The Changing Face of Neonatal Intensive Care in South Africa

In 1991 a cut-off weight of 1 000 g and/or 28 weeks' gestation for neonatal intensive care unit (NICU) admission was decided on by attending neonatologists at a Priorities in Perinatal Care Conference. These recommendations were not based on published evidence. At the time there were few data on the outcome of babies born in the public sector who received NICU. Aim. The aim of this study was to describe the demographic data (mother and baby) and outcomes of babies admitted to a tertiary NICU. Methods. During 1992 - 1996 (1992 cohort) and 1999 - 2000 (1999 cohort) two cohorts of babies treated in the NICU at Tygerberg Hospital; Western Cape; South Africa; were studied. Demogra- phic data were collected prospectively on all admissions with a birth weight of less than 1 501 g and a gestational age of less than 32 weeks. Outcome data were survival; days of ventilation and NICU stay. Results. There were 455 babies in the 1992 cohort and 272 in the 1999 cohort. The mothers' mean income was R892 per month and was higher in the 1999 cohort.The 1999 cohort comprised significantly smaller babies; at a mean birth weight of 1 119 g v. 1 198 g. The mean gestational age in the 1999 cohort was lower (29.2 v. 30.3 weeks); but so was the mortality rate (21.6v. 26.1). The main differences between the survivors and non-survivors were in their birth weight and gestational age and the mean income of their mothers. The mean number of ventilation days needed by these infants was low at 8.5 days; with an average stay in the NICU of 13 days. Discussion. Babies admitted to an NICU have a good chance of survival at a low mean number of ventilation and NICU days. The increase in survival in the 1999 cohort; in spite of low income; is in keeping with international trends and underlines the good short-term outcome of these small babies

Predictors of Survival in Infants with Congenital Diaphragmatic Hernia - Systemic Oxygenation Status Versus Dynamic Compliance of the Respiratory System

Objective. To compare whether early measurement of blood gases and/or dynamic compliance of the respiratory system (CRSdyn) predicts outcome in high-risk infants with unilateral congenital diaphragmatic hernia (CDH). Patients and methods. A retrospective study was performed at Tygerberg Children's Hospital between January 1992 and August 2001. High-risk infants with unilateral CDH; who presented with respiratory distress within 6 hours of birth; were included. Patients with other lethal congenital abnormalities were excluded. The first arterial blood gas value after endotracheal intubation was documented and the arterial-alveolar oxygen tension (a:A) ratio was calculated. CRSdyn was measured within 24 hours of birth. The ability of these measurements to predict outcome (survival or death during the newborn period) was determined. Results. Seventeen of 40 infants with CDH were categorised as high risk and included in the study. Eight of them (47) survived the neonatal period. The best single predictors of outcome were; in order; partial pressure of oxygen in arterial blood (PaO2); a:A ratio and dynamic compliance of the respiratory system standardised for body weight (CRSdyn/kg). The specificity and sensitivity at a PaO2 cut-off of 19.3 kPa were 7/8 (95confidence interval (CI): 0.473 - 0.997) and 9/9 (95CI: 0.634 - 1.000) respectively. Results for a:A ratio were cut-off 0.321; specificity 6/8 (95CI: 0.349 - 0.968); and sensitivity 9/9 (95CI: 0.634 - 1.000). Results for CRSdyn/kg were cut-off 0.259; specificity 6/8 (95CI: 0.349 - 0.968); and sensitivity 9/9 (95CI: 0.634 - 1.000). A linear discriminant function based on the 3 best single predictors was found to be no more effective than the first PaO2. Conclusions. Early oxygenation status predicts outcome better than the CRSdyn/kg in infants with unilateral CDH. However; both measurements predict outcome with high accuracy