Impact of the use of surfactant and Nasal CPAP in the reduction of mortality among very low birth weight preterm babies in Ile-Ife, south western Nigeria

Background: Respiratory distress syndrome causes significant morbidity and death especially among very low birth weight babies. Though the use of CPAP and surfactant have been shown to improve survival, these interventions were scarcely available in the past. This study aimed at comparing the clinical outcomes of preterm babies with RDS delivered at the Ife Hospital Unit of the Obafemi Awolowo University Teaching Hospitals Complex at two different periods. Objective: To compare the birth weight specific mortality rates and overall mortality rates of preterm babies with RDS between two periods in the neonatal ward of the Ife Hospital Unit of OAUTHC. Methods: A retrospective study comparing outcomes of 92 babies with RDS at GA 26 to 33+6 weeks between January 2015 and May 2016 and managed with intranasal oxygen alone to 104 babies of same gestational age characteristics between January 2019 and May 2020 who were managed withCPAP/surfactant. Results: The mean weight and gestational age of the babies respectively were 1.36 (±0.37) kg and 31.14 (±2.3) weeks in 2015/2016 and 1.35 (±0.322) kg and 30.95 (±2.24) weeks in 2019/2020. The overall case fatality rate and birth-weight specific mortality rates for ELBW, VLBW and LBW were 33.7%, 62.5%, 35.2% and 9.1% in 2015/2016 and 18.3%, 58.3%, 15.5% and 9.7% respectively in 2019/2020. Conclusion: While the use of CPAP and the administration of surfactant clearly show improved survival among very low birth weight babies who are at increased risk of death from RDS, this was not the case for extreme low birth weight babies.

Short-term outcomes of inborn v. outborn very-low-birth-weight neonates (<1 500 g) in the neonatal nursery at Groote Schuur Hospital, Cape Town, South Africa

Background. The Groote Schuur Hospital (GSH) neonatal nursery provides level 3 care for the Metro West Health District in the Western Cape Province of South Africa. Worldwide, very-low-birth-weight (VLBW) neonates delivered in level 3 neonatal units have better outcomes than those transported from other facilities.Objectives. To identify the characteristics and outcomes of VLBW neonates at GSH, with emphasis on differences between inborns and outborns. Methods. This was a retrospective cohort study. VLBW neonates admitted to the GSH neonatal nursery between 1 January 2012 and 31 December 2013 were enrolled on the Vermont Oxford Network database and reviewed.Results. Of 1 032 VLBW neonates enrolled, 906 (87.8%) were delivered at GSH and 126 (12.2%) were outborn. Access to antenatal care, antenatal steroids and inborn status were statistically significant predictors of mortality and survival without morbidity. The mothers of inborn patients were more likely than those of outborn patients to have received antenatal care (89.1% v. 57.9%; p<0.0001) and antenatal steroids (64.2% v. 15.2%; p<0.0001). Inborns required less ventilatory support (16.2% v. 57.9%; p<0.0001) and surfactant administration than outborns (25.3% v. 65.1%; p<0.0001), and developed less late infection (8.8% v. 23.4%; p<0.0001), severe intraventricular haemorrhage (3.7% v. 13.9%; p<0.0001) and chronic lung disease (5.3% v. 13.4%; p=0.003). The incidence of necrotising enterocolitis was similar in the two groups (5.9% v. 8.7%; p=0.227). The mortality rate was 18.4% for inborns and 33.3% for outborns (p<0.0001). Mortality declined as birth weight increased. Of the survivors, 85.0% of inborns and 70.2% of outborns did not develop serious morbidity (p=0.003).Conclusions. VLBW neonates delivered at GSH had better outcomes than their outborn counterparts. Perinatal regionalisation is beneficial to our patients, with antenatal care, timeous transfer in utero and antenatal steroids contributing to excellent outcomes

Birth Weight Recovery among very Low Birth Weight Infants Surviving to Discharge from Charlotte Maxeke Johannesburg Academic Hospital; Neonatal unit

Background. The recommended growth velocity (GV) of very low birth weight (VLBW) infants is 15 g/kg/day. Several factors have been associated with poor postnatal weight gain. Objective. To provide current information on the postnatal growth of VLBW infants at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).Methods. This was a longitudinal study of VLBW infants surviving to discharge from CMJAH neonatal unit from August to October 2013.Results. Sixty-nine infants were included in the study. The mean GV was 13.2 g/kg/day; the median weight loss was 7.69 and the median time for regaining birth weight was 16 days. Fifty-one infants (73.9) regained their birth weight at or before 21 days. There was a decrease in mean z-scores for weight (ZSWs) from -0.32 (standard deviation 1.25) at birth to -1.94 (1.35) at discharge. A multiple linear regression showed a negative association between ZSW at discharge and number of days nil per os without parenteral nutrition (PN). Antenatal steroids were associated with poor GV. There were no factors associated with regaining birth weight after 21 days on multiple logistic regression.Conclusion. This study showed a GV in VLBW infants approaching recommended standards. Number of days without PN and use of antenatal steroids were associated with poor postnatal growth

Improved Survival of Non-Ventilated Very-Low-Birth-Weight Infants at Madadeni Hospital; KwaZulu-Natal

Most reports of survival of very-low-birth-weight (VLBW) babies focus on infants in tertiary care centres in large metropolitan areas.1-5 Extrapolating data from major centres to peripheral hospitals is problematic because of various factors; including poor socio-economic conditions; absence of intensive/special-care facilities and equipment; and limited number of staff with knowledge and skills in neonatal care in smaller hospitals.3 We were able to raise the survival rate (SR) from 21 to 40 following the use of low-cost measures between 2002 and 2005

Periventricular Leucomalacia/ Intraventricular Hemorrhage Among Very Low Birth Weight Infants at Muhimbili National hospital (MNH); Dar-esSalaam; Tanzania

Introduction: Periventricular leucomalacia (PVL) and intraventricular haemorrhage (IVH) are two most important antecedents of neuro-developmental outcome in very low birth weight infants.Study objective: To determine the incidence of PVL/IVH and it's associated perinatal factors among very low birth weight (VLBW) infants admitted at neonatal unit Muhimbili National Hospital.Material and methods: Prospective study with a nested case-control study was conducted at the neonatal unit from May to November 2000. Three hundred seventy two VLBW neonates were recruited to the study on admission to the neonatal unit and were followed up to the postnatal age of 4 weeks or death depending on which came first. All 372 neonates had initial cranial-ultrasound examination within 72 hours of life. Cranial-ultrasound was done on 179 and 151 neonates at the postnatal age of 2 weeks and 4 weeks respectively. Records of all 372 neonates were reviewed to determine the presence or absence of the various perinatal factors. These data were analysed as a nested case-control study whereby a case was defined as any VLBW who had been recruited in the follow up study and had diagnosis of either PVL or IVH or both by cranial ultrasound and those VLBW who had been recruited in the follow up study without a diagnosis of either PVL or IVH were taken as controls. Results: A total of 4539 neonates were admitted to the neonatal unit during the study period and among these 443 (9.8) were VLBW. Two hundred fifty seven (58) out the 443 VLBW neonates died before the postnatal age of 4 weeks. Among the 372 VLBW infants recruited in the study; PVL was seen in 121/372 (32.5) with an overall incidence rate of 0.125/infant week and IVH was seen in 230/372 (61.8) with an overall incidence rate of 0.247/ infant week. Most of the PVL and IVH occurred during the first 3 days of life. All neonates with grade IV IVH died before the postnatal age of 4 weeks. Forty-seven neonates (12.6) developed post-hemorrhagic hydrocephalus. Maternal hemoglobin and neonatal hemoglobin showed significant `association with PVL and IVH respectively.Conclusion:There is high incidence of VLBW; IVH and PVL. IVH grade IV carries a very high mortality. Routine cranial-ultrasound on all VLBW neonates along with clinical follow up for long-term neuro-developmental outcome is recommended

Suivi des nouveaux-nes de faible poids de naissance: incidence de la sortie précoce sur la croissance pondérale dans le premier semestre de vie. A propos de 384 cas colliges au CHU de Yopougon

La prise en charge des nouveau-nes de faible poids de naissance en milieu hospitalier pediatrique necessite des solutions originales; peu couteuses; adaptees a chaque situation. Dans notre contexte de sous developpement et de sous equipement; l'abregement de la duree d'hospitalier est une solution envisageable. Nous rapportons les resultats d'une etude retrospective portant sur 384 enfants de faible poids de naissance recus au service de neonatologie du CHU de Yopougon de 1996 a 2002. Le but de cette etude est d'evaluer l'incidence de la sortie precoce et du suivi en ambulatoire sur l'evolution de la croissance ponderale de ces enfants. 83;33pour cent de notre serie; soit 320 enfants; etaient hospitalises pour des motifs varies dont le plus frequent etait la prematurite (67;5pour cent). La majorite des enfants hospitalises provenait de la salle d'accouchement du CHU de Yopougon. 81;30pour cent des enfants de notre serie etaient issus de meres menageres; sans emploi; vendeuses ou artisanes; don c des classes sociales defavorisees. L'age gestationnel des enfants variait entre 26 et 42 semaines avec une moyenne de 33;4 semaines et une dominance des pretermes (85pour cent). La duree d'hospitalisation variait entre 1 et 53 jours avec une moyenne de 14 jours. Elle etait plus longue chez les grands prematures et les moins de 1500g. Le poids des enfants a la sortie d'hospitalisation variait entre 1240g et 2580g avec une moyenne de 1680g. 42;81pour cent des enfants hospitalises etaient perdus de vue apres la sortie. 64;32pour cent de notre echantillon; soft 247 enfants; etaient suivis au long cours. Parmi eux; 48;58pour cent avaient rattrape leur poids. L'age du rattrapage ponderal variait entre 1 et 6 mois avec une moyenne de 3 mois. La majorite (87;5pour cent) avait rattrape leur poids avant l'age de 3 mois. Les enfants dont le poids de naissance etait egal ou superieur a 1500g et les enfants sous allaitement exclusif avaient mieux recupere leur poids que les autres. Il ressort de cette etude que la sortie precoce sous reserve des mesures d'accompagnement afin d'eviter les perdus de vue; est une solution adaptee a nos realites sanitaires et socio-economiques. Il faudra donc faciliter la compliance au suivi postnatal des nouveau-nes