1. Preterm Admissions in LUTH: An Overview
Dr Iretiola Fajolu
Consultant Paeditrician/Senior Lecturer
LUTH/CMUL

2. Facility overview (1)
Lagos University Teaching Hospital is a tertiary referral center
It has an O& G department with ANC facilities, a labour ward with 14 suites and 2 operating theatres.
There are 2 postnatal wards where stable babies are nursed by the sides of their mothers
Babies are usually discharged after 48hrs from the postnatal wards
There is also facility for assisted conception currently in the hospital.
The Neonatal unit with two wards - INBORN ward adjoining the labour ward (for babies born in LUTH) and the OUTBORN ward (for babies born outside LUTH and referred for further care)

3. Facility overview (2)
Inborn ward admission capacity – 40 with 21 incubators and 1 transport incubator
Outborn ward admission capacity – 40 with 15 incubators and 1 transport incubator
The Neonatology unit staff strength:
4 consultant Neonatologists
10 Resident doctors
26 Nurses
8 support staff
During call hours, there is a consultant on call; with 2 senior and 2 junior registrars and 2-3 house officers, sleeping in with a minimum of 6 nurses and 1 or 2 supportive staff .

4. Facility overview (3)
There is a children emergency center where babies admitted from outside are initially stabilized before admission or discharge as required
The unit also has access to a pharmacy, microbiology and clinical chemistry laboratory, radiology (X-rays, ultrasound scans, CT scan, MRI), surgical, blood bank, social welfare and pathology services within the hospital.
Discharged babies are followed up in the outpatient clinic till 2 years of life

5. Facility overview - LUTH
Annual delivery rate babies
Monthly admission rate – babies
Monthly referral rate neonates

6. Some definitions Preterm – Born before 37 completed weeks of gestation
Extreme preterm = <28 weeks gestation
Early preterm = weeks gestation
Moderate preterm = weeks gestation
Late preterm = weeks gestation
LBW = 1500 to <2500g
VLBW = 1000 to <1500g
ELBW = <1000g

7. Preterm admission statistics in the last one year at LUTH
Over the one year period we admitted 1057 neonates into the neonatal wards of LUTH
401 were preterm babies (37.9%)
Preterm discharges – 117 (70.1%)
Total mortality – 116
Preterm mortality -79 (68.1%) of total mortality
19.7% of all preterm infants died
80.3% survival

8. Pattern of neonatal admissions

9. Distribution of the preterm babies by preterm category

10. Mortality by ward

11. Mortality according to gestational age category

12. Mortality distribution by birth-weight category
55%

13. Challenges to managing preterm infants
The major challenge encountered in managing preterm infants is with the extreme LBW and and extreme preterm babies
Challenges with respiratory support (unavailability of surfactant, ventilators)
Maintaining temperature (incubators, KMC)
Sepsis (lab support – cost, delayed sampling)
Feeding problems (no BM, NEC)
Shortage of skilled staff
Financial constraints
Poor transport

14. Way forward Advocacy – Health care workers, Government and NGO
Educating the population
Education of healthcare workers (ECSB)
Well coordinated neonatal referral
Improved funding for health care
Female empowerment

15. Thank you