Factors influencing post-discharge growth velocity among preterm infants attending the Kawempe National Referral Hospital Preterm Clinic: a prospective cohort study

Abstract

Background: Neonatal mortality remains high globally, with 2.3 million deaths recorded in 2022, 34% of which were due to complications of prematurity and low birth weight, particularly in sub-Saharan Africa. Uganda’s preterm birth rate is 14 per 1000 live births, with complications of prematurity accounting for 29.6% of all the neonatal deaths. Many of the survivors grapple with impaired physical growth, learning, and behavioral challenges, hindering their full developmental potential. Poor post-discharge growth velocity is a common challenge in low-resource settings, often linked to inadequate follow-up care. This study aimed to determine the factors influencing the post-discharge growth velocity among preterm infants attending the preterm clinic at Kawempe National Referral Hospital (KNRH). Methods: This prospective cohort study was conducted at the Kawempe National Referral Hospital preterm clinic. Quantitative data were collected using a structured questionnaire to assess the incidence and determinants of poor post-discharge growth velocity among preterm infants at Day 7 and Day 28 post-discharge. Data were analyzed using STATA version 17.0. Descriptive statistics (median, interquartile range, percentages, and frequencies) were presented in tables. Multivariable logistic regression was used to identify independent factors associated with poor post-discharge growth velocity. Results: A total of 300 preterm infants were enrolled in the study. Eight (2.7%) were lost to follow-up by Day 7, leaving 292 infants, and 54 (18%) were lost by Day 28, resulting in a final cohort of 239 infants. The incidence of poor post-discharge growth velocity (defined as <15 g/kg/day) was 59.9% (175/292; 95% CI: 54.2–65.4) at Day 7, decreasing to 30.7% (73/239; 95% CI: 25.1–36.9) by Day 28. In multivariable logistic regression analysis, low birth weight was the strongest predictor, with affected infants being 86 times more likely to have poor post- discharge velocity (AOR = 85.65; p < 0.001), Rural residence was associated with over twice the risk of poor growth velocity (AOR = 2.25; p = 0.04) and Kangaroo Mother Care (KMC) reduced the risk of poor growth velocity by approximately 70% (AOR = 0.31; p = 0.026). Conclusion: This study found a high incidence of poor post-discharge growth velocity among preterm infants, with nearly one-third still affected by day 28. The key factors influencing poor post-discharge growth velocity were low birth weight, residence in rural areas, and lack of KMC. These findings highlight the need for targeted follow-up, especially for infants with these risk factors, to improve early postnatal growth outcomes in low-resource settings.