Determinants of survival in very low birth weight neonates in a public sector hospital in Johannesburg

Abstract

BackgroundAudit 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.MethodsThis was a retrospective chart review of 474 VLBW infants admitted within 24 hours of birth, between 1 July 2006 and 30 June 2007, to the neonatal unit of Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa. Binary outcome logistic regression on individual variables and multiple logistic regression was done to identify those factors determining survival.ResultsOverall survival was 70.5%. Survival of infants below 1001 grams birth weight was 34.9% compared to 85.8% for those between 1001 and 1500 grams at birth. The main determinant of survival was birth weight with an adjusted survival odds ratio of 23.44 (95% CI: 11.22 - 49.00) for babies weighing between 1001 and 1500 grams compared to those weighing below 1001 grams. Other predictors of survival were gender (OR 3. 21; 95% CI 1.6 - 6.3), birth before arrival at the hospital (BBA) (OR 0.23; 95% CI: 0.08 - 0.69), necrotising enterocolitis (NEC) (OR 0.06; 95% CI: 0.02 - 0.20), hypotension (OR 0.05; 95% CI 0.01 - 0.21) and nasal continuous positive airways pressure (NCPAP) (OR 4.58; 95% CI 1.58 - 13.31).ConclusionsSurvival rates compare favourably with other developing countries, but can be improved; especially in infants < 1001 grams birth weight. Resources need to be allocated to preventing the birth of VLBW babies outside hospital, early neonatal resuscitation, provision of NCPAP and prevention of NEC.

Short term outcome, complications and average direct cost in managing extremely low birth weight infants in a tertiary care centre in Sri Lanka

“…As all the deaths in our study occurred within first 7 days of life and during ICU stay, neonatal mortality rate and the mortality rate during NICU stay can be calculated as 23% and 25.7% respectively (4 babies did not get admitted to NICU). In another study done in South Africa, overall survival rate of VLBW was 70.5% and survival rate of ELBW infants was 34.9% 14 . In our study the overall survival rate of ELBW infants was 77%.…”

“…In the South African study 14 , mean duration of mechanical ventilation was 8.08 days and the mean duration of supplemental oxygen was 8.2 days in VLBW babies. In our study mean duration of mechanical ventilation and supplemental oxygen was 3.5 days and 8.9 days respectively.…”

What has high fertility got to do with the low birth weight problem in Africa?

“…Very small neonates, particularly those weighing less than 2.5 kilograms (5.5 pounds) at birth, are characterized by poor health outcomes in later life. In particular, a child born with low birth weight is less prepared to fight infections due to its weaker immune system and is therefore more predisposed to infectious diseases such as diarrhea and respiratory infections (Ballot et al 2010). For this and other reasons, children with low birth weight also tend to have high mortality.…”

The occurrence of high-risk factors for hearing loss in verylow- birth-weight neonates: A retrospective exploratory study of targeted hearing screening

“…Rates of disability among surviving VLBW neonates may be higher in developing countries such as South Africa (Ballot, Chirwa & Cooper, 2010) as the setting and resources in these contexts differ markedly to those in developed countries. Factors such as increased length of hospital stay (Mokhachane, Saloojee & Cooper, 2006), and increased risk of the surviving neonate being subjected to a variety of complications while in hospital (Wood et al, 2000) are known to result in a range of problems such as cerebral palsy, cognitive impairment, blindness and hearing impairment (Hack, 2007).…”