Facteurs de risque et devenir hospitalier des nouveaux- nés prématurés à l'hôpital gynéco-obstétrique et pédiatrique de Yaoundé

SUMMARY

Introduction and objectives

According to the World Health Organization, 12.9 million births are preterm corresponding to 9.6% of all births. Preterm births occur mostly in developing countries. They constitute one of the major causes of neonatal mortality and thus a public health problem. The aim of this study was to evaluate risk factors of preterm births in the YGOPH, assess their outcome, and the factors which influenced their mortality.

Methodology

It was a retrospective, analytic case-control study done from 1^st May 2003 to 31^st December 2011 at the neonatology unit of the YGOPH. The premature cases were comprised of 533 neonates with gestational ages less than 37weeks, and the controls were neonates with gestational ages of 37weeks or more. Data was collected from the admission case records and files. This data was comprised of the delivery past history, age of the baby on admission, weight, sex, gestational age, outcome, cause and time of death if it occurred, duration of hospitalization and socio-demographic and the obstetrical profile of the mother. Data was analyzed with the SPSS version 16.0 software. Odds Ratio was used to assess the impact of the variables on the risk factors of prematurity. Statistical significance was considered for a probability P value of less than 0.05, and correlation assessed with the Spearman's rank correlation coefficient R.

Results

Out of the 7130 neonates admitted in the neonatology unit during the study period, 1894 were born preterm, giving an incidence of 26.5%. Males were predominant with no statistically significant difference. We identified single parenthood, less than 3 antenatal visits as maternal risk factors for prematurity. On the other hand, follow-up of pregnancy and anti malaria prophylaxis were protective variables. Malaria (62.9%), pre eclampsia/eclampsia (64.6%), premature and prolonged rupture of membranes (60.2% and 57.8% respectively), urinary tract infection (51%) and threatened preterm delivery (77%) were associated with preterm delivery. Multiple pregnancies and congenital malformations were fetal risk factors. Neonatal mortality in these preterm neonates was 36.6%, and most (69%) occurred in the early neonatal period. The main causes of death were: neonatal infections (27.6%), birth asphyxia (11.9%) and congenital malformations (10.3%). Factors which influenced mortality were gestational age below 37, birth weight<1000g, 5^th min Apgar score less than 7, and resuscitation at birth.

Conclusion

The incidence of preterm births was 26.5% with a mortality rate of 36.6%. Risk factors for preterm birth were both maternal and fetal. Single women, non followed up of pregnancies, pathologies during pregnancy were the main maternal determinants of prematurity, whereas multiple pregnancies and congenital malformations were the main fetal risk factors.

To reduce prematurity and its consequent mortality, we thus recommend information and education of pregnant women and young girls at child bearing age on the importance of family planning and good follow up of pregnancies; intensify training of medical staff on the management of premature babies and pathologies during pregnancy, and equip hospitals for adequate neonatal resuscitation.