Monitoring and promoting the health of premature infants during their first year of life. Value and obstacles.

The value of and stumbling blocks for integrated management of premature babies were assessed based on the development and one-year outcomes of two groups of premature babies managed at the Cocody prematurity unit. Group 1 (G1) was composed of 67 infants who received regular follow-up and group 2 (G2) of 98 infants seen only when their parents brought them in for health problems. Data were collected over a four-year period(January 1991 to December 1994). Of the 234 premature babies discharged alive from the unit, 165 (70%) were reevaluated. The two groups were compared based on parent-related factors, the characteristics of the babies, and the health promotion services provided by the unit (weighing, nutrition, and management of common health problems). As compared to G2, the parents in G1 were older, more likely to be living together (92% vs 77%), and more likely to have a stable relationship (91% vs 67.35%) (P<0.05); they had fewer years of education and the fathers had a lower but more stable income. The risk at birth was higher in the G1 babies: their mean gestational age was 30.6 weeks versus 33.42 in G2, and their mean birth weight was 1393.13 g vs 1712.40 g in G2. G1 babies were more likely to have prematurity-related disorders than G2 babies (35.82% vs 9.18%). In G1, the hospital stay duration was longer and the number of home visits was higher. At one year of age, mean weight was higher in G1 than in G2 patients. Immunization coverage was 100% in G1 versus 70% in G2. The morbidity and readmission rate was significantly higher in G2 (33.67%) than in G1 (23.89%) (P<0.05). Favorable factors included good quality rapport between the mother and health care providers and maturity and stability of the couple from the emotional, social, and economic viewpoints, even when incomes were low. Also beneficial was the availability of various integrated health care services ensuring global management. Identified obstacles to good postnatal follow-up were largely related to inadequate parental knowledge of the hazards associated with prematurity and to social and economical instability of the couple.