P2B172: Risk Factors Associated with Adverse Neonatal Outcomes in Western Kenya

Background: While global estimates of neonatal deaths have decreased from 5 million in 1990 to 2.4 million in 2020, the risk of death in children is still greatest in the first 28 days of life. Given Kenya’s relatively high infant mortality rate (30 per 1,000 live births), there is a critical need to understand risk factors related to these adverse outcomes. This study aims to evaluate potential maternal and neonatal risk factors related to adverse neonatal outcomes in Kenyan infants.

Methods: This is an interim analysis of a longitudinal cohort study of infants born to women living with HIV who are maternally age-matched to those born unexposed to HIV in western Kenya within the Academic Model for Providing Access to Healthcare (AMPATH) Partnership. Both maternal and infant characteristics were prospectively collected, and infants were followed for the first 28 days of life. Multivariable logistic regression models were used to determine the associations between potential risk factors and adverse neonatal outcomes, defined as preterm birth ( < 37 weeks gestation), low birthweight ( < 2500 g), 5-minute APGAR ( < 7), newborn unit (NBU) admission, and mortality (death < 28 days of birth and in-utero death).

Results: A total of 511 infants and their mothers were included for analysis. Of these, 30.9% of infants experienced adverse neonatal outcomes (n=158). Of all infants, 18.4% were preterm (n=94), 16.0% were low birthweight (n=82), 7.8% were admitted to the NBU (n=40), 2.7% had an APGAR score < 7 at 5 minutes (n=14), 2.2% experienced neonatal deaths (n=11), and 0.8% experienced in-utero death (n=4). Regarding the frequency of adverse neonatal outcomes per infant, 18.8% had 1 (n=96), 8.4% had 2 (n=43), 2.7% had 3 (n=14), 0.8% had 4 (n=4), and 0.2% had 5 (n=1). Maternal factors associated with adverse neonatal outcomes included: twin pregnancy, maternal chronic disease (not including HIV), and positive maternal HIV status (16.5% vs. 3.7%, p< 0.001; 39.2% vs. 24.9%, p=0.002; 63.9% vs. 43.1% p< 0.001, See Table 1). Characteristics of infants with adverse neonatal outcomes were also examined, as shown in Table 2.

The model showed that twin pregnancy was associated with increased odds of adverse neonatal outcomes (aOR=4.38; 95% CI 2.15-9.32). Maternal chronic disease (aOR=1.69; 95% CI 1.09-2.62) and positive maternal HIV status (aOR=2.56; 95% CI 1.67-3.99) were also associated with higher odds of adverse neonatal outcomes. Maternal age, mode of delivery, and infant gender were not associated with adverse neonatal outcomes.

Conclusion: Risk factors, including twin pregnancy, maternal chronic disease, and maternal HIV status, were positively associated with infants having an adverse outcome in the first 28 days of life. By monitoring women who are pregnant with these risk factors, clinical providers can offer timely interventions to optimize care for infants in Kenya and beyond.