just admission process

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 - 2400 babies
 Monthly admission rate – 70-80 babies
 Monthly referral rate - 150 neonates

6. SOME DEFINITIONS
 Preterm – Born before 37 completed weeks of
gestation
 Extreme preterm = <28 weeks gestation
 Early preterm = 28-31 weeks gestation
 Moderate preterm = 32-33 weeks gestation
 Late preterm = 34-36 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
term
62%
preterm
38%

9. DISTRIBUTION OF THE PRETERM
BABIES BY PRETERM CATEGORY
Extreme
17%
Early
29%
Moderate
31%
Late
23%

10. MORTALITY BY WARD
0
50
100
150
200
250
Outborn Inborn
Deaths
Survival
20.8%
18.6

11. MORTALITY ACCORDING TO
GESTATIONAL AGE CATEGORY
0
20
40
60
80
100
120
140
Extreme Early Moderate Late
Survival
Mortality
45%
67.2 96.9%
96.9

12. MORTALITY DISTRIBUTION BY BIRTH-WEIGHT
CATEGORY
0
50
100
150
200
250
ELBW VLBW LBW NBW
Mortality
Survival
70.9
97
80%
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