Rates and predictors of mortality of very low birthweight infants in three Nigerian tertiary hospitals

Abstract

Prematurity is a leading worldwide cause of neonatal mortality 1,2 and 80% of the 2.5 million neonatal deaths each year are in infants born weighing up to 2500 grams. 1 Birthweight has been inversely related to degrees of illness and mortality risks. A 2012 policy statement from the American Academy of Paediatrics recommended that very low birthweight (VLBW) infants, born weighing up to 1500 grams, should receive care in high-level healthcare facilities. The aim was to ensure that they had the medical personnel, medication and equipment available to provide critical life support. 3 The clinical outcomes of VLBW infants is a quality of care benchmark that is used in many centres and regional, national and international neonatal networks in high-income settings. [4][5][6][7][8][9][10][11]

High inter‐rater reliability between physicians and nurses utilising modified Downes' scores in preterm respiratory distress

“…When their research team compared the Downes' score to the Silverman Andersen score in this Indian NICU, the Silverman Andersen score had lower inter‐rater reliability, and participants found the Downes' score to be comparatively easier to use and assessments were quicker to complete 9 . The use of the Downes' score or a modified Downes' score has also been implemented and its use published in multiple other LMIC settings, including China, 10 Indonesia, 11 and Nigeria 12 …”

“…9 The use of the Downes' score or a modified Downes' score has also been implemented and its use published in multiple other LMIC settings, including China, 10 Indonesia, 11 and Nigeria. 12 In addition to the use of the Downes' or Silverman Andersen scores as objective assessments for respiratory distress and score-based initiation of continuous positive airway pressure (CPAP), when incorporated into the culture of the neonatal unit and used serially as a vital sign they may be utilised for titration of CPAP support and for documentation of progression of disease. 9,[13][14][15] An increase in Downes' scores and Silverman Andersen scores has also been associated with increased risk of death due to respiratory failure, 12,15 which is consistent with our findings.…”

“…12 In addition to the use of the Downes' or Silverman Andersen scores as objective assessments for respiratory distress and score-based initiation of continuous positive airway pressure (CPAP), when incorporated into the culture of the neonatal unit and used serially as a vital sign they may be utilised for titration of CPAP support and for documentation of progression of disease. 9,[13][14][15] An increase in Downes' scores and Silverman Andersen scores has also been associated with increased risk of death due to respiratory failure, 12,15 which is consistent with our findings. Among very low birth weight infants (birth weight 500-1500 g) admitted to tertiary Nigerian NICUs, an increase in Downes' score was independently associated with adjusted odds of in-hospital mortality (aOR 1.27, 95% CI 1.14-1.41).…”

“…Among very low birth weight infants (birth weight 500-1500 g) admitted to tertiary Nigerian NICUs, an increase in Downes' score was independently associated with adjusted odds of in-hospital mortality (aOR 1.27, 95% CI 1.14-1.41). 12 An area of future research is evaluation of further simplifying these objective scores 16 and the inclusion of current objective scores into risk estimators with the addition of patient-level risk factors, such as gestational age and birth weight, 17 with the goal of supporting multi-disciplinary care teams, standardising and improving team communication, and empowering bedside care providers.…”

“…They reported that nearly half (47%) of all VLBW infants admitted to their sites died during hospitalisation, with respiratory distress noted as an independent predictor of death. 12 In a rural Ugandan NICU, McAdams et al described the implementation of bubble CPAP, noting that approximately half (52%) of infants treated with CPAP survived to hospital discharge. 13 Acknowledging that the magnitude of in-hospital mortality in our Ethiopian cohort is not an outlier among LMIC NICUs calls attention to the burden of neonatal mortality in LMICs and opportunities for improvement in outcomes with cost-effective, evidence-based care.…”