625 - Association of weight at KMC discharge and post-discharge mortality in Lusaka, Zambia

Poster Number: 625
Publication Number: 625.315

Albert Manasyan, University of Alabama School of Medicine, Birmingham, AL, United States; Jyoti Lakhwani, University Teaching Hospital, Lusaka, Lusaka, Zambia; herbert kapesa, N/A, lusaka, Lusaka, Zambia; Sylvia Machona, University Teaching Hospital, Lusaka, Lusaka, Zambia; J. Anitha Menon, University of Zambia, Lusaka, Lusaka, Zambia; Waldemar A. Carlo, University of Alabama School of Medicine, Birmingham, AL, United States

Background: Kangaroo mother care (KMC) reduces neonatal mortality and is being widely adopted in many low- and middle-income countries (LMICs). However, discharge criteria may vary due to variations in practice including space limitations at the health facilities.

Objective: Our objective is to evaluate the association of weight at KMC discharge and post-discharge mortality among preterm infants.

Design/Methods: This is a retrospective analysis of KMC admissions between January and March 2022 at the Women and Newborn Hospital in Lusaka, Zambia. All preterm babies at the Neonatal Intensive Care Unit (NICU) ready for stepdown care for further monitoring were transferred to the KMC ward. After hospital discharge, newborns were followed until 1 year of age either through the postnatal clinic or phone calls if they missed a visit. The main outcome of interest was post-discharge mortality following KMC discharge.

Results: We collected data on 157 newborns admitted to the KMC ward. While all newborns were discharged alive, 14 infants (8.9%) died following discharge - 1 (0.6%) within 28 days of life and 13 (8.3%) during the post-neonatal period. Most mothers (76.3%) were married, 13.5% were HIV-positive, and 71.7% were unemployed with no difference between mothers whose babies were alive or had died during the neonatal or post-neonatal periods. Overall, 57 (37.6%) of newborns were male and the most common cause of KMC admission was low birthweight (75.8%). While there was no difference in the average birthweight among newborns alive during the neonatal and post-neonatal periods, the average birthweight was 1,500g and 1,469 grams for the same periods, respectively. Most post-neonatal deaths were among newborns weighing < 1,499g at KMC admission (50.0%) and at KMC discharge (60.0%). Most post-neonatal deaths were among teenage mothers (40%), who were HIV-negative (81.8%), and mothers with one delivery (77.8%) and one pregnancy (70.0%). The average KMC stay was 7.7 (8.8) days and most babies (43.7%) gained < 25 grams during their KMC admission.

Conclusion(s): Facility-level barriers exist for appropriate implementation of KMC, leading to discharge below the recommended weight limit. Adherence to KMC weight discharge criteria and strengthening of postnatal care, including community KMC, may reduce post-neonatal mortality.