Factors Associated with Survival to Discharge of Newborns in a Middle-Income Country (original) (raw)
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BMC Pediatrics, 2010
Background: Audit of disease and mortality patterns provides essential information for health budgeting and planning, as well as a benchmark for comparison. Neonatal mortality accounts for about 1/3 of deaths < 5 years of age and very low birth weight (VLBW) mortality for approximately 1/3 of neonatal mortality. Intervention programs must be based on reliable statistics applicable to the local setting; First World data cannot be used in a Third World setting. Many neonatal units participate in the Vermont Oxford Network (VON); limited resources prevent a significant number of large neonatal units from developing countries taking part, hence data from such units is lacking. The purpose of this study was to provide reliable, recent statistics relevant to a developing African country, useful for guiding neonatal interventions in that setting.
National Journal of Medical Research, 2021
Introduction: There has been an effort in recent times to define physiological and laboratory parameters, which would be predictive of neonatal mortality in VLBW group. The present study was aimed to analyze the effects of various maternal, fetal and neonatal parameters on the mortality of VLBW infants admitted in NICU and to find out the causes of mortality in intramural very low birth weight babies. Methods: This is a hospital based prospective observational study from 1st July 2019 to 30th September 2020 at a tertiary care hospital in Surat. All intramural newborn babies who get admitted in NICU with birth weight <1500 grams were included in the study. The data was entered in MS-Excel database. All the analysis was done using the SPSS-20 software. Results: In this study out of total 108 patients, 45(41.6%) patients were discharged, 63 (58.3%) expired. In less than 1000 grams babies, 88.8% mortality was observed. In 1401-1500g, total 13 patients in which 5 patient (38.5%) expired and 8 (61.5%) patients survived. So higher rate of survival was observed with increase in birth weight. RDS (p value 0.00), Shock (p value 0.00), sepsis (p value 0.001) and birth asphyxia (p value 0.00) are statistically significant factors contributing to neonatal mortality. Conclusion: Common maternal risk factors predicting mortality in VLBW infants that were statistically significant observed were PIH, Meconium stained amniotic fluid, fetal distress, PROM and non-administration of 2 doses of antenatal steroids. Common fetal variables predicting mortality in VLBW that were statistically significant observed were smaller gestation age, crown heel length, head circumference and birth weight.
BMC Pediatrics, 2015
Background: Health protocols need to be guided by current data on survival and benefits of interventions within the local context. Periodic clinical audits are required to inform and update health care protocols. This study aimed to review morbidity and mortality in very low birth weight (VLBW) infants in 2013 compared with similar data from 2006/2007. Methods: We performed a retrospective review of patients' records from a neonatal computer database for 562 VLBW infants. These neonates weighed between 500 and 1500 g at birth, and were admitted within 48 hours after birth between 01 January 2013 and 31 December 2013. Patients' characteristics, complications of prematurity, and therapeutic interventions were compared with 2006/2007 data. Univariate analysis and multiple logistic regression were performed to establish significant associations of various factors with survival to discharge for 2013. Results: Survival in 2013 was similar to that in 2006/2007 (73.4% vs 70.2%, p = 0.27). However, survival in neonates who weighed 750-900 g significantly improved from 20.4% in 2006/2007 to 52.4% in 2013 (p = 0.001). The use of nasal continuous positive airway pressure (NCPAP) increased from 20.3% to 62.9% and surfactant use increased from 19.2% to 65.5% between the two time periods (both p < 0.001). Antenatal care attendance improved from 54.4% to 70.6% (p = 0.001) and late onset sepsis (>72 hours after birth) increased from 12.5% to 19% (p = 0.006) between the two time periods. Other variables remained unchanged between 2006/2007 and 2013. The main determinants of survival to discharge in 2013 were birth weight (odds ratio 1.005, 95% confidence interval 1.003-1.0007, resuscitation at birth (2.673, 1.375-5.197), NCPAP (0.247, 0.109-0.560), necrotising enterocolitis (4.555, 1.659-12.51), and mode of delivery, including normal vaginal delivery (0.456, 0.231-0.903) and vaginal breech (0.069, 0.013-0.364). Conclusions: There was a marked improvement in the survival of neonates weighing between 750 and 900 g at birth, most likely due to provision of surfactant and NCPAP. Provision of NCPAP, prevention of necrotising enterocolitis, and control of infection need to be prioritised in VLBW infants to improve their outcome.
Background: Ongoing care of surviving very low birth weight infants (VLBWI) is associated with increases in medical costs. Thus, knowing their length of hospital stay (LHS) will assist in counselling parents and budgeting for their neonatal care. Objective: To determine the LHS among VLBWI surviving to hospital discharge and factors associated with prolonged LHS. Methods: This was a retrospective analytic study performed at Chris Hani Baragwanath Academic Hospital, South Africa. Records of VLBWI who survived to hospital discharge between January 2015 and October 2016 were reviewed. Data on maternal and infant characteristics, morbidities and LHS were recorded. Comparison between those with and without prolonged LHS as defined by being discharged beyond 41 weeks of postmenstrual age was performed. Results: Records of 435 VLBWI who survived to hospital discharge were reviewed. Their mean birth weight and gestational age were 1234 ± 192 grams and 30 ± 2 weeks respectively. The median duration of LHS was 39 days, with a range of 11 to 183 days. The LHS increased proportionally with decreasing gestational age Journal of Pediatrics, Perinatology and Child Health 209 or birth weight. Thirty-four VLBWI (7.82%) had prolonged duration of hospital stay. On multiple logistic regression analysis factors associated with prolonged LHS were gestational age (OR: 2.01; 95% CI 1.6-2.61), chronic lung disease (OR: 9.40; 95% CI 2.53-34.72), and healthcare associated infections (OR: 31.86; 95% CI 6.75-150.3). Conclusions: The median LHS stay for the VLBWI was noted to be 5.5 weeks (39 days) and neonates with morbidities, namely chronic lung disease and healthcare associated infections are more likely to have prolonged LHS.
Factors associated with poor prognosis in very-low-birth-weight infants
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
To evaluate predictors of poor outcome, including the CRIB (Clinical Risk Index for Babies) score, in a local population of very-low-birth-weight (VLBW) infants, in order to provide guidelines for selection of these babies for expensive tertiary care. Two hundred and thirty-one neonates born at less than 31 weeks' gestation and/or weighing between 1001 g and 1500 g, enrolled prospectively as part of a multicentre study evaluating the CRIB score. Univariate analysis (chi-square/t-tests) and multivariate analysis (stepwise logistic regression) on the above sample to determine predictors of poor outcome. Neonatal Unit, Johannesburg Hospital. Death or impairment (namely oxygen therapy > 28 days, grade 3 or 4 intraventricular haemorrhage, or ventricular enlargement). Poor outcome was predicted by birth weight, lowest oxygen requirement in the first 12 hours (which are two components of the CRIB score), and maximum partial arterial carbon dioxide pressure (PaCO2) in the first 72 ho...
Abstract Objective Report on survival to discharge of children in a combined paediatric/neonatal intensive care unit (PNICU). Design and setting Retrospective cross-sectional record review. Participants All children (medical and surgical patients) admitted to PNICU between 1 January 2013 and 30 June 2015. Outcome measures Primary outcome—survival to discharge. Secondary outcomes—disease profiles and predictors of mortality in different age categories. Results There were 1454 admissions, 182 missing records, leaving 1272 admissions for review. Overall mortality rate was 25.7% (327/1272). Mortality rate was 41.4% (121/292) (95% CI 35.8% to 47.1%) for very low birthweight (VLBW) babies, 26.6% (120/451) (95% CI 22.5% to 30.5%) for bigger babies and 16.2% (86/529) (95% CI 13.1% to 19.3%) for paediatric patients. Risk factors for a reduced chance of survival to discharge in paediatric patients included postcardiac arrest (OR 0.21, 95% CI 0.09 to 0.49), inotropic support (OR 0.085, 95% CI 0.04 to 0.17), hypernatraemia (OR 0.16, 95% CI 0.04 to 0.6), bacterial sepsis (OR 0.32, 95% CI 0.16 to 0.65) and lower respiratory tract infection (OR 0.54, 95% CI 0.30 to 0.97). Major birth defects (OR 0.44, 95% CI 0.26 to 0.74), persistent pulmonary hypertension of the new born (OR 0.44, 95% CI 0.21 to 0.91), metabolic acidosis (OR 0.23, 95% CI 0.12 to 0.74), inotropic support (OR 0.23, 95% CI 0.12 to 0.45) and congenital heart defects (OR 0.29, 95% CI 0.13 to 0.62) predicted decreased survival in bigger babies. Birth weight (OR 0.997, 95% CI 0.995 to 0.999), birth outside the hospital (OR 0.21, 95% CI 0.05 to 0.84), HIV exposure (OR 0.54, 95% CI 0.30 to 0.99), resuscitation at birth (OR 0.49, 95% CI 0.25 to 0.94), metabolic acidosis (OR 0.25, 95% CI 0.10 to 0.60) and necrotising enterocolitis (OR 0.23, 95% CI 0.12 to 0.46) predicted poor survival in VLBW babies. Conclusions Ongoing mortality review is essential to improve provision of paediatric critical care.
Survival of extremely low-birth-weight infants
South African Journal of Child Health, 2013
Objectives. Survival of extremely low-birth-weight (ELBW) infants in a resource-limited public hospital setting is still low in South Africa. is study aimed to establish the determinants of survival in this weight category of neonates, who, owing to limited intensive care facilities, were not mechanically ventilated. Design. A retrospective study in which patient data were retrieved from the departmental computer database. Setting. e neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa. Subjects. Neonates admitted at birth between January 2006 and December 2010 with birth weights of ≤900 g. Outcome measures. Survival at discharge was the major outcome. Maternal variables were age, parity, gravidity, antenatal care, antenatal steroids, place and mode of delivery and HIV status. Neonatal variables were gestational age (GA), birth weight (BW), gender, place of birth, hypothermia, resuscitation at birth, sepsis, necrotising enterocolitis, intraventricular haemorrhage, jaundice, nasal continuous positive airway pressure (NCPAP) with or without surfactant, and Apgar scores. Results. A total of 382 neonates were included in the study. Overall survival was 26.5%. e main causes of death, as per the Perinatal Problem Identi cation Programme (PPIP) classi cation, were extreme multi-organ immaturity and respiratory distress syndrome. e main determinants of survival were BW (odds ratio (OR) 0.994; 95% con dence interval (CI) 0.991 -0.997) and GA (OR 0.827; 95% CI 0.743 -0.919). Overall the rate of NCPAP use was 15.5%, and NCPAP was not associated with improved survival. Conclusion. Survival of ELBW infants is low. BW and GA were the strongest predictors of survival. E ective steps are required to avoid extreme prematurity, encourage antenatal care, and provide antenatal steroids when preterm birth is anticipated. S Afr J CH 2013;7(1):13-16.
Background: World over, Neonatal mortality has been used as an indicator for the health of the underfive population. There is a higher risk for a baby to have serious disability or even death, if the baby is born early. In 2013, about one third (36%) of infant deaths were due to pretermrelated causes (Prevention, 2017). Zambia's target is to reduce the neonatal mortality rate to less than 12 per 1,000 live births by 2021 . The main aim of this study was to assess the factors associated with mortality among neonates admitted in the Neonatal Intensive Care Unit at Methods: A cross-sectional retrospective audit was carried out to look at mortality records for neonates (at NICU-UTH, Lusaka, Zambia) from January 2015 to December 2017. A stratified random sampling method was used to select the study units. The data extraction form was used to collect the information from the neonatal mortality records chosen for the study. A total of 99 study participant files were extracted and used for this study. Stata version 14 was used to analyse the data.
Acta Clinica Croatica
We investigated mortality, causes, timing and risk factors for death until hospital discharge in very-low-birth-weight (VLBW) infants born in two Croatian perinatal care regions. This retrospective study included 252 live born VLBW infants. The mortality rate until hospital discharge was 30.5% (77/252). VLBW infants who died had by 4 weeks lower gestational age (GA) than surviving infants (median GA, 25 vs. 29 weeks), lower birth weight (BW) (mean BW, 756.4 vs. 1126.4 g), lower 5-minute Apgar score (median 5 vs. 8) and were more often resuscitated at birth (41.6 vs. 19.4%; p<0.001 all). Infants who survived were more often small-for-gestational age (SGA) (28.0 vs. 15.6%; p=0.04) and more often received continuous-positive-airway-pressure (CPAP) in delivery room (13.1 vs. 2.6%; p=0.01). Multivariate logistic regression revealed that parameters influencing death until hospital discharge were 5-minute Apgar score (OR 0.780, 95% CI 0.648-0.939) and higher Clinical Risk Index for Babies (CRIB) score (OR 1.677, 95% CI 1.456-1.931). ROC analysis showed that CRIB score (AUC 0.927, sensitivity 92.2, specificity 81.1; p<0.001) was the strongest predictor of death until hospital discharge. In infants who died within 12 hours, death was most commonly attributed to immaturity and in those surviving >12 hours to necrotizing enterocolitis.