PC2115: Predictors of Survival for Premature Infants in a District Hospital in Togo

Background: Prematurity is the leading cause of mortality for children under 5 years globally and survival rates remain discouraging for low-income countries and areas of limited resources. According to the World Health Organization, a 32-week premature infant born in a low-income country has a 50% survival rate and a 28-week premature infant has < 10% survival rate. For low-resource hospitals in these settings, uncertainty remains regarding the limits of viability and predictors for survival.

Methods: A retrospective chart review was performed at a 60-bed private district hospital in Togo that provides comprehensive obstetric care with an average of 650 births, including about 75 premature infants, annually. Data was collected for a 24 month time period (2013-2014) for all infants with gestational age < 37 weeks born at the hospital or admitted within the first 24 hours of life. Infants with incomplete or missing charts were excluded. Gestational age was determined by one or more methods and if there was discrepancy between multiple dating methods, the oldest estimated gestational age was used. Infants alive at time of hospital discharge were deemed survivors. Chi-square and Fisher’s exact tests were used for data analysis. The study was approved by Northwestern University’s IRB and the district hospital’s Ethics Committee.

Results: Data was collected for 125 premature infants ranging in age from 24.6 – 36.6 weeks gestation (mean 32.8 weeks) and birth weight from 640 – 2990 grams (mean 1856g). The overall survival rate for premature infants was 84%. The survival rate for ≤32-week infants was 76% and for ≤28-week infants it was 44%. When infants ≥35 weeks gestation were excluded, predictors for survival were antenatal steroid use (p=0.002), birth in the hospital (p=0.003), birth weight >1000g (p < 0.0001), and IV antibiotics for the first week of life (p=0.044). Use of antenatal magnesium sulfate or antibiotics alone were not statistically significant predictors for survival. The overall age of viability was 27 weeks gestation and the "weight of viability" was 1000 grams.

Conclusion: This retrospective review identified predictors for survival of premature infants in a single district hospital in Togo. Birth weight >1000g was a strong predictor of survival and was a more practical tool than gestational age for determining viability in this setting. Other predictors of survival were use of antenatal steroids, birth in the hospital, and use of IV antibiotics for the first week of life.