Opinions of health care professionals about the management of premature babies at birth in Brazzaville, Congo

Prematurity-related morbidity and mortality rates remain high in developing countries and could be decreased by preventive measures and/or improved ma nagement of premature babies. Providing health care professionals with spec ific training tailored to local constraints could help to improve the progn osis of prematurity in Africa. A study was undertaken in Brazzaville among health care professionals responsible for managing premature babies at birt h. The objectives were to determine how these professionals perceived their work and to encourage them to develop a consensus about the best managemen t strategy. A questionnaire on the prognosis of prematurity was given to th e physicians, midwives, and nurses who provided care to neonates in the del ivery rooms of the five public maternity departments of Brazzaville. Ninety -one questionnaires were completed, yielding a response rate of 40% to 65% across centers. The proportion of midwives among the respondents was higher than that of nurses and physicians in all the study centers except the tea ching hospital. In all five centers and across all three job categories, ge stational age and birth weight were given as the main determinants of the p rognosis, and the most common thresholds for these two parameters above whi ch the risk of sequelae was felt to be small were 35 weeks and 2500 g, resp ectively. Responses regarding the gestational age threshold above which res uscitation in the delivery room is warranted varied across centers; the mos t common threshold given by nurses and midwives was 32 weeks and that given by physicians was 28 weeks. Most midwives and nurses indicated that resusc itation in the delivery room was warranted in babies weighing more than 150 0 g, whereas the threshold given by physicians was 1000 g. In all centers a nd all job categories, Apgar's score, considered alone or in combination wi th gestational age and birth weight, was the main criterion used to decide whether resuscitation in the delivery room should be continued or stopped. Although this study was not exhaustive, it provides indications on local pr actices and illustrates the complexity of the situations faced by health ca re professionals in the delivery room. There is clearly a need for a longit udinal study in a cohort of premature babies to evaluate quality of life, m ortality, and the frequency and type of sequelae. This study also highlight s the value of specific training and continuing education of health care pr ofessionals, as well as the need for consensus development, which was consi dered desirable by 95% of the respondents.