An audit of neonates admitted to the general ward at Charlotte Maxeke Johannesburg academic hospital
Date
2013
Authors
Ramdin, Tanusha
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Abstract
South Africa is one of the countries in which neonatal mortality has either remained the
same or decreased marginally over the past 20 years (1). Resource constraints result in
early discharge of well newborns and curtailment of follow up home visits by nurses.
This potentially high-risk group of infants may contribute to these neonatal deaths post
hospital discharge. In addition, once a neonate has been home, they are no longer
admitted to the neonatal unit but to the general paediatric wards that may lack
specialized neonatal care.
Numerous programs, algorithms, education drives and protocols have been devised in
an attempt to improve the quality of healthcare offered to the newborn. These have led
to a perceptible decline in the neonatal mortality and morbidity rates respectively. The
neonatal mortality and morbidity rates remain unacceptably high however, particularly
in resource poor settings.
Aim: The aim 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. Patients transferred from other tertiary hospitals were
excluded.
Patients with incomplete records were also excluded
Results: There were a total of 73 neonates admitted with a mean weight of 3.2kg (SD
0.65). The median age for 0-7 days was 4 days and for 8-28 days was 17 days. The
majority of neonates 41/73 (56.2%) were male and 21/73 (28.8%) were HIV exposed.
In the HIV exposed group only 16/21 (76%) were on HIV prophylaxis. Although
antenatal care (ANC) was received by 76.7% of mothers, this is lower than ANC
received by the general population. Lack of ANC could possibly be a risk factor for
admission of neonates. Possible risk factors for serious illness included 8 (11%) were ex
premature infants and 11 (15.1%) had a low birth weight (<2.5 kg). Individual
indicators for severity of illness by World Health Organization (WHO) Integrated
Management of Childhood and Neonate Illness (IMCNI) were used. The most frequent
indicators were tachypnoea (RR>60) 34 (46.6%), jaundice 30 (41.1%) and only 1 (1%)
presented with convulsions. Respiratory distress was very sensitive (100%) and
relatively specific (76%) for detecting bronchopneumonia (BRPN) with a LR of 3.98.
The other clinical indicators were neither specific nor sensitive in detecting serious
illness.
Most 45 (61%) were referred from the local clinic. The commonest diagnoses were
bronchopneumonia (BRPN) 20 (27.4%), neonatal sepsis (NNS) 22 (30.1%) and
jaundice 22 (30.1%). Two patients died (2.7%). Their diagnoses were NNS and BRPN
Conclusions: There are a significant number of newborns admitted to the general
paediatric wards, although the mortality rate in this group was low. IMCNI guidelines
remain the most sensitive indicator of the need for admission, and “routine” blood
investigations are often non-contributory Community based care and education
programmes as well as targeted neonatal care in hospitals for this group is warranted.
Description
dissertation submitted to the Faculty of Health Sciences for the degree of Masters in Medicine in the
University of the Witwatersrand, Johannesburg. August ,2013