Outcome of very low birth weight infants cared for in Kenyatta National Hospital's newborn unit

Abstract

There has been tremendous development in the field of neonatology over the past 30 years. This has particularly been in the care of lower birth weight infants especially those born premature. Before the 1960s most infants weighing less than 1500 grams at birth died soon after being born. By the 1980s, however, more than 90% of such infants were surviving the neonatal period. This massive improvement was brought about by the revolutionary developments in neonatal intensive care that took place in the intervening period. Of the few survivors in the period before 1960, close to half developed major and often permanent neurological morbidity including mental retardation, cerebral palsy, deafness and blindness. These early graduates of newborn units were therefore probably merely increasing the population of disabled and dependent members in society. Because of this, the rapid increase of surviving Very Low Birth Weight (VLBW, less than 1500 grams at birth) infants that followed the neonatal intensive care revolution of the 1970s and 1980s caused some initial anxiety regarding the probability of an equal increase in disabled members of society. It became imperative that due attention be paid towards the quality of these survivors. The proportion of these graduates that was able to lead normal or near normal life had to be the definition of the true successes of this technological revolution. The principle desirable outcome was therefore identified as normal long-term neuro-developmental and neuro-physical scores. This made it essential that reliable, accurate and universally reproducible methods of such assessment be devised and used exclusively. Before the 1960s there were no universally accepted tools for measuring the intellectual capacity of young children. These have not only been developed but have continued to be improved in recent years. Mental development can now be estimated from as early as infancy. It is however preferred that such assessments be made at or beyond2 years age. This is because developmental scores made in infancy have not always correlated well with those performed later in life (which are more accurate). Assessment of the graduates of neonatal units therefore requires evaluations going up to school age to enhance accuracy and reliability. Such programs are expensive, tedious and technically very demanding to maintain. Simpler, less expensive, methods of long term outcome predictions and assessments will therefore continue to be required in resource poor countries with grossly insufficient budgetary allocation for health services. The use of early physical growth parameters as correlates with neurological outcome could be one such option. Extensive research by several workers in the early 1980s revealed that early growth parameters correlate with long term neurodevelopmental outcomes. This suggests that profiles of early growth indices can predict individual infants at higher risk of later neurological deficits. Identification of infants With such growth patterns will not only be useful in predicting their outcomes but may help separate them from those needing more attention for longer periods and help bring down the overall cost of follow up programs. This thesis intends to establish the proportion of very low birth weight infants whose early growth indices indicate their being at risk of undesirable later developmental

outcomes. Since one of the most important determinant of growth is feeding, the early feeding regime that produces the best early growth will also be investigated. Some of the intermediate neuromotor and neurosensory deficits will be quantified. The other post-neonatal morbidities and post neonatal mortality will be investigated for the cohort. This will help quantify the overall burden to society, financial and social, brought about by this sub group of the population