A profile of babies born before arrival to hospital in a peri-urban setting

Abstract

Babies born before arrival (BBAs) to hospital constitute a special group with regard to mortality and morbidity. With high neonatal mortality rates in South Africa, this study set out to describe maternal and neonatal characteristics of BBAs, and their outcomes in comparison to babies born in the health sector. Methods: A retrospective review of BBAs that presented to Edendale Hospital, a peri-urban regional hospital in the Midlands of Kwazulu-Natal, during the period 1 July 2010 to 30 June 2011. Employing case-control sampling, all babies born outside a health facility who presented to hospital within 24 hours of life were included. Cases were compared to the next in-hospital delivery occurring immediately after each BBA presented. Results: During the review period, there was 135 BBAs (prevalence rate 1.8%). Of these, 71% presented after hours (4 pm – 7 am) and most deliveries occurred at home (73.8%). There was no birth attendant present at 70.5% of deliveries. Average birth weights were similar (2.86kg in the sample group, 95% 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 sample group (23% versus 9%, p < 0.0001). Admitted BBAs had significantly lower average weights than those not admitted (2.19 versus 2.96 kg, 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 sample group (23% versus 6.7%, p < 0.0001), and only 54.4% of mothers of the admitted BBAs had booked antenatally, compared to 78.89% of mothers whose babies were discharged. Admission and complication rates were similar between the groups, but the average length of stay was seven days longer in admitted BBAs compared to admitted controls. Conclusions: Prevalence of BBAs is comparable to other developing countries, and is associated with poor antenatal attendance, prematurity, delay in presentation to hospital and lengthier hospital stays. These factors have implications on prehospital care of newborns and access to maternal and child health care in general.