Case-load, associated characteristics and outcomes of small for gestational age (SGA) neonates admitted to a tertiary hospital neonatal unit in Kigali, Rwanda: a cross-sectional study

Small for gestational age (SGA) is defined as birth weight less than the 10th percentile with a population prevalence of 17% in sub-Saharan Africa. Mortality and morbidity are worse in SGA neonates and there are long term implications from fetal growth restriction. Objective: the goal of this study was to evaluate and report the case-load, associated characteristics and outcomes of neonates admitted with SGA at the largest tertiary public hospital in Kigali, Rwanda. Methods: a prospective, cross-sectional, observational study was performed. We defined SGA as birth weight <10th percentile by gender according to the Alexander reference population. Eligible infants were identified through the neonatal registry. Results: of 1184 admitted neonates, 38% were SGA. Mortality in these SGA neonates (16%) was higher than appropriate for gestational age neonates (AGA, 13.4%) (AOR=2.03, CI: 1.1-3.5, p=0.011). SGA neonates, compared to their AGA peers, had a more extended hospital stay, and displayed faster postnatal growth. Conclusion: the case-load of SGA neonates in this reference hospital setting is high. The poorer outcomes in SGA neonates speaks to the need for: i. continued improvements in antenatal care throughout the health system to decrease the prevalence of small for gestation age and therefore case-load and ii. Optimisation of direct care for SGA neonates in order to minimise negative outcomes.