Full-term newborns with normal birth weight requiring special care in a resourceconstrained setting

Abstract

Introduction: The level of clinical care and facilities to support the often more viable full-term newborns with normal birth weight compared with preterm/low birth weight newborns that require special care at birth are likely to be attainable in many resource-poor settings. However, the nature of the required care is not evident in current literature. This study therefore set out to determine maternal and perinatal profile of surviving full-term newborns with normal birth weight in a poorly-resourced setting.

Methods: A retrospective cohort study of newborns with gestational age ≥37 weeks and birth weight ≥2500g recruited in an inner-city maternity hospital in Lagos, Nigeria. Primary factors/outcomes were determined by multivariate logistic regression analyses and population attributable risk (PAR).

Results: Of the 2687 full-term newborns with normal birth weight studied, 242 (9.0%) were admitted into special care baby unit (SCBU) representing 53.6% of all SCBU admissions. Fetal distress, low 5- minute Apgar scores, neonatal sepsis and hyperbilirubinemia as well as maternal factors such as primiparity, type of employment, lack of antenatal care and emergency cesarean delivery were predictive of SCBU admission. The leading contributors to SCBU admission were neonatal sepsis (PAR=96.8%), and hyperbilirubinemia (PAR=58.7%).

Conclusion: A significant proportion of newborns requiring special care are full-term with normal birth weight and are associated with modifiable risk factors that can be effectively addressed at appropriately equipped  secondary-level hospitals. Prenatal maternal education on avoidable risk factors is warranted.

Key words: antenatal care, developing country, emergency cesarean delivery, hyperbilirubinemia, neonatal intensive care, special baby care