Analysis of care received by very-low-birthweight neonates at Worcester Provincial Hospital in 2018 after implementation of the Western Cape Provincial Peri-viability Decision Support Framework
Date
2022-08
Authors
Journal Title
Journal ISSN
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Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: Background: A significant proportion of very-low-birthweight (VLBW; <1500g) infants are born at
regional hospitals in South Africa (SA) and little is known regarding their care and outcomes. Since
2017, clinicians at regional hospitals throughout the Western Cape (WC) have utilized the WC
Department of Health Periviability Decision Support Framework to guide care of VLBW infants.
Objectives: To describe care of VLBW infants at Worcester Provincial Hospital (WPH) in 2018,
compared to recommendations in the Framework and to secondarily compare differences in shortterm
outcomes of VLBW infants managed before (2016) and after (2018) the implementation of these
guidelines.
Methods: A retrospective cohort study was conducted of all live-born VLBW infants ≤7 days managed
at WPH, in 2016 and 2018. Information related to neonatal care was collected from medical records
of patients born in 2018 only, and compared with Framework recommendations according to
birthweight categories (500-799g; 800-999g; 1000-1499g). Information regarding mortality at
discharge and at age 12 months, readmission before age 12 months, and length of neonatal stay was
captured for all included neonates. Results were reported using frequencies, percentages, and
proportions with corresponding 95% confidence intervals.
Results: In total 227 infants were included, of which 115 were born in 2018 and included in the primary
objective analysis. Infant and maternal characteristics were similar for the 2016 and 2018 cohorts.
Complete framework adherence was achieved in 54% (n=90) of infants 1000-1499g, 42% (n=12) of
infants 800-999g, and no infants of 500-799g were managed with complete adherence. Adherence to
≥80% of recommendations was achieved in 69% of infants. For the secondary objectives, survival to
discharge (73.2% in 2016 vs 71.9% in 2018) and 1 year (70.5% in 2016 vs 70.4% in 2018) did not change
significantly after Framework implementation. Clinically meaningful reductions in neonatal
readmissions (30.6% in 2016 vs 23.5% in 2018) and length of stay (33 days in 2016 vs 28 days in 2018)
were observed from 2016 to 2018.
Conclusions: The majority of VLBW infants at WPH in 2018 were managed with ≥80% adherence to
the Framework, but considerable differences in adherence were noted by birthweight categories. A
clinically important decreased length of neonatal stay and readmission were observed postimplementation;
this in combination with no increase in mortality represents a potential gain for a
resource-restricted healthcare system.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Description
Thesis (MMed) -- Stellenbosch University, 2022.
Keywords
Birth weight, Low -- Worcester (South Africa), Newborn infants -- Mortality -- Worcester (South Africa), Prematurely born children -- Worcester (South Africa), Neonatology -- Worcester (South Africa), UCTD