Short-term mortality and morbidity of very low-birthweight infants over 9 years at Groote Schuur Hospital, Cape Town, South Africa

Main Article Content

H Crichton
L Tooke

Abstract





Background. With the advancement of neonatal care there has been a decrease in mortality rates of very low-birthweight (VLBW) (≤1 500 g) infants worldwide. However, this has been at the cost of increased morbidity in this vulnerable group. Currently there are little up to date data on short-term morbidities for VLBW infants in low and middle-income countries.


Objectives. The primary objective was to describe the neonatal mortality rate in infants weighing 401 to 1 500 g admitted to Groote Schuur Hospital neonatal unit over a 9-year period. Secondary objectives were to evaluate the main neonatal short-term morbidities.


Methods. We conducted a secondary analysis of prospectively collected observational data. All VLBW infants admitted to GSH neonatal unit from 2012 - 2020 were included in the study. Data were benchmarked against the Vermont Oxford Network (VON) database.


Results. A total of 4 645 infants were included in the study. The overall mortality rate was 19.8%, which remained static over the study period. There was a significantly higher mortality rate associated with decreasing birthweight. The mortality rate for outborn v. inborn infants was higher: 30.3% v. 18.4% (p=0.046). There was a significant risk of higher short-term morbidity in infants <1 000 g. The survival rate without major morbidity was 68.5% which compared favourably with that of the VON.


Conclusion. The results demonstrate that mortality rates are higher compared with developed countries. However, and importantly, survival without morbidity was comparable. Strategies to improve mortality and morbidity in VLBW infants are multifaceted and require a collaborative and innovative approach.





Article Details

How to Cite
Short-term mortality and morbidity of very low-birthweight infants over 9 years at Groote Schuur Hospital, Cape Town, South Africa. (2024). South African Journal of Child Health, 18(2), e1516. https://doi.org/10.7196/SAJCH.2024.v18i2.1516
Section
Research

How to Cite

Short-term mortality and morbidity of very low-birthweight infants over 9 years at Groote Schuur Hospital, Cape Town, South Africa. (2024). South African Journal of Child Health, 18(2), e1516. https://doi.org/10.7196/SAJCH.2024.v18i2.1516

References

Ramokolo V, Malaba T, Rhoda N, Kauchali S, Goga A. A landscape analysis of preterm birth in South Africa: Systemic gaps and solutions. S Afr Health Rev 2019;2019(1):133-144.

Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller A-B, et al. Born too soon: The global epidemiology of 15 million preterm births. Reproductive Health 2013;10(1):S2. https://doi.org/10.1186/1742-4755-10-S1-S2

World Health Organization. Neonatal mortality rate 2020. Geneva: WHO, 2022. https://www.who.int/data/gho/data/indicators/indicator-details/GHO/ neonatal-mortality-rate-(per-1000-live-births) (accessed 10 June 2022).

Rhoda N, Velaphi S, Gebhardt G, Kauchali S, Barron P. Reducing neonatal deaths in South Africa: Progress and challenges. S Afr Med J 2018;108(3):9-16. https://doi.org/10.7196/SAMJ.2018.v108i3.12804

Helenius K, Sjörs G, Shah PS, et al. Survival in very preterm infants: an international comparison of 10 national neonatal networks. Pediatrics 2017;140(6):e20171264. https://doi.org/10.1542/peds.2017-1264

Velaphi S, Mokhachane M, Mphahlele R, Beckh-Arnold E, Kuwanda M, Cooper P. Survival of very-low-birth-weight infants according to birth weight and gestational age in a public hospital. S Afr Med J 2005;95(7):504-509.

Tshehla RM, Coetzee M, Becker PJ. Mortality and morbidity of very low- birthweight and extremely low-birthweight infants in a tertiary hospital in Tshwane. S Afr J Child Health 2019;13(2):89-97. https://doi.or/10.7196/ SAJCH.2019.v13i2.1582

Rylance S, Ward J. Early mortality of very low-birthweight infants at Queen Elizabeth Central Hospital, Malawi. Paediatrics Int Child Health 2013;33(2):91- 96. https://doi.org/10.1179/2046905513Y.0000000053

Tamene A, Abeje G, Addis Z. Survival and associated factors of mortality of preterm neonates admitted to Felege Hiwot specialised hospital, Bahir Dar, Ethiopia. SAGE Open Med 2020;8. https://doi.org/10.1177/2050312120953646

Tooke L, Ehret DE, Okolo A, et al. Limited resources restrict the provision of adequate neonatal respiratory care in the countries of Africa. Acta Paediatrica 2022;111(2):275-283. doi.org/10.1111/apa.16050

Lategan I, Price C, Rhoda NR, Zar HJ, Tooke L. Respiratory interventions for preterm infants in LMICs: A prospective study from Cape Town, South Africa. Front Global Women Health 2022;3. https://doi.org/10.3389/fgwh.2022.817817

Edwards EM, Ehret DE, Soll RF, Horbar JD. Vermont Oxford Network: A worldwide learning community. Translational Pediatr 2019;8(3). https://doi. org/10.21037/tp.2019.07.01

Stevenson A, Joolay Y, Levetan C, Price C, Tooke L. A comparison of the accuracy of various methods of postnatal gestational age estimation; including Ballard score, foot length, vascularity of the anterior lens, last menstrual period and also a Clinician’s non-structured assessment. J Trop Pediatrics 2021;67(1):fmaa113. https://doi.org/10.1093/tropej/fmaa113

Ballot DE, Chirwa T, Ramdin T, et al. Comparison of morbidity and mortality of very low birth weight infants in a central hospital in Johannesburg between 2006/2007 and 2013. BMC Pediatrics 2015;15(1):1-11. https://doi.org/10.1186/ s12887-015-0337-4

Michaelis IA, Krägeloh-Mann I, Manyisane N, Mazinu MC, Jordaan ER. Prospective cohort study of mortality in very low birthweight infants in a single centre in the Eastern Cape province, South Africa. BMJ Paed Open 2021;5(1):e000918. https://doi.org/10.1136/bmjpo-2020-000918

Liu G, Segrè J, Gülmezoglu AM, et al. Antenatal corticosteroids for management of preterm birth: A multi-country analysis of health system bottlenecks and potential solutions. BMC Preg Child 2015;15(2):1-16. https:// doi.org/10.1186/1471-2393-15-S2-S3

Frade Garcia A, Edwards EM, de Andrade Lopes JM, et al. Neonatal admission temperature in middle-and high-income countries. Pediatrics 2023;152(3):e2023061607. https://doi.org/10.1542/peds.2023-061607

Gibbs L, Tooke L, Harrison M. Short-term outcomes of inborn v. outborn very- low birthweight neonates (<1 500 g) in the neonatal nursery at Groote Schuur Hospital, Cape Town, South Africa. S Afr Med J 2017;107(10):900-903. https:// doi.org/10.7196/SAMJ.2017.v107i10.12463

Riemer LJ, Le Roux SM, Harrison MC, Tooke L. Short-term outcomes of HIV-exposed and HIV-unexposed preterm, very low birthweight neonates: A longitudinal, hospital-based study. J Perinatol 2020;40(3):445-455. https:// doi.org/10.1038/s41372-019-0541-4

Mangiza M, Ehret DE, Edwards EM, Rhoda N, Tooke L. Morbidity and mortality in small for gestational age very preterm infants in a middle-income country. Front Pediatr 2022;10:915796. https://doi.org/10.3389/fped.2022.915796

Ballot D, Ghoor A, Scher G. Prevalence of and risk factors for cranial ultrasound abnormalities in very-low-birth-weight infants at Charlotte Maxeke Johannesburg Academic Hospital. S Afr J Child Health 2017;11(2):66-70. https://doi.org/10.7196/SAJCH.2017.v11i2.1167

Griffin JB, Jobe AH, Rouse D, McClure EM, Goldenberg RL, Kamath- Rayne BD. Evaluating WHO-recommended interventions for preterm birth: A mathematical model of the potential reduction of preterm mortality in sub-Saharan Africa. Glob Health: Science Prac 2019;7(2):215-227. https:// doi.org/10.9745/GHSP-D-18-00402

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