Mortality and morbidity of very low-birthweight and extremely low-birthweight infants in a tertiary hospital in Tshwane

Background. Since 2000, South Africa (SA) has had a relatively static neonatal mortality rate, estimated to be 12/1 000 live births, with complications of prematurity being the leading cause of neonatal mortality. Survival to hospital discharge of small infants has improved over the last few decades; however, this is more marked in developed countries where neonatal intensive care, nasal continuous positive airway pressure, mechanical ventilation and surfactant are available to the majority of infants.  Objectives. The primary objective was to determine overall mortality of very low-birthweight and extremely low birthweight (ELBW) infants in the neonatal unit at Steve Biko Academic Hospital (SBAH). Secondary objectives were to determine the frequency of major morbidities, identify factors associated with morbidity and mortality, determine survival without major morbidity, and whether birthweight can accurately predict outcome.  Methods. This was a retrospective cross-sectional study of infants with a birthweight of 500 - 1 499 g who had been admitted to the neonatal unit of SBAH between June 2016 and May 2017.  Results. Overall survival to hospital discharge was 75.7%, with only 17.7% of infants weighing <750 g surviving. Survival without major morbidity was 35.1%. Small-for-gestational age, invasive ventilation, and culture-positive early-onset sepsis were associated with an increased risk of mortality, whereas higher birthweight and the use of nCPAP decreased mortality in multivariable analysis.  Conclusion. Although the overall survival of infants weighing <1 500 g is comparable to other large SA public hospitals, survival of ELBW infants is poor, while these are the infants that require the most interventions, placing a heavy burden on limited resources. However, it remains difficult to recommend a cut-off weight for potentially life-saving interventions.