Njokanma, FO

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67Trop J Obstet Gynaecol, Vol 27 (1), April 2010and supported by recognizable reallocation and commitment of resources towards providing the requisite infrastructure, facilities and trained personnel. In other words, we can leap or we can crawl – it's up to the policy makers!Specific Approaches to the Challenge of High Mortality Among Preterm Babies· Aggressive advocacy directed at generating the required political will· Penetrating health education directed at the populace and expectant mothers· Emphasis on quality antenatal careo Detection of risk factors for preterm delivery should be followed by early referral to a better-staffed and better-equipped centre· Regionalization of perinatal and neonatal careo S u c c e s s  d e p e n d s  o n  e f f e c t i v e  communication and transportation between levels of health care delivery· In utero referral of high risk motherso In-utero referral to a centre equipped for care of the high risk neonate has a far superior outcome in comparison to referral of the same baby after delivery· Training and retraining of health care personnelo Training health workers in the art of Neonatal Resuscitation produces dramatic results with respect to reduction in asphyxia-related morbidity and mortalityo This effort need not be expensive as it can readily be facilitated 'in-house' by already trained personnel. It should also be possible to organize group training for perinatal service providers pooled from various institutions within a given region.· The use of appropriate technologyo Of course the provision of a thermo-neutral environment by way of incubators with all kinds of monitoring gadgets and controls is the ideal. However, in the presence of lean resources, even a safe heating mechanism A preterm baby as we all know is one delivered before 37 completed weeks of gestation. The prevalence of preterm deliveries in most countries lies between 5% and 10% although there are reports of figures as low as 3% (Zideh 2001) and as high as 16.7% (Pambou et al 2006). Observations from Nigeria in the past two decades have yielded figures of 5.2% to 7.6%. (Njokanma and Olanrewaju 1995, Ibhanesebhor and Afadapa 1996). WHY DO PRETERM BABIES DIE?Preterm delivery is one of the commonest causes of death worldwide (Lawn, Cousens and Zupan). This is even more obvious in developing countries (Ngoc et al 2006) where babies die who might have survived in more privileged settings. Thus while preterm babies generally constitute less than 10% of deliveries, they account for up to 60 percent of mortality (Ngoc et al 2006, Ambe et al 2007). In Nigeria, mortality of preterm babies born at or before 32 weeks is unacceptably high – 624/100 (Ibhanesebhor and Afadapa,) 919/1000 (Njokanma and Olanrewaju).· Proximate medical causes and associated causes of mortalityo Birth asphyxiao Sepsiso Poor temperature regulationo Recurrent apnoeao Intraventricular haemorrhage· Remote causes are related to:o Dearth of facilities and trained health care personnel to take care of the listed problemso Poverty o IgnoranceWHAT IS THE WAY OUT?There must be a comprehensive and holistic approach to the challenge of high neonatal mortality especially as it affects preterm babies. If we depend on the generally poor allocation of resources that trickles down to the quality of care available to high-risk babies, success will be compromised right at the outset. For any serious effort to be translated into desired success, such effort must be accompanied IMPROVING THE OUTCOME OF PRETERM BABIES IN RESOURCE POOR SETTINGSFidelis O. NjokanmaLagos State University College of Medicine/ Lagos State University Teaching Hospital, Ikeja, Lagos.INTRODUCTION68Trop J Obstet Gynaecol, Vol 27 (1), April 2010deaths: data from 7993 pregnancies in six developing countries. Bull WHO 2006 84; 699 – 705.5. Njokanma OF, Olanrewaju DM. A study of Neonatal Deaths at the gun State University Teaching Hospital, Sagamu. J Trop Med Hyg 1995; 98: 156 – 160.6. Pambou O, Ntsika-Kaya P, Ekoundzola JR, Mayanda F. Preterm births at Brazzaville University Hospital. Sante 2006; 10: 185 – 189.7. Zeitlin J, Draper ES, Kolle L, et al. Differences in Rates and Short-term Outcome of Live Births Before 32 Weeks of Gestation in Europe in 2003: Results From t h e  M O S A I C  C o h o r t .  8. Zideh SM. Obstetrical outcome amongst preterm singleton births. Saudi Med J 2001; 22: 342 – 6.http://www.pediatrics.org/cgi/content/full/121/4/e936providing warmth within a safe but fixed temperature is far better than nothing. o For the reasonable stable baby, kangaroo baby care is of proven benefit.· Finally the option of partnering with better endowed institutions and/philanthropic NGOs should always be kept open.References1. Ambe JP, Idrisa A, Usman JD. A review of preterm admissions into special care baby unit in University of Maiduguri Teaching Hospital: a four year experience. Niger J Clin Pract 2007; 10: 229 – 33.2. I b h a n e s e b h o r  S E ,  A f a d a p a  M A .  Epidemiology of Preterm delivery in Benin-City. Nig J Paediatr 1996; 23: 27 – 32.3. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when, where, why? Lancet 2005; 365: 891 – 900.4. Ngoc NTN, Merialdi M, Abdel-Aleem H et al. Causes of stillbirths and early neonatal 

Improving the outcome of preterm babies in resource poor settings

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Improving the outcome of preterm babies in resource poor settings

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