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Wondie WT, Zeleke KA, Wubneh CA. Incidence and predictors of mortality among low birth weight neonates in the first week of life admitted to the neonatal intensive care unit in Northwestern Ethiopia comprehensive specialized hospitals, 2022. Multi-center institution-based retrospective follow-up study. BMC Pediatr 2023; 23:489. [PMID: 37759160 PMCID: PMC10523684 DOI: 10.1186/s12887-023-04319-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Globally, a high number of neonatal mortalities occurs in the first week of life, particularly among low birth weight neonates in low-income countries, including Ethiopia. However, there is limited evidence on the early neonatal mortality of low-birth-weight neonates in Ethiopia. Therefore, this study aimed to assess incidence and predictors of mortality among low-birth-weight neonates in their first week of life admitted to the neonatal intensive care unit in Northwestern Ethiopia Comprehensive Specialized Hospitals, 2022. METHODS A multi-center retrospective follow-up study was conducted from March 21, 2020 to March 1, 2022, among 761 early neonates with low birth weight admitted in Northwestern Ethiopia Comprehensive Specialized Hospitals. The study participants were selected using simple random sampling technique. Data were collected using a data abstraction checklist ,and checked for completeness and entered into EPI data version 4.6, then exported to STATA 14 for analysis. Kaplan Meier failure curve and log-rank test were used to estimate and compare the probability of death. Both bivariable and multivariable Weibull regression models were fitted to identify predictors of mortality. Finally, a hazard ratio with 95% CI was computed, and variables having a p-value < 0.05 were considered as a significant predictor of mortality. RESULTS The incidence of mortality among low birth weight neonates in their first week of life was 75.63 per 1000 neonate day observation (95% CI: 66.76-85.67), preeclampsia (AHR = 1.77;95% CI:1.32-2.36s), perinatal asphyxia (AHR = 1.64; 95% CI:1.14-2.36), respiratory distress syndrome (AHR = 1.76 95% CI;1.31-2.34), necrotizing enterocolitis (AHR = 2.78 95% CI;1.79-4.32), prematurity (AHR = 1.86; 95% CI:1.30-2.67), and birth weight < 1000gram (AHR = 3.13;95% CI: 1.91-5.12) and 1000-1499 gram (AHR = 1.99; 95% CI:1.47-2.68) were predictors. CONCLUSION The incidence of early neonatal mortality in low birth weight neonates was incredibly higher than the overall early neonatal mortality in Northwest Ethiopia (Amhara region). Preeclampsia, perinatal asphyxia, respiratory distress syndrome, necrotizing enterocolitis, prematurity, and birth weight were predictors of mortality. Therefore, stakeholders shall give early identification and emphasis on preventable and treatable predictors. Furthermore, the health care provider shall give education about the importance of breastfeeding, and Antenatal and postnatal care.
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Affiliation(s)
- Wubet Tazeb Wondie
- Department of Pediatrics and Child Health Nursing, College of Medicine, and Health Science, Ambo University, Ambo, Ethiopia.
| | - Kassaye Ahmed Zeleke
- Department of Neonatal Health Nursing, School of Nursing, College of Medicine, and Health Science, University of Gondar, Gondar, Ethiopia
| | - Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine, and Health Science, University of Gondar, Gondar, Ethiopia
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Gamberini C, Juliana NCA, de Brouwer L, Vogelsang D, Al-Nasiry S, Morré SA, Ambrosino E. The association between adverse pregnancy outcomes and non-viral genital pathogens among women living in sub-Saharan Africa: a systematic review. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1107931. [PMID: 37351522 PMCID: PMC10282605 DOI: 10.3389/frph.2023.1107931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
Adverse pregnancy outcomes are the main causes of maternal and neonatal morbidity and mortality, including long-term physical and psychological sequelae. These events are common in low- and middle-income countries, particularly in Sub Saharan Africa, despite national efforts. Maternal infections can cause complications at any stage of pregnancy and contribute to adverse outcomes. Among infections, those of the genital tract are a major public health concern worldwide, due to limited availability of prevention, diagnosis and treatment approaches. This applies even to treatable infections and holds true especially in Sub-Saharan Africa. As late as 2017, the region accounted for 40% of all reported treatable non-viral genital pathogens worldwide, many of which have been independently associated with various adverse pregnancy outcomes, and that include Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum. Two databases (PubMed and Embase) were examined to identify eligible studies published up to October 2022. This study reviewed findings on the association between infections by treatable non-viral genital pathogens during pregnancy and adverse pregnancy outcomes among women living in Sub-Saharan Africa. Articles' title and abstract were screened at first using keywords as "sexually transmitted infections", "non-viral", "adverse pregnancy outcome", "Africa", "sub-Saharan Africa", "pregnant women", "pregnancy", and "pregnancy outcome". Subsequently, according to the eligibility criteria, potential articles were read in full. Results showed that higher risk of preterm birth is associated with Treponema pallidum, Chlamydia trachomatis and Candida albicans infections. Additionally, rates of stillbirth, neonatal death, low birth weight and intrauterine growth restriction are also associated with Treponema pallidum infection. A better insight on the burden of non-viral genital pathogens and their effect on pregnancy is needed to inform antenatal care guidelines and screening programs, to guide the development of innovative diagnostic tools and other strategies to minimize transmission, and to prevent short- and long-term complications for mothers and children.
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Affiliation(s)
- Carlotta Gamberini
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Naomi C. A. Juliana
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Lenya de Brouwer
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
| | - Dorothea Vogelsang
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
| | - Salwan Al-Nasiry
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Department of Obstetrics and Gynecology, Research School GROW for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Servaas A. Morré
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, UP, India
- Dutch Chlamydia trachomatis Reference Laboratory on Behalf of the Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Elena Ambrosino
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
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Debere MK, Haile Mariam D, Ali A, Mekasha A, Chan GJ. Survival status and predictors of mortality among low-birthweight neonates admitted to KMC units of five public hospitals in Ethiopia: Frailty survival regression model. PLoS One 2022; 17:e0276291. [PMID: 36355701 PMCID: PMC9648734 DOI: 10.1371/journal.pone.0276291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/04/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low birth weight (LBW) and preterm birth are leading causes of under-five and neonatal mortality globally. Data about the timing of death and outcomes for LBW and preterm births are limited in Ethiopia and could be used to strengthen neonatal healthcare. This study describes the incidence of neonatal mortality rates (NMR) stratified by newborn size at birth for gestational age and identifies its predictors at five public hospitals in Ethiopia. METHODS A prospective follow-up study enrolled 808 LBW neonates from March 2017 to February 2019. Sex-specific birthweight for gestational age percentile was constructed using Intergrowth 21st charts. Mortality patterns by birthweight for-gestational-age-specific survival curves were compared using the log-rank test and Kaplan-Meier survival curves. A random-effects frailty survival model was employed to identify predictors of time to death. RESULTS Among the 808 newborns, the birthweight distribution was 3.2% <1000 g, 28.3% <1500 g, and 68.1% <2000 g, respectively. Birthweight for gestational age categories were 40.0% both preterm and small for gestational age (SGA), 20.4% term SGA, 35.4% appropriate weight for gestational age, and 4.2% large for gestational age (LGA). The sample included 242 deaths, of which 47.5% were both preterm and SGA. The incidence rate of mortality was 16.17/1000 (95% CI 14.26-18.34) neonatal-days of observation. Neonatal characteristics independently related to increased risk of time-to-death were male sex (adjusted hazards ratio [AHR] 3.21 95% CI 1.33-7.76), born preterm (AHR 8.56 95% CI 1.59-46.14), having been diagnosed with a complication (AHR 4.68 95% CI 1.49-14.76); some maternal characteristics and newborn care practices (like lack of effective KMC, AHR 3.54 95% CI 1.14-11.02) were also significantly associated with time-to-death. CONCLUSIONS High mortality rates were measured for low birthweight neonates-especially those both preterm and SGA births-even in the context of tertiary care. These findings highlight the need for improved quality of neonatal care, especially for the smallest newborns.
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Affiliation(s)
- Mesfin Kote Debere
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Damen Haile Mariam
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Ali
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amha Mekasha
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Grace J. Chan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
- Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of Amrica
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Healthcare-associated Infections in Very Low Birth-weight Infants in a South African Neonatal Unit: Disease Burden, Associated Factors and Short-term Outcomes. Pediatr Infect Dis J 2022; 41:911-916. [PMID: 35980840 PMCID: PMC9555825 DOI: 10.1097/inf.0000000000003666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infection is a leading cause of death among very low birth-weight (VLBW) infants in resource-limited settings. METHODS We performed a retrospective review of healthcare-associated infection (HAI) episodes among VLBW infants from January 1, 2016, to December 31, 2017. The epidemiology, causative organisms and short-term outcomes were analyzed. Logistic regression was used to investigate for factors associated with development of HAI. RESULTS During the study period, 715 VLBW infants with suspected HAI were investigated, including 162/715 (22.7%) proven and 158/715 (22.1%) presumed HAI. Of the proven infections, 99/162 (61.1%) contained at least one Gram-negative organism per blood culture; 84/162 (51.9%) single Gram-negative organisms and 15/162 (9.3%) polymicrobial growth. Independent factors associated with development of any HAI included low gestational age, small for gestational age, indwelling central venous catheter and invasive ventilation. Compared with infants in whom HAI had been excluded, infants with HAI were more likely to be diagnosed with necrotizing enterocolitis (5.6% vs. 23.1%; P < 0.001) and bronchopulmonary dysplasia (1.0% vs. 4.4%; P = 0.007). Infants with any HAI also had a longer hospital stay [44 (25-65) vs. 38 (26-53) days; P < 0.001] and increased mortality [90/320 (28.1%) vs. 21/395 (5.3%); P < 0.001] compared with infants who did not develop HAI episodes. CONCLUSIONS Proven and presumed HAI are a major contributor to neonatal morbidity and mortality; further research is urgently needed to better understand potential targets for prevention and treatment of HAI in resource-limited neonatal units.
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Alam MJ, Islam MM, Maniruzzaman M, Ahmed NAMF, Tawabunnahar M, Rahman MJ, Roy DC, Mydam J. Socioeconomic inequality in the prevalence of low birth weight and its associated determinants in Bangladesh. PLoS One 2022; 17:e0276718. [PMID: 36301890 PMCID: PMC9612499 DOI: 10.1371/journal.pone.0276718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Low birth weight (LBW) is a major risk factor of child mortality and morbidity during infancy (0-3 years) and early childhood (3-8 years) in low and lower-middle-income countries, including Bangladesh. LBW is a vital public health concern in Bangladesh. The objective of the research was to investigate the socioeconomic inequality in the prevalence of LBW among singleton births and identify the significantly associated determinants of singleton LBW in Bangladesh. MATERIALS AND METHODS The data utilized in this research was derived from the latest nationally representative Bangladesh Demographic and Health Survey, 2017-18, and included a total of 2327 respondents. The concentration index (C-index) and concentration curve were used to investigate the socioeconomic inequality in LBW among the singleton newborn babies. Additionally, an adjusted binary logistic regression model was utilized for calculating adjusted odds ratio and p-value (<0.05) to identify the significant determinants of LBW. RESULTS The overall prevalence of LBW among singleton births in Bangladesh was 14.27%. We observed that LBW rates were inequitably distributed across the socioeconomic groups (C-index: -0.096, 95% confidence interval: [-0.175, -0.016], P = 0.029), with a higher concentration of LBW infants among mothers living in the lowest wealth quintile (poorest). Regression analysis revealed that maternal age, region, maternal education level, wealth index, height, age at 1st birth, and the child's aliveness (alive or died) at the time of the survey were significantly associated determinants of LBW in Bangladesh. CONCLUSION In this study, socioeconomic disparity in the prevalence of singleton LBW was evident in Bangladesh. Incidence of LBW might be reduced by improving the socioeconomic status of poor families, paying special attention to mothers who have no education and live in low-income households in the eastern divisions (e.g., Sylhet, Chittagong). Governments, agencies, and non-governmental organizations should address the multifaceted issues and implement preventive programs and policies in Bangladesh to reduce LBW.
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Affiliation(s)
- Md. Jahangir Alam
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
- * E-mail: (MJA); , (JM)
| | - Md. Merajul Islam
- Department of Statistics, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | | | | | - Most. Tawabunnahar
- Department of Statistics, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | | | - Dulal Chandra Roy
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Janardhan Mydam
- Division of Neonatology, Department of Pediatrics, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, United States of America
- Department of Pediatrics, Rush Medical Center, Chicago, IL, United States of America
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
- * E-mail: (MJA); , (JM)
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Scaria L, Soman B, George B, Ahamed Z, Hariharan S, Jeemon P. Determinants of very low birth weight in India: The National Family Health Survey – 4. Wellcome Open Res 2022; 7:20. [PMID: 35694198 PMCID: PMC9171295 DOI: 10.12688/wellcomeopenres.17463.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background
Low birth weight (LBW) is susceptible to neonatal complications, chronic medical conditions, and neurodevelopmental disabilities. We aim to describe the determinants of very low birth weight (VLBW) in India and compare it with the determinants of LBW based on the National Family Health Survey – 4 (NHFS-4)
Methods
Data from the NFHS-4 on birthweight and other socio-demographic characteristics for the youngest child born in the family during the five years preceding the survey were used. Data of 147,762 infant–mother pairs were included. Multiple logistic regression models were employed to delineate the independent predictors of VLBW (birth weight<1500 g) or LBW (birth weight: 1500-2499 g).
Results
Of the 147,762 children included in the study, VLBW and LBW were observed in 1.2% and 15.8% of children, respectively. The odds of VLBW were higher in female children (aOR: 1.36, 95% CI: 1.15–1.60), among mothers aged 13–19 years (aOR: 1.58, 95% CI: 1.22–2.07), mothers with severe or moderate anaemia (aOR: 1.61, 95% CI: 1.34–1.94), mothers without recommended antenatal care (aOR: 1.47, 95% CI: 1.31–1.90), maternal height less than 150 cm (aOR: 1.54, 95% CI: 1.29–1.85) and among mothers with multiple pregnancy (aOR: 21.34, 95% CI: 14.70–30.96) in comparison to their corresponding counterparts. In addition to the variables associated with VLBW, educational status of mothers (no education; aOR: 1.08, 95% CI: 1.02–1.15 and primary education; aOR: 1.16, 95% CI: 1.08–1.25), caste of the children (scheduled tribe; aOR: 1.13, 95% CI: 1.03–1.24), and wealthiness of the family (poorest wealth quintiles; aOR: 1.11, 95% CI: 1.03–1.19) were associated with LBW.
Conclusions
Interventions targeting improvements in antenatal care access, maternal health, and nutritional status may reduce the number of VLBW infants. Social determinants of LBW require further detailed study to understand the high propensity of low birth-weight phenotypes in the disadvantaged communities in India.
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Affiliation(s)
- Liss Scaria
- AMCHSS, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Biju Soman
- AMCHSS, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Babu George
- Child Development Centre, Government Medical College, Trivandrum, Kerala, 695011, India
| | - Zulfikar Ahamed
- Child Development Centre, Government Medical College, Trivandrum, Kerala, 695011, India
| | - Sankar Hariharan
- Pediatrics, Government Medical College, SAT Hospital, Trivandrum, Kerala, 695011, India
| | - Panniyammakal Jeemon
- AMCHSS, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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Scaria L, Soman B, George B, Ahamed Z, Hariharan S, Jeemon P. Determinants of very low birth weight in India: The National Family Health Survey – 4. Wellcome Open Res 2022; 7:20. [DOI: 10.12688/wellcomeopenres.17463.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background Low birth weight (LBW) is susceptible to neonatal complications, chronic medical conditions, and neurodevelopmental disabilities. We aim to describe the determinants of very low birth weight (VLBW) in India based on the National Family Health Survey – 4 (NHFS-4). Methods Data from the NFHS 4 on birthweight and other socio-demographic characteristics for the youngest child born in the family during the five years preceding the survey were used. Data of 147,762 infant–mother pairs were included. Multiple logistic regression models were employed to delineate the independent predictors of VLBW (birth weight<1500 g) or LBW (birth weight <2500 g). Results Of the 147,762 children included in the study, VLBW and LBW were observed in 1.2% and 15.8% of children, respectively. The odds of VLBW were higher in female children (aOR: 1.36, 95% CI: 1.15–1.60), among mothers aged 13–19 years (aOR: 1.58, 95% CI: 1.22–2.07), mothers with severe or moderate anaemia (aOR: 1.61, 95% CI: 1.34–1.94), mothers without recommended antenatal care (aOR: 1.47, 95% CI: 1.31–1.90), maternal height less than 150 cm (aOR: 1.54, 95% CI: 1.29–1.85) and among mothers with multiple pregnancy (aOR: 21.34, 95% CI: 14.70–30.96) in comparison to their corresponding counterparts. In addition to the variables associated with VLBW, educational status of mothers (no education; aOR: 1.08, 95% CI: 1.02–1.15 and primary education; aOR: 1.16, 95% CI: 1.08–1.25), caste of the children (scheduled tribe; aOR: 1.13, 95% CI: 1.03–1.24), and wealthiness of the family (poorest wealth quintiles; aOR: 1.11, 95% CI: 1.03–1.19) were associated with LBW. Conclusions Interventions targeting improvements in antenatal care access, maternal health, and nutritional status may reduce the number of VLBW infants. Social determinants of LBW require further detailed study to understand the high propensity of low birth-weight phenotypes in the disadvantaged communities in India.
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Ramdin TD, Saggers RT, Bandini RM, Magadla Y, Mphaphuli AV, Ballot DE. Neurodevelopmental Outcomes of Extremely Low Birth Weight Survivors in Johannesburg, South Africa. Front Pediatr 2022; 10:902263. [PMID: 35664886 PMCID: PMC9160720 DOI: 10.3389/fped.2022.902263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Improved survival in extremely low birth weight infants (ELBWI) in Sub-Saharan Africa has raised the question whether these survivors have an increased chance of adverse neurodevelopmental outcomes. OBJECTIVES To describe neurodevelopmental outcomes of ELBWI in a neonatal unit in South Africa. METHODS This was a prospective follow-up study. All ELBWI who survived to discharge between 1 July 2013 and 31 December 2017 were invited to attend the clinic. Bayley Scales of Infant and Toddler Development (version III) were conducted at 9 to 12 months and 18 to 24 months. RESULTS There were 723 ELBWI admissions during the study period, 292 (40.4%) survived to hospital discharge and 85/292 (29.1%) attended the neonatal follow up clinic. The mean birth weight was 857.7 g (95% CI: 838.2-877.2) and the mean gestational age was 27.5 weeks (95% CI 27.1-27.9). None of the infants had any major complication of prematurity. A total of 76/85 (89.4%) of the infants had a Bayley-III assessment at a mean corrected age of 17.21 months (95% CI: 16.2-18.3). The mean composite scores for cognition were 98.4 (95% CI 95.1-101.7), language 89.9 (95% CI 87.3-92.5) and motor 97.6 (95% CI 94.5-100.6). All mean scores fell within the normal range, The study found 28 (36.8%) infants to be "at risk" for neurodevelopmental delay. CONCLUSION Our study demonstrates good neurodevelopmental outcome in a small group of surviving ELBWI, but these results must be interpreted in the context of the high mortality in this group of infants.
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Affiliation(s)
- Tanusha D Ramdin
- Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,PRINCE (Project to Improve Neonatal Care), School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Robin T Saggers
- Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,PRINCE (Project to Improve Neonatal Care), School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Rossella M Bandini
- PRINCE (Project to Improve Neonatal Care), School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Yoliswa Magadla
- Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,PRINCE (Project to Improve Neonatal Care), School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Aripfani V Mphaphuli
- Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,PRINCE (Project to Improve Neonatal Care), School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Daynia E Ballot
- PRINCE (Project to Improve Neonatal Care), School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Ingemyr K, Elfvin A, Hentz E, Saggers RT, Ballot DE. Factors influencing survival and short-term outcomes of very low birth weight infants in a tertiary hospital in Johannesburg. Front Pediatr 2022; 10:930338. [PMID: 36186656 PMCID: PMC9523153 DOI: 10.3389/fped.2022.930338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The neonatal mortality rate in South Africa is lower than the global average, but still approximately five times higher than some European and Scandinavian countries. Prematurity, and its complications, is the main cause (35%) of neonatal deaths. OBJECTIVE To review the maternal, delivery period and infant characteristics in relation to mortality in very low birth weight (VLBW) infants at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). METHODS This was a retrospective descriptive study of VLBW infants admitted to CMJAH between 1 January 2017 and 31 December 2018. All infants with a birth weight between 500 to ≤ 1,500 grams were included. The characteristics and survival of these infants were described using univariate analysis. RESULTS Overall survival was 66.5%. Provision of antenatal steroids, antenatal care, Cesarean section, female sex, resuscitation at birth, and 5-min Apgar score more than five was related with better survival to discharge. Among respiratory diagnoses, 82.8% were diagnosed with RDS, 70.8% received surfactant therapy and 90.7% received non-invasive respiratory support after resuscitation. At discharge, 59.5% of the mothers were breastfeeding and 30.8% spent time in kangaroo mother care. CONCLUSION The two-thirds survival rate of VLBW infants is similar to those in other developing countries but still remains lower than developed countries. This may be improved with better antenatal care attendance, coverage of antenatal steroids, temperature control after birth, improving infection prevention and control practices, breastfeeding rates and kangaroo mother care. The survival rate was lowest amongst extremely low birth weight (ELBW) infants.
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Affiliation(s)
- Kristin Ingemyr
- Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Anders Elfvin
- Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.,Region Västra Götaland, Department of Paediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabet Hentz
- Department of Paediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.,Region Västra Götaland, Department of Paediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Robin T Saggers
- Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.,School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daynia E Ballot
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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10
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Kebede BF, Genie YD, Aregawi DH, Tadele BA. Survival Status and Predictors of Mortality Among Low Birthweight Neonates Admitted in Amhara Region Referral Hospitals of Ethiopia: Retrospective Follow-Up Study. Health Serv Res Manag Epidemiol 2022; 9:23333928221117364. [PMID: 35923501 PMCID: PMC9340404 DOI: 10.1177/23333928221117364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/17/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Being born with low birthweight is a major determinant of perinatal,
neonatal, and infant survival. Even though low birthweight-related neonatal
mortality is high, there is an information gap regarding the survival status
of low birthweight neonates and their predictors of mortality in
Ethiopia. Objective This study was conducted to assess the survival status and predictors of
mortality among low birthweight neonates admitted to Amhara region referral
hospitals in Ethiopia. Methods and Materials A retrospective follow-up study was conducted on randomly selected low
birthweight neonates admitted to the Amhara region referral hospital between
January 01-2017 and December 30-2018. Data were entered into Epi-data
4.4.2.1 and exported to Stata 14 for cleaning and analysis. A cox regression
model was used to analyze the data. Tables, charts, and text were used to
report the results. Results This study revealed that 35.2% of participants died with incidence rates of
37.86 per 1000 person-day observations (95%CI: 31.79-45.10). Sepsis
(AHR:1.72(95% CI: 1.05-2.81), respiratory distress (AHR: 2.03 (95%
CI:1.36-3.03), necrotizing enterocolitis (AHR: 2.47 (95% CI: 1.17-5.20),
congenital anomalies (AHR:2.37 (95% CI: 1.36-4.13), extreme low birth weight
(AHR:2.62 (95% CI:1.54-4.44) and prematurity (AHR: 2.55 (95% CI:1.10-5.92)
were independent predictors of mortality. Conclusion Sepsis, respiratory distress, necrotizing enterocolitis, congenital
anomalies, extremely low birth weight, and premature birth were the
independent predictors of mortality. Therefore, it is better for all
stakeholders to focus more on the early diagnosis and management of low
birth weight neonates with the factors associated with mortality.
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11
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Woelile TA, Kibret GT, Workie HM, Amare AT, Tigabu A, Aynalem YA, Chanie ES, Birlie TA. Survival Status and Predictors of Mortality Among Low-Birth-Weight Neonates Admitted to the Neonatal Intensive Care Unit at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia, 2020. Pediatric Health Med Ther 2021; 12:451-466. [PMID: 34512075 PMCID: PMC8427078 DOI: 10.2147/phmt.s323526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Low birth weight neonates are subjected to different comorbidities due to anatomical and physiological immaturity. Globally, 60-80% of neonatal mortality was due to low birth weight. Hence, this study aimed to assess the survival status and predictors of mortality among low birth weight neonates. METHODS An institutional-based retrospective cohort study design was conducted among 718 low birth weight neonates admitted to the neonatal intensive care unit from January 1, 2017, to December 30, 2019, at Felege Hiwot Comprehensive Specialized Hospital. Data were entered into Epi data version 3.1 and analyzed with STATA version 14. Kaplan-Meier curves together with a Log rank test were used to estimate the survival time and showed the presence of differences among groups. Cox proportional-hazard regression was used to estimate the hazard ratio at the 5% level of significance to determine the net effect of each explanatory variable on survival status. RESULTS The overall incidence density was 35.3 per 1000 person-day observations (CI: 30.8 -40.6) with 5715 follow-up days. Deliveries outside the health institution [AHR; 2.31 (95% CI: 1.20-4.42)], maternal age <18 years [AHR; 3.08 (95% CI: 1.64-5.81)] and maternal age >35 years [AHR; 3.83 (95% CI: 2.00-7.31)], neonatal sepsis [AHR; 2.33 (95% CI: 1.38-3.94)], neonatal respiratory distress syndrome [AHR; 1.92 (95% CI: 1.27-2.89)], necrotizing enterocolitis [AHR; 3.09 (95% CI: 1.69-5.64)] and birth weight <1000 gm [AHR; 3.61 (95% CI: 1.73-7.55)] were found to be significant predictors. CONCLUSION This study showed that two of the seven low birth weight neonates died during the follow-up period. Therefore, it is better for health care providers and other stakeholders to focus more on early diagnosis and management of low birth weight neonates with sepsis, respiratory distress syndrome, necrotizing enterocolitis and counseling mothers on the risk of having a child in early and old age.
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Affiliation(s)
- Tamiru Alene Woelile
- Department of Pediatrics and Neonatal Nursing, Wolaita Sodo University, Sodo, Southern Nation and Nationalities of Ethiopia, Ethiopia
| | - Getasew Tesfa Kibret
- Department of Pediatrics and Child Health Nursing, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
| | | | - Abraham Tsedalu Amare
- Department of Adult Health Nursing, Debre Tabor University, Debra Tabor, Amhara, Ethiopia
| | - Agimasie Tigabu
- Department of Adult Health Nursing, Debre Tabor University, Debra Tabor, Amhara, Ethiopia
| | | | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Tekalign Amera Birlie
- Department of Adult Health Nursing, Debre Tabor University, Debra Tabor, Amhara, Ethiopia
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12
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Tamirat KS, Sisay MM, Tesema GA, Tessema ZT. Determinants of adverse birth outcome in Sub-Saharan Africa: analysis of recent demographic and health surveys. BMC Public Health 2021; 21:1092. [PMID: 34098914 PMCID: PMC8186187 DOI: 10.1186/s12889-021-11113-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/23/2021] [Indexed: 01/18/2023] Open
Abstract
Background More than 75% of neonatal deaths occurred in the first weeks of life as a result of adverse birth outcomes. Low birth weight, preterm births are associated with a variety of acute and long-term complications. In Sub-Saharan Africa, there is insufficient evidence of adverse birth outcomes. Hence, this study aimed to determine the pooled prevalence and determinants of adverse birth outcomes in Sub-Saharan Africa. Method Data of this study were obtained from a cross-sectional survey of the most recent Demographic and Health Surveys (DHS) of ten Sub-African (SSA) countries. A total of 76,853 children born five years preceding the survey were included in the final analysis. A Generalized Linear Mixed Models (GLMM) were fitted and an adjusted odds ratio (AOR) with a 95% Confidence Interval (CI) was computed to declare statistically significant determinants of adverse birth outcomes. Result The pooled prevalence of adverse birth outcomes were 29.7% (95% CI: 29.4 to 30.03). Female child (AOR = 0.94, 95%CI: 0.91 0.97), women attended secondary level of education (AOR = 0.87, 95%CI: 0.82 0.92), middle (AOR = 0.94,95%CI: 0.90 0.98) and rich socioeconomic status (AOR = 0.94, 95%CI: 0.90 0.99), intimate-partner physical violence (beating) (AOR = 1.18, 95%CI: 1.14 1.22), big problems of long-distance travel (AOR = 1.08, 95%CI: 1.04 1.11), antenatal care follow-ups (AOR = 0.86, 95%CI: 0.83 0.86), multiparty (AOR = 0.88, 95%CI: 0.84 0.91), twin births (AOR = 2.89, 95%CI: 2.67 3.14), and lack of women involvement in healthcare decision-making process (AOR = 1.10, 95%CI: 1.06 1.13) were determinants of adverse birth outcomes. Conclusion This study showed that the magnitude of adverse birth outcomes was high, abnormal baby size and preterm births were the most common adverse birth outcomes. This finding suggests that encouraging antenatal care follow-ups and socio-economic conditions of women are essential. Moreover, special attention should be given to multiple pregnancies, improving healthcare accessibilities to rural areas, and women’s involvement in healthcare decision-making. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11113-z.
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Affiliation(s)
- Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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13
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Tessema ZT, Tamirat KS, Teshale AB, Tesema GA. Prevalence of low birth weight and its associated factor at birth in Sub-Saharan Africa: A generalized linear mixed model. PLoS One 2021; 16:e0248417. [PMID: 33705473 PMCID: PMC7951905 DOI: 10.1371/journal.pone.0248417] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Low birth weight (LBW) is one of the major determinants of perinatal survival, infant morbidity, and mortality, as well as the risk of developmental disabilities and illnesses in future lives. Though studies were conducted to assess the magnitude and associated factors of low birth weight, most of the studies were at a single center and little information on the regional level. Hence, this study assessed the prevalence and associated factors of low birth weight in Sub-Saharan countries. Method This study was based on secondary data sources from 35 Sub-Saharan countries’ Demography and Health Survey (DHS). For this study, we used the Kids Record (KR file) data set. In the KR file, all under-five children who were born in the last five years preceding the survey in the selected enumeration area who had birth weight data were included for the study. To identify determinants of low birth weight multivariable mixed-effect logistic regression model fitted. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤0.05 in the multivariable model were used to declare significant factors associated with low birth weight at birth. Result The pooled prevalence of newborn babies’ low birth weight measured at birth in Sub-Saharan Africa was 9.76% with (95% CI: 9.63% to 9.89%). Female child, women not participated in healthcare decision making, and wider birth intervals, divorced/ separated women, and twin pregnancies associated with increased occurrences of low birth weight, while some level of woman and husband education, antenatal care visits, older maternal age, and multiparity associated with reduced occurrence low birth weight. Conclusion This study revealed that the magnitude of low birth weight was high in sub-Saharan Africa countries. Therefore, the finding suggests that more emphasis is important for women with a lack of support, multiples, and healthcare decision-making problems.
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Affiliation(s)
- Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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14
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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 Paediatr Open 2021; 5:e000918. [PMID: 33665373 PMCID: PMC7893654 DOI: 10.1136/bmjpo-2020-000918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Neonatal mortality is a major contributor worldwide to the number of deaths in children under 5 years of age. The primary objective of this study was to assess the overall mortality rate of babies with a birth weight equal or below 1500 g in a neonatal unit at a tertiary hospital in the Eastern Cape Province, South Africa. Furthermore, different maternal-related and infant-related factors for higher mortality were analysed. Methods This is a prospective cohort study which included infants admitted to the neonatal wards of the hospital within their first 24 hours of life and with a birth weight equal to or below 1500 g. Mothers who consented answered a questionnaire to identify factors for mortality. Results 173 very low birth weight (VLBW) infants were recruited in the neonatal department between November 2017 and December 2018, of whom 55 died (overall mortality rate 32.0%). Twenty-three of the 44 infants (53,5%) with a birth weight below 1000 g died during the admission. One hundred and sixty-one mothers completed the questionnaire and 45 of their babies died.Main factors associated with mortality were lower gestational age and lower birth weight. Need for ventilator support and sepsis were associated with higher mortality, as were maternal factors such as HIV infection and age below 20 years. Conclusion This prospective study looked at survival of VLBW babies in an underprivileged part of the Eastern Cape of South Africa. Compared with other public urban hospitals in the country, the survival rate remains unacceptably low. Further research is required to find the associated causes and appropriate ways to address these.
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Affiliation(s)
- Isabel A Michaelis
- Paediatrics, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
| | - Ingeborg Krägeloh-Mann
- Children's Hospital, Neuropaediatrics, Developmental Neurology, Social Paediatrics, Eberhard Karls University Tübingen Faculty of Medicine, Tübingen, Baden-Württemberg, Germany
| | - Ncomeka Manyisane
- Paediatrics, Walter Sisulu University, Mthatha, Eastern Cape, South Africa
| | - Mikateko C Mazinu
- Biostatistics unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Esme R Jordaan
- Biostatistics unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
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15
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Nabwera HM, Wang D, Tongo OO, Andang’o PEA, Abdulkadir I, Ezeaka CV, Ezenwa BN, Fajolu IB, Imam ZO, Mwangome MK, Umoru DD, Akindolire AE, Otieno W, Nalwa GM, Talbert AW, Abubakar I, Embleton ND, Allen SJ. Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya. PLoS One 2021; 16:e0244109. [PMID: 33444346 PMCID: PMC7808658 DOI: 10.1371/journal.pone.0244109] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To describe the patient population, priority diseases and outcomes in newborns admitted <48 hours old to neonatal units in both Kenya and Nigeria. STUDY DESIGN In a network of seven secondary and tertiary level neonatal units in Nigeria and Kenya, we captured anonymised data on all admissions <48 hours of age over a 6-month period. RESULTS 2280 newborns were admitted. Mean birthweight was 2.3 kg (SD 0.9); 57.0% (1214/2128) infants were low birthweight (LBW; <2.5kg) and 22.6% (480/2128) were very LBW (VLBW; <1.5 kg). Median gestation was 36 weeks (interquartile range 32, 39) and 21.6% (483/2236) infants were very preterm (gestation <32 weeks). The most common morbidities were jaundice (987/2262, 43.6%), suspected sepsis (955/2280, 41.9%), respiratory conditions (817/2280, 35.8%) and birth asphyxia (547/2280, 24.0%). 18.7% (423/2262) newborns died; mortality was very high amongst VLBW (222/472, 47%) and very preterm infants (197/483, 40.8%). Factors independently associated with mortality were gestation <28 weeks (adjusted odds ratio 11.58; 95% confidence interval 4.73-28.39), VLBW (6.92; 4.06-11.79), congenital anomaly (4.93; 2.42-10.05), abdominal condition (2.86; 1.40-5.83), birth asphyxia (2.44; 1.52-3.92), respiratory condition (1.46; 1.08-2.28) and maternal antibiotics within 24 hours before or after birth (1.91; 1.28-2.85). Mortality was reduced if mothers received a partial (0.51; 0.28-0.93) or full treatment course (0.44; 0.21-0.92) of dexamethasone before preterm delivery. CONCLUSION Greater efforts are needed to address the very high burden of illnesses and mortality in hospitalized newborns in sub-Saharan Africa. Interventions need to address priority issues during pregnancy and delivery as well as in the newborn.
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Affiliation(s)
- Helen M. Nabwera
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Alder Hey Children’s Hospital NHS Trust, Liverpool, United Kingdom
| | - Dingmei Wang
- Children's Hospital of Fudan University, Minhang District, Shanghai, China
| | | | | | - Isa Abdulkadir
- Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | | | | | | | | | | | | | | | - Walter Otieno
- Maseno University, Maseno, Kenya
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Jomo Kenyatta Highway Kaloleni Kisumu KE, Central, Kenya
| | - Grace M. Nalwa
- Maseno University, Maseno, Kenya
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Jomo Kenyatta Highway Kaloleni Kisumu KE, Central, Kenya
| | | | - Ismaela Abubakar
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nicholas D. Embleton
- Newcastle University, Newcastle upon Tyne, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, High Heaton, Newcastle upon Tyne, United Kingdom
| | - Stephen J. Allen
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Alder Hey Children’s Hospital NHS Trust, Liverpool, United Kingdom
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16
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Yang R, Chen D, Deng Q, Xu X. The effect of donor human milk on the length of hospital stay in very low birthweight infants: a systematic review and meta-analysis. Int Breastfeed J 2020; 15:89. [PMID: 33115488 PMCID: PMC7594457 DOI: 10.1186/s13006-020-00332-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Donor human milk (DHM) is an alternative to preterm infant formula if the mother's own milk is not available. Since the lactation period and preservation treatment of DHM are different from those of mother's own milk, we aimed to determine the reduction in the length of hospital stay by DHM compared to preterm infant formula. METHODS In this systematic review, we searched PubMed/MEDLINE, EMBASE, and the Cochrane Library to retrieve studies on the impact of DHM on the clinical outcomes of preterm infants published before 1 November 2019. The study included very low birthweight (VLBW) infants taking either DHM or infant formula with data on the length of hospital stay. Data were analysed using Review Manager 5.3 software. RESULTS The literature search yielded 136 articles, and four randomised controlled trials (RCTs) and eight observational studies met the inclusion criteria. A meta-analysis of the RCTs (N = 725) showed no reduction in the length of hospital stay in both the DHM and infant formula groups (- 0.22 days; 95% CI -6.38, 5.95 days), whereas that of the eight observational studies (N = 2496) showed a significant reduction in the length of hospital stay in the DHM group (- 11.72 days; 95% CI -22.07, - 1.37 days). A subgroup analysis of the RCTs revealed that the incidence of necrotising enterocolitis (NEC) was significantly lower in the DHM group when the analysis included high-quality RCTs (RR = 0.32; 95% CI 0.15, 0.69). CONCLUSIONS This systematic review of RCTs showed that DHM neither prolonged nor shortened the length of hospital stay in VLBW infants compared to preterm infant formula; however, it reduced the incidence of NEC, further validating the protective role of DHM in the health and safety of VLBW infants.
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Affiliation(s)
- Rui Yang
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Danqi Chen
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qingqi Deng
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinfen Xu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
- Haining Maternal and Child Health Hospital, Branch of Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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17
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Choi J, Urubuto F, Dusabimana R, Agaba F, Teteli R, Kumwami M, O'Callahan C, Cartledge PT. Establishing a neonatal database in a tertiary hospital in Rwanda - an observational study. Paediatr Int Child Health 2019; 39:265-274. [PMID: 31079590 DOI: 10.1080/20469047.2019.1607056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Monitoring and evaluation is vital in the quest to improve the quality of care and to reduce the morbidity and mortality of neonates in a resource-limited setting. Databases offer several advantages such as data on large cohorts of neonates and from multiple centres. Aim: To establish a minimal dataset neonatal database in Kigali, Rwanda and to assess the quality and timing of the data entry process. Secondary objectives were to describe survival rates and associated risk factors. Methods: A cross-sectional, observational study was undertaken at a tertiary hospital in Kigali, Rwanda. The Rwanda Neonatal Data Collection Form was designed specifically for the database, based on the Vermont-Oxford Network neonatal data-collection tool with locally relevant amendments. All admitted neonates were enrolled during the study period of 2011-2017 with ongoing data-collection. Infants were recruited and data collected prospectively and cross-checked retrospectively with the inclusion of basic data on neonates who were not initially recruited prospectively. Results: 3391 analysable cases were recruited: 1420 prospective and 1971 retrospective cases. Prospective data collection peaked at 90%. Data entry was not always complete with data-points left blank with only 21% having adequate data available (0-25% missing). All-cause mortality during the study period was 16% and annual mortality ranged from 12% to 24%. On multivariate analysis, place of birth (AOR 2.17), small-for-gestational-age (AOR 2.05) and gestational age were all positively associated with survival. Conclusions: An academic setting in a low- or middle-income country can create and maintain a neonatal database without funding and produce a wealth of actionable results. Throughout the process, there were considerable challenges which must be addressed if such a database is to be optimised, maintained and created in other clinical sites. Abbreviations: CHUK: Centre Hospitalier et Universitaire de Kigali (University Teaching Hospital of Kigali); CPAP: continuous positive airway pressure; HCP: Healthcare professional; HRH, Human Resources for Health Programme; LMIC: low- and middle-income countries; MeSH: Medical subject headings; MoH: Ministry of Health; NAR: Newborn admission record; QI: Quality improvement; REDCap: Research electronic data capture; RNDB: Rwanda neonatal database; RNDCF: Rwanda neonatal data collecion form; SGA: Small for gestational age; STROBE: Strengthening the reporting of observational studies in epidemiology; VON: The Vermont-Oxford Network.
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Affiliation(s)
- Jaeseok Choi
- Department of Paediatrics, University of Rwanda , Kigali , Rwanda.,Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda
| | - Fedine Urubuto
- Department of Paediatrics, University of Rwanda , Kigali , Rwanda.,Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda
| | - Raban Dusabimana
- Department of Paediatrics, University of Rwanda , Kigali , Rwanda.,Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda
| | - Faustine Agaba
- Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda
| | - Raissa Teteli
- Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda.,Department of Paediatrics, Harmony Private Clinic , Kigali , Rwanda
| | - Muzungu Kumwami
- Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda
| | - Cliff O'Callahan
- Department of Paediatrics, Middlesex Hospital and University of Connecticut , Connecticut , USA
| | - Peter Thomas Cartledge
- Department of Pediatrics, Univerisity Teaching Hospital of Kigali , Kigali , Rwanda.,USA and Department of Paediatrics, Rwanda Human Resources for Health (HRH) Program, Yale University , Kigali , Rwanda
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18
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van Maldeghem I, Nusman CM, Visser DH. Soluble CD14 subtype (sCD14-ST) as biomarker in neonatal early-onset sepsis and late-onset sepsis: a systematic review and meta-analysis. BMC Immunol 2019; 20:17. [PMID: 31159729 PMCID: PMC6547508 DOI: 10.1186/s12865-019-0298-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 05/21/2019] [Indexed: 12/29/2022] Open
Abstract
Background Early diagnosis of bacterial sepsis in neonates is hampered by non-specific symptoms and the lack of rapid responding laboratory measures. The biomarker soluble CD14 subtype (sCD14-ST) seems promising in the diagnostic process of neonatal sepsis. In order to evaluate the differences in diagnostic accuracy of sCD14-ST between early onset sepsis (EOS) and late onset sepsis (LOS) we assessed this systematic review and meta-analysis. Results Twelve articles were included in the systematic review and 10 in the meta-analysis. There was a high risk of bias on patient selection, index test and/or flow and timing. The overall quality of the included studies was moderate. At sepsis onset a consequently higher level of sCD14-ST was found in septic neonates compared to healthy controls with significant higher levels in LOS compared to EOS. In the first 24 h after sepsis onset a significant increase in pooled means of plasma sCD14-ST levels was seen in EOS (t(71.6) = 7.3, p < .0001) while this was not seen in LOS or healthy controls. Optimal cut-off values ranged from 305 to 672 ng/l for EOS cases versus healthy controls. The pooled sensitivity was 81% (95%CI: 0.76–0.85), the pooled specificity was 86% (0.81–0.89) with an AUC of 0.9412 (SE 0.1178). In LOS optimal cut-off values ranged from 801 to 885 ng/l with a pooled sensitivity of 81% (0.74–0.86) and a pooled specificity of 100% (0.98–1.00). An AUC and SROC was not estimable in LOS because of the low number of studies. Conclusions sCD14-ST is a promising and rapid-responding diagnostic biomarker for EOS and LOS. The difference in pooled means between EOS and LOS underlines the importance to consider EOS and LOS as two different disease entities, requiring separate analysis in original articles and systematic reviews. Electronic supplementary material The online version of this article (10.1186/s12865-019-0298-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iris van Maldeghem
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Charlotte M Nusman
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Douwe H Visser
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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19
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Yismaw AE, Tarekegn AA. Proportion and factors of death among preterm neonates admitted in University of Gondar comprehensive specialized hospital neonatal intensive care unit, Northwest Ethiopia. BMC Res Notes 2018; 11:867. [PMID: 30522518 PMCID: PMC6282301 DOI: 10.1186/s13104-018-3970-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/29/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Neonatal mortality accounts for 43% of under-five child mortality in Ethiopia where preterm is the second leading cause of neonatal death and steadily increased in low-income countries. Therefore, assessing the proportion of death and associated factors among preterm neonates has a paramount importance in designing an effective strategy to intervene and achieve sustainable development goal. RESULTS In this study proportion of preterm neonatal death in this study was 28.8% [95% CI (25.1, 32.9)]. Complications during index pregnancy [AOR = 1.92, 95% CI (1.09, 3.38)], gestational age [AOR = 0.78, 95% CI (0.69, 0.91)], small for gestational age [AOR = 2.42, 95% CI (1.33, 4.38)], APGAR score at birth < 7 [AOR = 2.39, 95% CI (1.34, 4.27)], hyaline membrane disease [AOR = 5.15, 95% CI (2.83, 9.36)], neonatal respiratory distress at admission [AOR = 1.93, 95% CI (1.13, 3.31)], presence of jaundice [AOR = (3.39, 95% CI (1.90, 6.05)], received kangaroo mother care [AOR = 0.13, 95% CI (0.05, 0.35)], and hypoglycemia at admission [AOR = 3.86, 95% CI (2.12, 7.06)] were statistically significant. The proportion of preterm neonatal death was high. Ministry of health and responsible organizations should give special attention for preterm neonates to prevent life-threatening complications.
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Affiliation(s)
- Ayenew Engida Yismaw
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Abebe Ayinalem Tarekegn
- Department of Health Economics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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20
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Ballot DE, Ramdin T, White DA, Lipman J. A comparison between raw and predicted mortality in a paediatric intensive care unit in South Africa. BMC Res Notes 2018; 11:829. [PMID: 30477580 PMCID: PMC6260679 DOI: 10.1186/s13104-018-3946-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/21/2018] [Indexed: 11/26/2022] Open
Abstract
Objective Paediatric intensive care resources are limited in sub-Saharan Africa. The mortality rate in a combined Paediatric/Neonatal Intensive Care Unit in Johannesburg, South Africa was almost double that in a dedicated paediatric intensive care unit in the same country. This study aimed to compare the raw mortality rate with that predicted with the Paediatric Index of Mortality (version 3), by doing a retrospective analysis of an existing database. Results A total of 530 patients admitted to the intensive care unit between 1 January 2015 and 31 December 2017 were included. The raw mortality rate was 27.1% and the predicted mortality rate was 27.0% (p = 0.971). Cardiac arrest during ICU admission (p < 0.001), non-reactive pupils (0.035), inotropic support (p < 0.001) and renal disease (p = 0.002) were all associated with an increased risk of mortality. These findings indicate that the high mortality rate is due to the severity of illness in the patients that are admitted. It also indicates that the quality of care delivered is acceptable.
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Affiliation(s)
- Daynia Elizabeth Ballot
- Paediatric/Neonatal Intensive Care Unit, Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X 39, 2000, Johannesburg, South Africa.
| | - Tanusha Ramdin
- Paediatric/Neonatal Intensive Care Unit, Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X 39, 2000, Johannesburg, South Africa
| | - Debbie Ann White
- Paediatric/Neonatal Intensive Care Unit, Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X 39, 2000, Johannesburg, South Africa
| | - Jeffrey Lipman
- Intensive Care Services, Royal Brisbane and Women's Hospital and The University of Queensland, Herston, Australia
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21
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Gumede S, Black V, Naidoo N, Chersich MF. Attendance at antenatal clinics in inner-city Johannesburg, South Africa and its associations with birth outcomes: analysis of data from birth registers at three facilities. BMC Public Health 2017; 17:443. [PMID: 28832284 PMCID: PMC5498856 DOI: 10.1186/s12889-017-4347-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Antenatal care (ANC) clinics serve as key gateways to screening and treatment interventions that improve pregnancy outcomes, and are especially important for HIV-infected women. By disaggregating data on access to ANC, we aimed to identify variation in ANC attendance by level of care and across vulnerable groups in inner-city Johannesburg, and document the impact of non-attendance on birth outcomes. Methods This record review of routine health service data involved manual extraction of 2 years of data from birth registers at a primary-, secondary- and tertiary-level facility within inner-city Johannesburg. Information was gathered on ANC attendance, HIV testing and status, pregnancy duration, delivery mode and birth outcomes. Women with an unknown attendance status were considered as not having attended clinic, but effects of this assumption were tested in sensitivity analyses. Multiple logistic regression was used to identify associations between ANC attendance and birth outcomes. Results Of 31,179 women who delivered, 88.7% (27,651) had attended ANC (95% CI = 88.3–89.0). Attendance was only 77% at primary care (5813/7543), compared to 89% at secondary (3661/4113) and 93% at tertiary level (18,177/19,523). Adolescents had lower ANC attendance than adults (85%, 1951/2295 versus 89%, 22,039/24,771). Only 37% of women not attending ANC had an HIV test (1308/3528), compared with 93% of ANC attenders (25,756/27,651). Caesarean section rates were considerably higher in women who had attended ANC (40%, 10,866/27,344) than non-attenders (13%, 422/3360). Compared to those who had attended ANC, non-attenders were 1.6 fold more likely to have a preterm delivery (95% CI adjusted odds ratio [aOR] = 1.4–1.8) and 1.4 fold more likely to have a stillbirth (aOR 95% CI = 1.1–1.9). Similar results were seen in analyses where missing data on ANC attendance was classified in different ways. Conclusion Inner-city Johannesburg has an almost 5% lower ANC attendance rate than national levels. Attendance is particularly concerning in the primary care clinic that serves a predominantly migrant population. Adolescents had especially low rates, perhaps owing to stigma when seeking care. Interventions to raise ANC attendance, especially among adolescents, may help improve birth outcomes and HIV testing rates, bringing the country closer to achieving maternal and child health targets and eliminating HIV in children. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4347-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Siphamandla Gumede
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Vivian Black
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicolette Naidoo
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew F Chersich
- Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ballot DE, Agaba F, Cooper PA, Davies VA, Ramdin T, Chirwa L, Rakotsoane D, Madzudzo L. A review of delivery room resuscitation in very low birth weight infants in a middle income country. Matern Health Neonatol Perinatol 2017; 3:9. [PMID: 28560046 PMCID: PMC5448148 DOI: 10.1186/s40748-017-0048-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advanced levels of delivery room resuscitation in very low birth weight infants are reported to be associated with death and complications of prematurity. In resource limited settings, the need for delivery room resuscitation is often used as a reason to limit care in these infants. METHODS This was a review of delivery room resuscitation in very low birth weight infants born in a tertiary hospital in South Africa between 01 January 2013 and 30 June 2016. Outcomes included death and serious complications of prematurity. Advanced delivery room resuscitation was defined as the need for intubation, chest compressions or the administration of adrenaline. RESULTS A total of 1511 very low birth weight infants were included in the study. The majority (1332/1511 (88.2%) required oxygen in the delivery room. Face mask ventilation was needed in 45.2% (683/1511). Advanced delivery room resuscitation was only required in 10.6% (160/1511). More than half the infants who required advanced delivery room resuscitation died (89/160; 55.6%). Advanced delivery room resuscitation was required in significantly more infants <1000 grams at birth than those infants >1000 grams (83/539 (15.4%) vs 77/972 (7.9%) p < 0.001). Advanced delivery room resuscitation was significantly associated with a 5 minute Apgar score < 6 (OR 13.8 (95%CI 8.6-22.0), supplemental oxygen at day 28 (OR 2.2 (95% CI 1.4-3.9), metabolic acidosis (OR 2.3 (95% CI 1.1-4.8) and death (OR 1.9 95% CI 1.1-3.3). Other serious complications of prematurity were not associated with advanced delivery room resuscitation. Mortality was increased in infants with a low admission temperature (35.1 °C (SD 0.92) vs 36.1 °C (SD 1.4) (p < 0.001). CONCLUSION There was a high mortality rate associated with advanced delivery room resuscitation; however complications of prematurity were not increased in survivors..The need for advanced delivery room resuscitation alone should not be used as a predictor of poor outcome in very low birth weight infants. Survivors of advanced delivery room resuscitation should be afforded ventilatory support if required. Special care must be taken to avoid hypothermia in very low birth weight infants requiring resuscitation at birth.
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Affiliation(s)
- Daynia E Ballot
- Department of Paediatrics and Child Health, University of the Witwatersrand, Private Bag X 39, Johannesburg, 2000 South Africa
| | - Faustine Agaba
- Department of Paediatrics and Child Health, University of the Witwatersrand, Private Bag X 39, Johannesburg, 2000 South Africa
| | - Peter A Cooper
- Department of Paediatrics and Child Health, University of the Witwatersrand, Private Bag X 39, Johannesburg, 2000 South Africa
| | - Victor A Davies
- Department of Paediatrics and Child Health, University of the Witwatersrand, Private Bag X 39, Johannesburg, 2000 South Africa
| | - Tanusha Ramdin
- Department of Paediatrics and Child Health, University of the Witwatersrand, Private Bag X 39, Johannesburg, 2000 South Africa
| | - Lea Chirwa
- Department of Paediatrics and Child Health, University of the Witwatersrand, Private Bag X 39, Johannesburg, 2000 South Africa
| | - David Rakotsoane
- Department of Paediatrics and Child Health, University of the Witwatersrand, Private Bag X 39, Johannesburg, 2000 South Africa
| | - Lethile Madzudzo
- Department of Paediatrics and Child Health, University of the Witwatersrand, Private Bag X 39, Johannesburg, 2000 South Africa
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Ballot DE, Ramdin T, Rakotsoane D, Agaba F, Chirwa T, Davies VA, Cooper PA. Assessment of developmental outcome in very low birth weight infants in Southern Africa using the Bayley Scales of Infant Development (III). BMJ Paediatr Open 2017; 1:e000091. [PMID: 29637126 PMCID: PMC5862217 DOI: 10.1136/bmjpo-2017-000091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/27/2017] [Accepted: 07/30/2017] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES The study aimed to compare the developmental outcome of very low birth weight infants with a group of normal-term controls in a tertiary hospital in sub-Saharan Africa. DESIGN A group of 105 very low birth weight infants were assessed at a mean age of 17.6 months (95% CI 16.7 to 18.6) using the Bayley Scales of Infant Development, Third Edition, and compared with a group of normal-term controls at the same mean age. RESULTS Seven of the study infants (7%) had developmental delay (a score below 70), compared with none in the control group (p=0.04). Three of the seven study infants were delayed on all three subscales, one of whom had cerebral palsy. A further 34% of the study infants were 'at risk' of developmental delay (a score below 85). There was no difference in the mean composite score between the study group and controls for the cognitive (p=0.56), motor (p=0.57) or language (p=0.66) subscales. There was no difference in mean composite scores on all subscales between infants who were appropriate for gestational age and those who were small for gestational age. Cognitive and motor scores remained stable in paired assessments of study infants before and after 1 year of age; language scores decreased significantly (p<0.001). Mechanical ventilation was the only risk factor significantly associated with a cognitive score below 85 in study infants. CONCLUSION Very low birth weight infants in sub-Saharan Africa are at risk of developmental delay and require long-term neurodevelopmental follow-up.
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Affiliation(s)
- Daynia Elizabeth Ballot
- Division of Neonatology, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tanusha Ramdin
- Division of Neonatology, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - David Rakotsoane
- Division of Neonatology, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Faustine Agaba
- Division of Neonatology, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias Chirwa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Alan Davies
- Division of Neonatology, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Alan Cooper
- Division of Neonatology, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
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Ballot DE, Davies VA, Cooper PA, Chirwa T, Argent A, Mer M. Retrospective cross-sectional review of survival rates in critically ill children admitted to a combined paediatric/neonatal intensive care unit in Johannesburg, South Africa, 2013-2015. BMJ Open 2016; 6:e010850. [PMID: 27259525 PMCID: PMC4893876 DOI: 10.1136/bmjopen-2015-010850] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Report on survival to discharge of children in a combined paediatric/neonatal intensive care unit (PNICU). DESIGN AND SETTING Retrospective cross-sectional record review. PARTICIPANTS All children (medical and surgical patients) admitted to PNICU between 1 January 2013 and 30 June 2015. OUTCOME MEASURES Primary outcome-survival to discharge. Secondary outcomes-disease profiles and predictors of mortality in different age categories. RESULTS There were 1454 admissions, 182 missing records, leaving 1272 admissions for review. Overall mortality rate was 25.7% (327/1272). Mortality rate was 41.4% (121/292) (95% CI 35.8% to 47.1%) for very low birthweight (VLBW) babies, 26.6% (120/451) (95% CI 22.5% to 30.5%) for bigger babies and 16.2% (86/529) (95% CI 13.1% to 19.3%) for paediatric patients. Risk factors for a reduced chance of survival to discharge in paediatric patients included postcardiac arrest (OR 0.21, 95% CI 0.09 to 0.49), inotropic support (OR 0.085, 95% CI 0.04 to 0.17), hypernatraemia (OR 0.16, 95% CI 0.04 to 0.6), bacterial sepsis (OR 0.32, 95% CI 0.16 to 0.65) and lower respiratory tract infection (OR 0.54, 95% CI 0.30 to 0.97). Major birth defects (OR 0.44, 95% CI 0.26 to 0.74), persistent pulmonary hypertension of the new born (OR 0.44, 95% CI 0.21 to 0.91), metabolic acidosis (OR 0.23, 95% CI 0.12 to 0.74), inotropic support (OR 0.23, 95% CI 0.12 to 0.45) and congenital heart defects (OR 0.29, 95% CI 0.13 to 0.62) predicted decreased survival in bigger babies. Birth weight (OR 0.997, 95% CI 0.995 to 0.999), birth outside the hospital (OR 0.21, 95% CI 0.05 to 0.84), HIV exposure (OR 0.54, 95% CI 0.30 to 0.99), resuscitation at birth (OR 0.49, 95% CI 0.25 to 0.94), metabolic acidosis (OR 0.25, 95% CI 0.10 to 0.60) and necrotising enterocolitis (OR 0.23, 95% CI 0.12 to 0.46) predicted poor survival in VLBW babies. CONCLUSIONS Ongoing mortality review is essential to improve provision of paediatric critical care.
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Affiliation(s)
- Daynia E Ballot
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Wits- UQ Critical Care Infection Collaboration, Johannesburg, South Africa
| | - Victor A Davies
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter A Cooper
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias Chirwa
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Argent
- Faculty of Health Sciences, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Mervyn Mer
- Wits- UQ Critical Care Infection Collaboration, Johannesburg, South Africa Department of Internal Medicine, Division of Critical Care and Pulmonology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Low birth weight, very low birth weight and extremely low birth weight in African children aged between 0 and 5 years old: a systematic review. J Dev Orig Health Dis 2016; 7:408-15. [DOI: 10.1017/s2040174416000131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Low birth weight (LBW<2500), very low birth weight (VLBW<1500), extremely low birth weight (ELBW<1500) infants are at high risk for growth failure that result in delayed development. Africa is a continent that presents high rates of children born with LBW, VLBW and ELBW particularly sub-Saharan Africa. To review the existing literature that explores the repercussions of LBW, VLBW and ELBW on growth, neurodevelopmental outcome and mortality in African children aged 0–5 years old. A systematic review of peer-reviewed articles using Academic Search Complete in the following databases: PubMed, Scopus and Scholar Google. Quantitatives studies that investigated the association between LBW, VLBW, ELBW with growth, neurodevelopmental outcome and mortality, published between 2008 and 2015 were included. African studies with humans were eligible for inclusion. From the total of 2205 articles, 12 articles were identified as relevant and were subsequently reviewed in full version. Significant associations were found between LBW, VLBW and ELBW with growth, neurodevelopmental outcome and mortality. Surviving VLBW and ELBW showed increased risk of death, growth retardation and delayed neurodevelopment. Post-neonatal interventions need to be carried out in order to minimize the short-term effects of VLBW and ELBW.
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