Masters Degrees (Paediatrics and Child Health)

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Browsing Masters Degrees (Paediatrics and Child Health) by Subject "Birth weight, Low -- South Africa"

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    The association between admission temperature and adverse outcomes in very low birthweight neonates admitted to a tertiary neonatal service in South Africa
    (Stellenbosch : Stellenbosch University, 2021, 2021-12) Jones, Thomas; Kali, Gugu; Holgate, Sandi; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Background: Neonatal hypothermia is commonly seen in the early neonatal period and has been shown to contribute significantly to both short and long term morbidity and mortality. This is particularly true in high risk neonates including pre-term and low birth weight neonates. The incidence of neonatal hypothermia in sub-Saharan African countries has been shown to be anywhere from 60 – 85%, and is a major public health issue in low resource countries. Our goal was to calculate the prevalence of admission hypothermia in very low birth weight (VLBW) neonates, and to establish relationships between admission hypothermia and adverse short and long-term outcomes. Methods: This was a retrospective descriptive cohort study looking at all VLBW neonates admitted to the Tygerberg Hospital neonatal wards between the 1st of January 2016 and the 31st of December 2017. Demographic data and short-term outcomes such as respiratory distress needing surfactant, necrotising enterocolitis and severe intraventricular haemorrhage were recorded from the Vermont Oxford Network (VON) database. Long-term outcome data (cerebral palsy, developmental delay, and vision or hearing impairment) were collected from the Tygerberg Hospital high risk neonatal clinic notes. All the patients were categorized into one of five temperature categories as per the WHO definitions prior to data analysis. Categorical data was analysed using the standard Chi-squared test and Fisher’s exact test. Multivariate analyses were performed using logistic regression comparing outcomes between the temperature categories, in order to identify any associations between admission hypothermia and both short and long term outcomes. Other perinatal variables (i.e. gestational age, antenatal steroids, and need for resuscitation) were included in these multivariate analyses. Statistical significance was defined as a P-value of < 0.05. Results: The final cohort after exclusions consisted of 1492 VLBW neonates. The prevalence of admission hypothermia was 68.9%. Of those neonates with admission hypothermia, 297 (28%) had mild, 718 (69.5%) had moderate, and 13 (1.2%) had severe hypothermia according to the WHO classification. We noted a significant delay between time of birth and time of admission to the neonatal unit across the cohort, with a median time of admission being 71 minutes (IQR: 51 – 115 minutes). In-hospital mortality was 15.1%, with the majority of deaths occurring within the first week of life. Taking significant confounders into account, there was no statistically significant relationship between admission hypothermia and any of the short- and long-term adverse outcomes on the multivariate analysis. Conclusion: Admission hypothermia is common amongst VLBW neonates admitted to the neonatal service in Tygerberg Hospital. However, there was no significant association between admission hypothermia and adverse short- or long-term outcomes. Further research is needed to fully understand the impact that admission hypothermia has in this setting, however it is clear that the procedures in place to prevent admission hypothermia need to be strengthened, with the first critical step being shortening of the time between birth and admission to the nursery.