Preterm birth rate among live births at Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu was 6.4 percent, lower than the estimated rates for Bhutan (around 10-15 percent).

This is according to the first-ever study conducted on the prevalence of preterm births and its outcomes in the country. Preterms are those babies born before 37 weeks.

A resident doctor with the Department of Pediatrics, Faculty of Postgraduate Medicine of Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB), Dr Dinesh Pradhan, conducted the study last year.

All live preterm births at JDWNRH from January to December last year were observed till their discharge from the hospital. However, preterm babies born in another hospital and referred to JDWNRH, home deliveries or born on the way to the hospital, and preterm stillbirth or intra-uterine fetal death were not included in the study.

Globally, 11.1 percent  babies are born preterm.

Dr Dinesh Pradhan, during the fourth international conference on medical and health sciences earlier this month, said that 15.4 percent of all under-five deaths were due to preterm birth-related complications, making it the leading cause of under-five mortality.    

Bhutan did not have a reliable preterm birth rate or data regarding outcome of preterm babies, he said. “Morbidity and mortality patterns of preterm babies in the JDWNRH NICU have not been studied.”

He said that a comprehensive study was necessary to highlight deficiencies and to suggest improvements in the care package for preterm babies.

The study found that most mothers who were younger than 30 were housewives and had secondary education. Pregnancy registration rate and adequacy of antenatal visits were high at 94.5 and 66.2 percent respectively.

It found that most preterm births were a singleton (86.3 percent) and the predominant mode of delivery was cesarean section (52.2 percent). More than half of the births were initiated spontaneously and the male to female ratio was 1.2:1.

About 68 percent of the babies were late preterm and 54.3 percent had low birth weight. “Half of them required NICU admission,” he said.

A facility-based study of causes of under-five mortality (2009-2011) by UNICEF and health ministry found that 37 percent of newborn deaths in Bhutan were due to preterm birth complications.

Mothers’ demographic data, details of pregnancy, and delivery of the baby were collected for the study. “Morbidity and mortality information, as well as discharge outcome were collected on those who required NICU admission,” he said.

The study found that overall mortality rate was 11 percent and 21.6 percent for admitted preterm neonates. Preterm small-for-gestational-age neonates and those born after provider-initiated preterm birth had significantly increased the risk of mortality. Half of the deaths occurred in the first 7 days.

Provider-initiated births are the births following induction of labour or cesarean section for maternal or fetal indications.

He said that the mortality risks were highest for extremely preterm, extremely low birth weight, small-for-gestational-age and those born due to provider-initiated preterm births.

Respiratory distress, neonatal jaundice, and sepsis were the most common morbidities among the admitted preterm neonates.

The study found that the majority of the preterm neonates discharged without complications.

The limitations of the study were gestational age assessment that is late pregnancy registration and reliance on second- or third-trimester ultrasounds and not having a control group to determine the strength of association of risk factors with preterm birth.

The study recommends a national preterm morbidity and mortality database in three referral hospitals with NICU facilities and a review to identify root cause and prevent preterm births.

It also recommends an improving care package meaning improving continuum of care from antenatal to postnatal period, raise awareness among public based on data from the study.

Dr Dinesh Pradhan said the study will also provide baseline data for future research and quality improvement projects.

Dechen Tshomo