Outcomes of extremely low-birthweight neonates at a tertiary hospital in the Western Cape, South Africa: A retrospective cohort study

Background. Neonates of extremely low birthweight (ELBW; <1 000 g) have the highest neonatal mortality in South Africa (SA).  Objective. To describe the morbidity and mortality of ELBW neonates treated at a tertiary hospital in SA.  Methods. This was a retrospective cohort study including all live-born ELBW neonates treated at Tygerberg Hospital between 1 January and 31 December 2016. Data were extrapolated from a prospectively collected neonatal database and patient records. Multiple logistic regression and survival analysis were performed to identify risk factors of mortality.  Results. The sample included 256 neonates. The following morbidities were recorded: respiratory distress syndrome (83.2%); bronchopulmonary dysplasia (8.2%); intraventricular haemorrhage (34.5%); periventricular leukomalacia (0.6%); necrotising enterocolitis (10.5%); and retinopathy of prematurity (31.2%). The survival-to-discharge rate was 63.3%. Cause of death was documented as extreme prematurity in 41% of the inpatient deaths. Birthweight was a significant predictor of mortality (hazard ratio 0.99; 95% confidence interval 0.992 - 0.999). Of the 162 neonates who survived until discharge, 11 died following discharge.  Conclusion. Morbidity and mortality rates remain high among ELBW neonates. To improve survival, resources need to be allocated to neonatal resuscitation, surfactant therapy and increasing availability of intensive-care beds.