Predicting mortality and length-of-stay for neonatal admissions to private hospital neonatal intensive care units: a Southern African retrospective study

Abstract

Objectives: To predict neonatal mortality and length of stay (LOS) from readily available perinatal data for neonatal intensive care unit (NICU) admissions in Southern African private hospitals. Methods: Retrospective observational study using perinatal data from a large multicentre sample. Fifteen participating NICU centres in the Medi-Clinic private hospital group in Southern Africa. We used 2376 infants born between 1 January -31 December 2008 to build the regression models, and a further 1 578 infants born between 1 January -31 December 2007 to test the models. Outcome measures were mortality and length of hospital stay for NICU admissions. Results: Of the infants included in the 2008 dataset, ninety-one (3.8%) died after being admitted to NICU centres. The median LOS for non-transferred survivors was 11 days. An analysis of the structural peculiarities of the data showed high correlations between groups of the perinatal variables pertaining to the size and Apgar scores of the newborn infants, respectively. The logistic regression model to predict neonatal mortality had a good fit (AUC: 0.8507, misclassification rate: 13.6%), but the low positive predictive value of this model reduces its usefulness. The poisson log-linear model to predict LOS had a good fit (predicted R 2 : 0.7027). Conclusions: Apgar score at one minute, birth weight, and delivery mode significantly influence the odds of neonatal death and are associated with significant effects on LOS.

Factors Associated with Survival to Discharge of Newborns in a Middle-Income Country

“…The present results are also similar to a report from a private healthcare group in South Africa, who found that birth weight, Apgar score, and mode of delivery were all associated with neonatal mortality [18]. This is interesting, as the majority of patients in the private health care group were of White and Indian ethnicity, whereas those in the current report were almost exclusively Black African.…”

Risk factors for mortality among human immunodeficiency virus‐exposed and unexposed infants admitted to a neonatal intensive care unit in Botswana

“…The epidemiology of neonatal mortality in Southern Africa is not well understood. The cumulative mortality in this high‐risk NNU population was 24.5%, similar to that found in intensive care settings in other resource poor settings such as Benin, Ethiopia, Nigeria and Saudi Arabia, but higher than the 3.8% neonatal mortality was found in a private hospital NNU in South Africa . Mortality differences may in part reflect the ability to resuscitate very preterm infants and other factors related to resource availability .…”

“…The cumulative mortality in this high-risk NNU population was 24.5%, similar to that found in intensive care settings in other resource poor settings such as Benin, 16 Ethiopia, 17 Nigeria 18 and Saudi Arabia, 19 but higher than the 3.8% neonatal mortality was found in a private hospital NNU in South Africa. 20 Mortality differences may in part reflect the ability to resuscitate very preterm infants and other factors related to resource availability. 3 Our results are consistent with previous studies of neonatal mortality in Sub-Saharan Africa that have identified preterm birth, low birthweight and neonatal infection as important risk factors for neonatal mortality.…”

A Selected Review of the Mortality Rates of Neonatal Intensive Care Units

“…The total mortality rates varied between countries. The overall in-hospital mortality rates were reported to be 3.1 and 3.8% in South Africa in 2007 and 2008, respectively ( 36 ), 4% in Canada from January 1996 to October 1997 ( 22 ), 5.7% in Portugal between 2004 and 2008 ( 34 ), 6.5% in Qatar from 2002 to 2006 ( 35 ), 8.1% in England between 2008 and 2010 ( 25 ), 9.2% in Australia across 1995–2006 ( 20 ), 14.2% in Nigeria between June 2012 and May 2013 ( 33 ), and 26–29% in Uganda in 2012 ( 37 ).…”