rate for high risk neonates in our study corresponds well to results from other low income countries, where neonatal intensive care facilities are not yet available [26,30,31].…”

Section: Discussionsupporting

confidence: 87%

“…Our ndings revealed that the overall proportion of NEC was only 1.4% (4 cases) among the study participants without signi cant difference between the control and intervention groups, but the study was underpowered to detect statistical signi cance. This low incidence of NEC is similar to studies from Iran [25] and Jordan [26]. However, studies examining the age at onset of NEC reported a mean age of 6-7 days for the occurrence of NEC in more mature preterm infants and a possible delay in the onset of NEC to more than 14 days for smaller infants with lower gestational age [27,28].…”

Section: Discussionsupporting

confidence: 86%

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Enhancing early breast milk for sick and preterm neonates admitted at regional referral hospitals in Dar es Salaam, Tanzania

Hyera¹,

Assenga²,

Kazimoto³

et al. 2020

Preprint

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Background: Feeding is a cornerstone in the management of sick or preterm neonates and early initiation of breastfeeding is the single most effective intervention associated with reduced neonatal mortality. However, enteral feeding is often delayed due to haemodynamic instability and the perceived risk of necrotizing enterocolitis (NEC). Alternative routes for early breast milk administration are either oropharyngeal colostrum or minimal enteral nutrition. One strategy to overcome delays in enteral feeds is the implementation of standardized feeding guidelines.Methods: This study was conducted in three regional hospitals in Dar es Salaam, consisting of a historical control group at baseline and an intervention group after implementation of locally developed feeding guidelines. Neonates were consecutively recruited and followed to a maximum of 28 days of life. The controls received routine standard care, while the intervention group received early enteral feeding. The outcomes measured were NEC, time to regain birth weight and neonatal mortality. Odds ratio was used to determine the association between feeding and outcomes, statistical significance was considered when p-value ≤0.05.Results: 292 neonates were enrolled in this study, 163 (55.8%) controls at baseline and 129 (44.2%) after the intervention. Study participants comprised of 130 (44.5%) neonates with very low birth weight and 162 (55.5%) with hypoxic ischemic encephalopathy. The mean age of initiating feeding was 45.34 ± 21.58 SD hours amongst the controls and 8.43 ± 3.02 SD hours in the intervention group. Overall, 1.4% (4 cases) of the neonates were diagnosed with NEC, 1.8% (3 cases) in the control group and 0.8 % (1 case) in the intervention group (P=0.4; 95% CI: 0.25-23.3). The mean duration of regaining birth weight was significantly reduced from 11.26 ± 4.34 SD days among controls to 8.25 ± 2.96 SD days in the intervention group (p=0.000; 95% CI: 1.61 - 4.41). Mortality in this high-risk groups of neonates remained high (40.8%), without significant difference between the control (41.7%) and intervention group (39.5%). Conclusions: Neonates who received early breast milk feeding following the implementation of feeding guidelines significantly regained birth weight earlier. No association was demonstrated between early breast milk feeding and increased NEC or mortality.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 86%

Enhancing early breast milk for sick and preterm neonates admitted at regional referral hospitals in Dar es Salaam, Tanzania

Hyera¹,

Assenga²,

Kazimoto³

et al. 2020

Preprint

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“…Early initiation of breast milk feeding signi cantly reduced the duration of regaining birth weight more than three days in the intervention group when compared to the controls. This nding demonstrates the bene t of early enteral feeding in the prevention of postnatal growth failure and is consistent with studies from Uganda [13], Iran [26] and India [12,30]. However, this did not correspond with a shortened hospital stay as shown in previous studies [12,26] and may be explained by other factors such as neonatal sepsis which may impact on the early stabilization of the neonates.…”

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 86%

Enhancing early initiation of breast milk for sick and preterm neonates admitted at regional referral hospitals in Dar es Salaam, Tanzania

Hyera¹,

Assenga²,

Kazimoto³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Feeding is the cornerstone in the management of sick or preterm neonates and early initiation of breastfeeding is the single most effective intervention associated with reduced neonatal mortality. Alternative routes for early breast milk administration are either oropharyngeal colostrum or minimal enteral nutrition. However, enteral feeding is often delayed due to haemodynamic instability and the perceived risk of necrotizing enterocolitis (NEC). One strategy to overcome delays in enteral feeds is the implementation of standardized feeding guidelines.Methods: This study was conducted in three regional hospitals in Dar es Salaam, consisting of a historical control group at baseline and an intervention group after implementation of co-created and locally adapted feeding guidelines. Neonates were consecutively recruited and followed to a maximum of 28 days of life. The controls received routine standard care, while the intervention group received early enteral feeding. The outcomes measured were NEC, time to regain birth weight and neonatal mortality. Odds ratio was used to determine the association between feeding and outcomes, statistical significance was considered when p-value ≤0.05.Results: 292 neonates were enrolled in this study, 163 (55.8%) controls at baseline and 129 (44.2%) after the intervention. Study participants comprised of 130 (44.5%) neonates with very low birth weight and 162 (55.5%) with hypoxic ischemic encephalopathy. The mean age of initiating feeding was 45.34 ± 21.58 SD hours amongst the controls and was significantly reduced to 8.43 ± 3.02 SD hours in the intervention group. Overall, 1.4% (4 cases) of the neonates were diagnosed with NEC, 1.8% (3 cases) in the control group and 0.8 % (1 case) in the intervention group (P=0.4; 95% CI: 0.25-23.3). The mean duration of regaining birth weight was significantly reduced from 11.26 ± 4.34 SD days among controls to 8.25 ± 2.96 SD days in the intervention group (p=0.000; 95% CI: 1.61 - 4.41, n = 110). Mortality in these high-risk groups of neonates remained high (40.8%, n = 119), without significant difference between the control (41.7%) and intervention group (39.5%). Conclusions: After implementation of co-created and contextualized feeding guidelines the mean duration of initiating mother’s milk was significantly reduced. Neonates in the intervention group who received early breast milk feeding significantly regained birth weight earlier. However, the study was underpowered to detect a small difference in important outcomes, including NEC and mortality. A randomized study with a large sample size and high power is recommended to further confirm the safety of early provision of mother’s milk among high-risk neonates in a low resource setting.Trial registration: The study was registered on October 3, 2018 to the Pan African Clinical Trial Registry (www.pactr.org) under the identification number PACTR201810856025709.

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“…CPAP was not used as the primary mode of ventilation in babies <28 weeks’ gestation. A previous study found that only one-third of very low birth weight infants in our unit were primarily supported using CPAP 17. This is an area that requires effort to build the culture and confidence of not intubating extremely premature infants.…”

Section: Discussionmentioning

confidence: 86%

Bubble CPAP therapy for neonatal respiratory distress in level III neonatal unit in Amman, Jordan: a prospective observational study

Al-lawama¹,

Alkhatib²,

Wakileh³

et al. 2018

IJGM

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PurposeBubble continuous positive airway pressure (bCPAP), a noninvasive respiratory support modality used to manage newborns with respiratory distress, provides continuous pressure that helps prevent derecruitment of alveoli, increasing the lungs’ functional residual capacity, and thus decreasing the work of breathing. bCPAP can be used to manage various respiratory conditions in the newborn. In this prospective study, we describe our experience using bCPAP therapy as the primary respiratory support in a level III neonatal unit in Amman, Jordan. In addition to reporting therapeutic indications, durations, and side effects, we aimed to identify areas requiring improvement in bCPAP therapy in our population.Patients and methodsThis prospective observational study investigated the usage of bCPAP in the management of respiratory distress in newborns admitted to a Jordan University Hospital in Amman. The newborns were followed until discharge. The patients’ demographic and clinical data were recorded.ResultsA total of 143 babies (mean gestational age, 36±2.7 weeks; mean birth weight, 2,770±1,800 g) were included. All received bCPAP as the primary respiratory support. The most common underlying cause of respiratory distress was transient tachypnea of the newborn (42%), followed by prolonged respiratory transition (34%). The therapy success rate was 93.7%; only nine infants failed bCPAP. The most common side effect was physical facial injury.ConclusionThe use of neonatal bCPAP therapy is well established in Jordan University Hospital. The area of potential improvement was the low rate of bCPAP use as a primary respiratory support in extremely premature infants.

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Mortality and Short-Term Outcomes of Very Low Birth Weight Infants at a Tertiary Care Center in Jordan: Comparison with Other Countries

Cited by 5 publications

References 12 publications

Enhancing early breast milk for sick and preterm neonates admitted at regional referral hospitals in Dar es Salaam, Tanzania

Enhancing early breast milk for sick and preterm neonates admitted at regional referral hospitals in Dar es Salaam, Tanzania

Enhancing early initiation of breast milk for sick and preterm neonates admitted at regional referral hospitals in Dar es Salaam, Tanzania

Bubble CPAP therapy for neonatal respiratory distress in level III neonatal unit in Amman, Jordan: a prospective observational study

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