Survival rate of babies of birth weight between 501-1000 g and 22-27 weeks gestational age

66 Figure 53. Number and survival rate of babies 22-27 weeks GA according to centres 3.12 Perinatal and neonatal mortality rates These are important indicators of both obstetric and neonatal outcomes. The births are obtained by records of all births in the hospitals of each neonatal unit and the mortality rates are calculated pertaining to that for inborn babies only. Perinatal mortality rate No. stillbirths + neonatal deaths 7 days BW 500 g and above or gestation 22 weeks and above x 1000 TBs No. total births TBs Early Neonatal mortality rate No. neonatal deaths 7 days BW 500 g and above or gestation 22 weeks and above x 1000 LBs No. livebirths LBs Neonatal mortality rate No. neonatal deaths 28 days BW 500 g and above or gestation 22 weeks and above x 1000 LBs No. livebirths LBs 68 67 61 59 59 58 56 55 52 51 50 48 47 45 44 43 43 42 42 41 40 39 39 34 34 34 33 32 25 24 20 16 10 20 30 40 50 60 70 80 22 11 24 16 27 12 28 31 3 23 7 9 20 10 33 29 30 17 14 15 21 26 13 5 19 2 25 32 4 8 18 6 P e rc e n ta g e s u rv iv a l N u m b e r o f b a b ie s Fig. 53 Survival of 22-27 weeks GA according to gestational age and centers All patients 22-27 weeks GA No. survived Survival rate 67 The birth census in Appendix 3 shows the form for the number of total births and stillbirths, and the number of neonatal deaths in all the centres obtained from the study. The 2008 perinatal, early neonatal and neonatal mortality rates were calculated to be 13.2 per 1000 TBs, 4.7 and 6.2 per 1000 LBs respectively, for our SDP group. Total births, neonatal deaths and mortality rates, 2008 Total Births 258635 No. Stillbirths 2198 No. Livebirths 256437 Inborn deaths 7 days early neonatal deaths 1216 Inborn deaths 28 days neonatal deaths 1577 Stillbirth rate 8.6 per 1000 TBs Perinatal mortality rate PMR 13.2 per 1000TBs Early neonatal mortality rate Early NMR 4.7 per 1000 LBs Neonatal mortality rate NMR 6.2 per 1000 LBs Figure 54. Centre Mortality rates These mortality rates are high when compared to the overall national figures which were 7.7 for PMR, 2.9 for Early NMR and 3.7 for NMR see Figure 52. This is expected as these NICUs are tertiary centres handling high risk pregnancies and sick babies. 0.0 5.0 10.0 15.0 20.0 25.0 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 M o rt a li ty r a te p e r 1 b ir th s Centre Number Fig. 54 Centre mortality rates Stillbirth rate Neonatal mortality rate Perinatal mortality rate 68 3.13 Discharge Babies were usually discharged straight home from the participating NICUs in the hospitals. Some may have been discharged from a paediatric ward following extended care after NICU stay e.g. babies with prolonged oxygen requirement, or rarely transferred elsewhere. For survivors the mean duration of hospital stay according to gestation and birthweight groups are as shown in Tables 55 and 55a-e and Figure 55. The shorter stay of babies 500 g birth weight or below was related to their lower survival rate. Figure 55. Duration of hospital stay of survivors according to birthweight category The duration of hospital stay is dependent on many factors especially gestational age and birth weight and whether babies survived. About 80 of all deaths in the NICUs occur within the first week of life Figure 56. Figure 56. Number and percentage of deaths according to gestational age and centre 20 40 60 80 100 120 140 160 501 -1000 1001 - 1500 1501 - 2500 2500 N u m b e r o f d a y s Birth weight grams Fig. 55 Duration of hospital stay of survivors according to birthweight category 20 40 60 80 100 120 140 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 P e rc e n ta g e N u m b e r o f d e a th s Centre Number Fig. 56 Number and percentage of geaths according to gestational age and centre Deaths 7 days Deaths 28days deaths in first week of all neonatal deaths 69 3.14 Enteral nutrition on discharge 3.14.1 Enteral nutrition on discharge by gestational age Majority of the babies 38 were on mixed feeding on discharge. Three thousand seven hundered and twenty five babies 33 were breastfed and 10 percent were on formula feeding on discharge. Nineteen percent of the babies were not fed enterally mainly because they were too ill to be fed and had died before enteral feeding could be commenced. The feeding pattern was the same in the different gestational age groups whereby mixed feeding was the main type of feeding on discharge. Figure 57. Enteral feeding on discharge by gestational age 3.14.2 Enteral feeding on discharge by birth weight 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 22 22 - 24 25 - 27 28 - 31 32 - 36 No Feeding Mix Feeding Formula Feeding Breast Feeding 200 400 600 800 1000 1200 1400 1600 Breast Feeding Formula Feeding Mix Feeding 70 Figure 58. Enteral feeding on discharge by birth weight Mixed feeding was the commonest type of feeding in all birth weight groups except for the 2500 g group where slightly more babies were breastfed. 3.14.3 Breastfeeding rate on discharge by centre Figure 59. Breastfeeding rate on discharge by centre Nine thousand four hundred and forty three babies were discharged alive in 2008. Of these 3723 39.43 were breastfedon discharge. Seven centres Centres 3,17,18, 21, 23, 32 and 33 had more than 50 babies who were breastfed on discharge.. Centre 3 had the highest percentage 87.31 of exclusively breastfed babies on discharge. 3.14.4 Enteral feeding on discharge and NEC The incidence of NEC among VLBW babies who were exclusively breastfed on discharge was 2.4. The rate in the exclusively formula fed and mixed feeding on discharge groups was higher at 3.8. Breast Feeding and NEC among Babies ≤ 1500 grams Fig. 60 Type of feeding among the ELBWs Versus NEC 10 20 30 40 50 60 70 80 90 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 22 18 103 82 BF NEC Not BF NEC