Short-term mortality and morbidity of very low-birthweight infants over 9 years at Groote Schuur Hospital, Cape Town, South Africa

Abstract

Background. With the advancement of neonatal care there has been a decrease in mortality rates of very low-birthweight (VLBW) (≤1 500 g) infants worldwide. However, this has been at the cost of increased morbidity in this vulnerable group. Currently there are little up to date data on short-term morbidities for VLBW infants in low and middle-income countries. Objectives. The primary objective was to describe the neonatal mortality rate in infants weighing 401 to 1 500 g admitted to Groote Schuur Hospital neonatal unit over a 9-year period. Secondary objectives were to evaluate the main neonatal short-term morbidities. Methods. We conducted a secondary analysis of prospectively collected observational data. All VLBW infants admitted to GSH neonatal unit from 2012 - 2020 were included in the study. Data were benchmarked against the Vermont Oxford Network (VON) database. Results. A total of 4 645 infants were included in the study. The overall mortality rate was 19.8%, which remained static over the study period. There was a significantly higher mortality rate associated with decreasing birthweight. The mortality rate for outborn v. inborn infants was higher: 30.3% v. 18.4% (p=0.046). There was a significant risk of higher short-term morbidity in infants <1 000 g. The survival rate without major morbidity was 68.5% which compared favourably with that of the VON. Conclusion. The results demonstrate that mortality rates are higher compared with developed countries. However, and importantly, survival without morbidity was comparable. Strategies to improve mortality and morbidity in VLBW infants are multifaceted and require a collaborative and innovative approach.