Profile of babies born before arrival at hospital in a peri-urban setting
Background. Babies born before arrival (BBAs) at hospital constitute a special group at risk of high morbidity and mortality.
Objective. We conducted a 12-month retrospective review to describe maternal and neonatal characteristics of BBAs, and their outcomes compared with babies born in the state health sector.
Methods. Using case-control sampling, all babies born outside a health facility and who presented to hospital within 24 hours of life were included and compared to the next in-hospital delivery occurring immediately after each BBA presented.
Results. During the period reviewed, 135 BBAs (prevalence 1.8%) presented; 71% after hours with most deliveries occurring at home (73.8%). There was no birth attendant present at 70.5% of deliveries. Average birth weights were similar (2.86 kg in the BBA group, 95% confidence interval (CI) 2.73 - 2.95; 2.94 kg in the control group, 95% CI 2.78 - 3.02), but significantly more preterm babies were found in the BBA group (23% v. 9%, respectively; p<0.0001). Admitted BBAs had significantly lower average weights than those who were not admitted (2.19 kg v. 2.96 kg, respectively; p<0.0001). No significant differences were found when maternal age, parity, co-morbidities and distance from the hospital were compared. There were significantly more unbooked mothers in the BBA group (23.0% v. 6.7%, respectively;p<0.0001). Only 54.40% of the admitted BBAs’ mothers had booked antenatally, compared with 78.89% of mothers whose babies were discharged. Admission and complication rates were similar between the groups, but average length of stay was longer in admitted BBAs compared with controls.
Conclusion. The prevalence of BBAs in this study is comparable to that in other developing countries, and is associated with poor antenatal attendance, prematurity, delay in presentation to hospital and lengthier hospital stays. These factors have implications for prehospital care of newborns and access to maternal and child healthcare in general
Nivisha Parag, Division of Emergency Medicine, Pietermaritzburg Metropolitan Hospitals Complex, Pietermaritzburg, South Africa; Division of Emergency Medicine, University of KwaZulu-Natal, Durban, South Africa
Neil Hugh McKerrow, KwaZulu-Natal Provincial Department of Health; Department of Paediatrics, University of KwaZulu-Natal, Durban, South Africa
Fathima Naby, Department of Paediatrics, Pietermaritzburg Metropolitan Hospitals Complex, Pietermaritzburg, South Africa; Department of Paediatrics, University of KwaZulu-Natal, Durban, South Africa
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Date published: 2014-04-10
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