Short-term outcomes of inborn v. outborn very-low-birth-weight neonates (<1 500 g) in the neonatal nursery at Groote Schuur Hospital, Cape Town, South Africa

Abstract

Background. The Groote Schuur Hospital (GSH) neonatal nursery provides level 3 care for the Metro West Health District in the Western Cape Province of South Africa. Worldwide, very-low-birth-weight (VLBW) neonates delivered in level 3 neonatal units have better outcomes than those transported from other facilities. Objectives. To identify the characteristics and outcomes of VLBW neonates at GSH, with emphasis on differences between inborns and outborns. Methods. This was a retrospective cohort study. VLBW neonates admitted to the GSH neonatal nursery between 1 January 2012 and 31 December 2013 were enrolled on the Vermont Oxford Network database and reviewed. Results. Of 1 032 VLBW neonates enrolled, 906 (87.8%) were delivered at GSH and 126 (12.2%) were outborn. Access to antenatal care, antenatal steroids and inborn status were statistically significant predictors of mortality and survival without morbidity. and chronic lung disease (5.3% v. 13.4%; p=0.003). The incidence of necrotising enterocolitis was similar in the two groups (5.9% v. 8.7%; p=0.227). The mortality rate was 18.4% for inborns and 33.3% for outborns (p<0.0001). Mortality declined as birth weight increased. Of the survivors, 85.0% of inborns and 70.2% of outborns did not develop serious morbidity (p=0.003). Conclusions. VLBW neonates delivered at GSH had better outcomes than their outborn counterparts. Perinatal regionalisation is beneficial to our patients, with antenatal care, timeous transfer in utero and antenatal steroids contributing to excellent outcomes.

Short-term outcomes of infants with an extremely low birth weight in a resource-limited neonatal intensive care unit, Grey’s Hospital, KwaZulu-Natal

“…Neonates born after 28 weeks of gestation and those with a birth weight of >900 g had better outcomes, but without statistical significance. The observed trend is similar to that of comparable local studies, [8][9][10][11][12] in which survival rates were also reported to improve with increasing gestational age and birth weight.…”

“…The observed incidence of maternal hypertensive disorders (52.5%) was similar to that reported from a study at the Groote Schuur Hospital in Cape Town, SA (54%). [12] In our study, survival rate did not appear to be significantly associated with antenatal care or steroids. In contrast, both Velaphi et al [9] and Kirsten et al [10] reported better neonatal outcomes when antenatal care was provided.…”

Causes of Illness and Preterm Infant Deaths in a Low Resource Setting in Southern Nigeria: A 5 Year Review

“…The preterm mortality rate in out-born was significantly higher than in-born. This was similar to a study among VLBW preterm infants by Gibbs et al [22] that reported mortality rate of 18.4% among in-born and 33.3% for out-born. It can be inferred that babies whose mothers received antenatal care and were delivered in hospital would have better outcomes as their problems are anticipated and management instituted early.…”

“…The overall preterm mortality rate of 24.6% was higher than 20.3% reported by Gibbs et al [22] but lower than 29% reported by Khan et al The reason for this could be the shorter duration of 6-12 months used in these studies. The preterm mortality rate in out-born was significantly higher than in-born.…”

“…These preterm infants had higher risks of infections and hypothermia due to premature immune systems, lack of neonatal transport services in the State and late presentation. [13] More preterm female infants died compared to their male counterparts which is in contrast to findings reported by other studies [15,22]. This could be because overall, more preterm female infants were admitted.…”