Determinants of survival in very low birth weight neonates in a public sector hospital in Johannesburg (original) (raw)
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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.
Factors Associated with Survival to Discharge of Newborns in a Middle-Income Country
Epidemiology of Communicable and Non-Communicable Diseases - Attributes of Lifestyle and Nature on Humankind, 2016
Clinical and mortality audit is an essential part of quality improvement in health care; information obtained in this process is used to develop targeted interventions to improve outcome. This study aimed to determine predictors of short-term survival in neonates. An existing neonatal database was reviewed. A total of 5018 neonates > 400 g admitted to a tertiary hospital (Johannesburg South Africa) between 1 January 2013 and 31 December 2015 were analysed. Mean birth weight was 2148 g (standard deviation [SD]: 972) and mean gestational age was 34.2 weeks (SD: 4.8). Overall survival was 85.6% (4294/5018). The most common causes of death were prematurity (46.2%), hypoxia (19.5%) and infection (17.2). The strongest predictors of survival were birth weight (OR 1.0; 95% confidence intervals (CI): 1.0-1.01) and gestational age (OR = 1.1, 95% CI: 1.05-1.17). Other predictors of survival included metabolic acidosis (OR = 0.14, 95% CI: 0.09-0.20), hyperglycemia (OR = 0.31, 95% CI: 0.23-0.41), mechanical ventilation (OR = 0.35, 95% CI: 0.28-0.46), major birth defect (OR = 0.12, 95% CI: 0.08-0.18), resuscitation at birth (OR = 0.39, 95% CI: 0.31-0.49) and Caesarean section (OR = 1.8, 95% CI: 1.44-2.25). In conclusion, resources need to be focused on improved care of VLBW infants.
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.
South African Journal of Child Health, 2019
Background. Since 2000, South Africa (SA) has had a relatively static neonatal mortality rate, estimated to be 12/1 000 live births, with complications of prematurity being the leading cause of neonatal mortality. Survival to hospital discharge of small infants has improved over the last few decades; however, this is more marked in developed countries where neonatal intensive care, nasal continuous positive airway pressure, mechanical ventilation and surfactant are available to the majority of infants. Objectives. The primary objective was to determine overall mortality of very low-birthweight and extremely low birthweight (ELBW) infants in the neonatal unit at Steve Biko Academic Hospital (SBAH). Secondary objectives were to determine the frequency of major morbidities, identify factors associated with morbidity and mortality, determine survival without major morbidity, and whether birthweight can accurately predict outcome. Methods. This was a retrospective cross-sectional study...
Pediatric Health, Medicine and Therapeutics
Background: Low birth weight neonates are subjected to different comorbidities due to anatomical and physiological immaturity. Globally, 60-80% of neonatal mortality was due to low birth weight. Hence, this study aimed to assess the survival status and predictors of mortality among low birth weight neonates. Methods: An institutional-based retrospective cohort study design was conducted among 718 low birth weight neonates admitted to the neonatal intensive care unit from January 1, 2017, to December 30, 2019, at Felege Hiwot Comprehensive Specialized Hospital. Data were entered into Epi data version 3.1 and analyzed with STATA version 14. Kaplan-Meier curves together with a Log rank test were used to estimate the survival time and showed the presence of differences among groups. Cox proportional-hazard regression was used to estimate the hazard ratio at the 5% level of significance to determine the net effect of each explanatory variable on survival status. Results: The overall incidence density was 35.3 per 1000 person-day observations (CI: 30.8 −40.6) with 5715 follow-up days. Deliveries outside the health institution [AHR; 2.31 (95% CI: 1.20-4.42)], maternal age <18 years [AHR; 3.08 (95% CI: 1.64-5.81)] and maternal age >35 years [AHR; 3.83 (95% CI: 2.00-7.31)], neonatal sepsis [AHR; 2.33 (95% CI: 1.38-3.94)], neonatal respiratory distress syndrome [AHR; 1.92 (95% CI: 1.27-2.89)], necrotizing enterocolitis [AHR; 3.09 (95% CI: 1.69-5.64)] and birth weight <1000 gm [AHR; 3.61 (95% CI: 1.73-7.55)] were found to be significant predictors. Conclusion: This study showed that two of the seven low birth weight neonates died during the follow-up period. Therefore, it is better for health care providers and other stakeholders to focus more on early diagnosis and management of low birth weight neonates with sepsis, respiratory distress syndrome, necrotizing enterocolitis and counseling mothers on the risk of having a child in early and old age.
Epidemiology international journal, 2022
Introduction: Neonatal mortality continues to be an urgent public health concern in developing countries. In sub-Saharan Africa, the neonatal mortality rate (NMR) accounts for 98% of under-five deaths among the regions. NMR is an essential outcome indicator for newborn care and reflects the quality of prenatal, intrapartum, and neonatal care, as well as adjustment to a new environment, nutrition, and infections. In Zambia, the progress in reducing NMR has been slow in the majority of public hospitals. We aimed to determine the risk factors associated with neonatal mortality at Roan Antelope General Hospital (RAGH) in Luanshya District. Methods: We reviewed medical records among neonates admitted to the RAGH Neonatal Care Unit (NCU) from January 2017 to December 2018. Data were collected using an electronic data extraction checklist from NCU registry. The main outcome was the occurrence of death within 28 days of birth. We used multivariable logistic regression to determine factors associated with neonatal death and calculated 95% confidence intervals (CIs). Results: Of 134 records reviewed, 53.7 % were female; majority (66.4 %) were spontaneous vaginal deliveries. Of all neonates, 21.2 % died whereas 69.7 % were discharged. The main reasons for admission were birth asphyxia (40.3%) and neonatal sepsis (38.1%). Having birth weight of ≤2.5 kg [adjusted odds ratio [(aOR) = 3.67 (95% CI: 1.99-6.82)], being a premature birth [aOR = 3.24 (95% CI: 1.80-5.82)], having neonatal jaundice [aOR = 3.09 (95% CI: 1.29-7.40)], being born at home [aOR = 2.63 (95% CI: 1.33-5.24)], and being male [(aOR) = 2.05 (95% CI: 1.02-4.10)] were associated with neonatal mortality. Conclusion: A significant percentage of neonatal deaths were reported between January 2017 and December 2019 at RAGH. Timely identification of high-risk mothers, effective referral system and advanced life support for preterm neonates may reduce neonatal mortality in the hospital.
BMJ Paediatrics Open, 2021
Background Neonatal mortality is a major contributor worldwide to the number of deaths in children under 5 years of age. The primary objective of this study was to assess the overall mortality rate of babies with a birth weight equal or below 1500 g in a neonatal unit at a tertiary hospital in the Eastern Cape Province, South Africa. Furthermore, different maternal-related and infant-related factors for higher mortality were analysed. Methods This is a prospective cohort study which included infants admitted to the neonatal wards of the hospital within their first 24 hours of life and with a birth weight equal to or below 1500 g. Mothers who consented answered a questionnaire to identify factors for mortality. Results 173 very low birth weight (VLBW) infants were recruited in the neonatal department between November 2017 and December 2018, of whom 55 died (overall mortality rate 32.0%). Twenty-three of the 44 infants (53,5%) with a birth weight below 1000 g died during the admission...
International Journal of Contemporary Pediatrics, 2017
Background: Very low birth weight (VLBW) infants often need institutional advanced neonatal care. There is paucity of literature about the survival and morbidities of this very vulnerable group of preterm very low birth weight infants in tertiary care teaching hospitals. The aim of the study was to measure the outcome of VLBW infants in terms of survival and various short-term morbidities in a tertiary care teaching hospital.Methods: This was a retrospective data analysis of all VLBW infants born in a tertiary care teaching hospital of eastern India, between 01 July 2014 and 31 December 2016. 35 VLBW infants were studied for the outcomes in terms of survival and morbidities like respiratory distress, apnoea of prematurity, intra ventricular haemorrhage, necrotizing enterocolitis, patent ductus arteriosus, retinopathy of prematurity and broncho pulmonary dysplasia.Results: The overall survival rate of VLBW infants weighing >750 g (n=30) was 96.6% and <750 gm (n=5), was 40%. The...
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.