An Audit of Neonates Admitted to the Paediatric General Ward in a Tertiary Hospital, in South Africa

Abstract

South Africa is one of the countries in which neonatal mortality has remained the same or decreased slowly over the past 20 years. Many newborns are discharged after birth and readmitted within a few days. The Integrated management of childhood and neonate illness (IMCNI) guidelines uses seven danger signs to identify sick young infants. Aim: The aim of the study was to determine the profile and outcome of neonates admitted to the general paediatric wards at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methodology:Audit of all newborns (<28days) admitted to the general wards from 1 January 2011 to 30 April 2011. Results: A total of 75 neonates were admitted with a mean weight of 3.2 kg (SD 0.65). The majority of neonates 41/75 (54.6%) were male and 21/75 (28%) were Human Immunodeficiency Virus (HIV)-exposed. In the HIV-exposed group only 16/21 (76%) were on HIV prophylaxis. The most important clinical signs were tachypnoea (RR>60) 34 (46.6%) and jaundice 30 (41.1%). Most neonates, 45 (61%) were referred from the local clinic. The most common diagnoses were bronchopneumonia (BRPN) 22 (29.3%), neonatal sepsis (NNS) 27 (36%) and jaundice 20 (26.7%). Two patients died (2.7%) from NNS and BRPN. Conclusions: A proportion of the neonates are admitted from home to the general paediatric ward with mostly NNS, BRPN and jaundice. Although the mortality is low, admission to a neonatal ward may be more appropriate. IMCNI guidelines remain the most sensitive indicator of the need for admission, and “routine” investigations are often a non-contributor.