Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
BMC Pediatrics
Published in: BMC Pediatrics 1/2015

Open Access 01-12-2015 | Research article

Comparison of morbidity and mortality of very low birth weight infants in a Central Hospital in Johannesburg between 2006/2007 and 2013

Authors: Daynia E Ballot, Tobias Chirwa, Tanusha Ramdin, Lea Chirwa, Irma Mare, Victor A Davies, Peter A Cooper

Published in: BMC Pediatrics | Issue 1/2015

Login to get access

Abstract

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.
Literature
1.
2.
Wang H, Liddell CA, Coates MM, Mooney MD, Levitz CE, Schumacher AE et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014. doi:10.1016/s0140-6736(14)60497-9.
3.
Velaphi SC, Rhoda N. Reducing neonatal deaths in South Africa - are we there yet and what can be done? South African J Child Health. 2012;6(3):67–71.CrossRef
4.
Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014. doi:10.1016/s0140-6736(14)60792-3.
5.
Velaphi SC, Mokhachane M, Mphahlele RM, Beckh-Arnold E, Kuwanda ML, Cooper PA. 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):504–9.PubMed
6.
Rylance S, Ward J. Early mortality of very low-birthweight infants at Queen Elizabeth Central Hospital, Malawi. Paediatr Int Child Health. 2013;33(2):91–6. doi:10.1179/2046905513y.0000000053.CrossRefPubMed
7.
Chen SD, Lin YC, Lu CL, Chen SC. Changes in Outcome and Complication Rates of Very-Low-Birth-Weight Infants in One Tertiary Center in Southern Taiwan between 2003 and 2010. Pediatr Neonatol. 2014. doi:10.1016/j.pedneo.2013.10.010.
8.
Hahn WH, Chang JY, Chang YS, Shim KS, Bae CW. Recent trends in neonatal mortality in very low birth weight Korean infants: in comparison with Japan and the USA. J Korean Med Sci. 2011;26(4):467–73. doi:10.3346/jkms.2011.26.4.467.CrossRefPubMedPubMedCentral
9.
Stevens TP, Harrington EW, Blennow M, Soll RF. Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev. 2007(4):CD003063. doi:10.1002/14651858.CD003063.pub3.
10.
11.
Kirsten GF, Kirsten CL, Henning PA, Smith J, Holgate SL, Bekker A, et al. The outcome of ELBW infants treated with NCPAP and InSurE in a resource-limited institution. Pediatrics. 2012;129(4):e952–9. doi:10.1542/peds. 2011-1365.CrossRefPubMed
12.
13.
Ballot DE, Chirwa TF, Cooper PA. Determinants of survival in very low birth weight neonates in a public sector hospital in Johannesburg. BMC Pediatr. 2010;10:30. doi:10.1186/1471-2431-10-30.
14.
15.
Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187(1):1–7.CrossRefPubMedPubMedCentral
16.
Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92(4):529–34.CrossRefPubMed
17.
Fenton TR. A new growth chart for preterm babies: Babson and Benda’s chart updated with recent data and a new format. BMC Pediatr. 2003;3:13. doi:10.1186/1471-2431-3-13.CrossRefPubMedPubMedCentral
18.
Owa JA A-DI, Owoeye AA. Comparison of Morbidity and Mortality Rates among low Birthweight Infants in two Neonatal Units from Developing Countries. Cape Town: IAMENEH; 2000; 2000.
19.
Cooper PA, Sandler DL, Simchowitz ID, Galpin JS. Effects of suboptimal intra-uterine growth on preterm infants between 30 and 32 weeks’ gestation. S Afr Med J. 1997;87(3):314–8.PubMed
20.
Gooden M, Younger N, Trotman H. What is the best predictor of mortality in a very low birth weight infant population with a high mortality rate in a medical setting with limited resources? Am J Perinatol. 2014;31(6):441–6. doi:10.1055/s-0033-1351658.CrossRefPubMed
21.
Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006(3):CD004454. doi:10.1002/14651858.CD004454.pub2.
22.
Miller SS, Lee HC, Gould JB. Hypothermia in very low birth weight infants: distribution, risk factors and outcomes. J Perinatol. 2011;31 Suppl 1:S49–56. doi:10.1038/jp.2010.177.CrossRefPubMed
23.
Hooven TA, Polin RA. Healthcare-associated infections in the hospitalized neonate: a review. Early Hum Dev. 2014;90 Suppl 1:S4–6. doi:10.1016/s0378-3782(14)70002-7.CrossRefPubMed
24.
Ballot DE, Ballot NS, Rothberg AD. Reasons for failure to administer antenatal corticosteroids in preterm labour. S Afr Med J. 1995;85(10):1005–7.PubMed
Metadata
Title
Comparison of morbidity and mortality of very low birth weight infants in a Central Hospital in Johannesburg between 2006/2007 and 2013
Authors
Daynia E Ballot
Tobias Chirwa
Tanusha Ramdin
Lea Chirwa
Irma Mare
Victor A Davies
Peter A Cooper
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2015
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-015-0337-4

Other articles of this Issue 1/2015

BMC Pediatrics 1/2015 Go to the issue

Research article

Resistive expressions in preschool children during peripheral vein cannulation in hospitals: a qualitative explorative observational study

Research article

Caregivers’ hair cortisol: a possible biomarker of chronic stress is associated with obesity measures among children with disabilities

Research article

Copper, zinc and iron levels in infants and their mothers during the first year of life: a prospective study

Research article

Survival status and predictors of mortality in severely malnourished children admitted to Jimma University Specialized Hospital from 2010 to 2012, Jimma, Ethiopia: a retrospective longitudinal study

Research article

A randomized controlled trial of hospital versus home based therapy with oral amoxicillin for severe pneumonia in children aged 3 – 59 months: The IndiaCLEN Severe Pneumonia Oral Therapy (ISPOT) Study

Research article

Associations of pubertal stage and body mass index with cardiometabolic risk in Hong Kong Chinese children: A cross-sectional study