Browsing by Author "Ballot, Daynia"

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    A Retrospective Observational Study of The Impact of HIV Status on The Outcome of Paediatric Intensive Care Unit Admissions
    (University of the Witwatersrand, Johannesburg, 2022-12) Whitehead, Kim; Ballot, Daynia
    BACKGROUND: Previously it was thought futile to offer HIV infected children ICU care, however this has changed with the availability of Antiretroviral Therapy (ART). Improved Prevention of Mother to Child Transmission (PMTCT) has led to a larger population of HIV exposed uninfected (HEU) children with unique health risks. Our study looked at how HIV exposure and infection impact presentation and outcomes in PICU in an era of improved access to ART and PMTCT. METHODS: A retrospective analysis of children admitted to PICU at a tertiary/quaternary hospital between 2015 and 2019 was conducted. De-identified data was obtained from an existing database and analysed using SPSS software. Medians and interquartile ranges were used to analyse continuous variables and frequencies and percentages to analyse categorical variables. The sample was then divided into three groups (HIV negative, HEU and HIV infected) and their presentation and outcomes compared using Chi-Squared and Kruskall-Wallis tests with a significance level set at p < 0.05. RESULTS: Our study showed that 16% (109/678) of children admitted to PICU were HEU and 5.2% (35/678) HIV infected. HIV infected children were admitted at a younger age (median two months) and had an increased incidence of lower respiratory tract infections than HIV negative children (p < 0.001). HIV infected children required longer ventilation and admission than HIV negative and HEU children (p < 0.001). HIV infected children had a higher mortality (40%) (p = 0.02) than HIV negative children (mortality 22.7%); when comparing children admitted with a medical diagnosis however the difference in mortality was not statistically significant (p = 0.273). HEU children were admitted at a younger age (median three months) with a higher incidence of lower respiratory tract conditions than HIV negative children (p < 0.001). HEU children had similar outcomes to HIV negative children with no statistically significant difference in duration of ICU stay (p =0.163); ventilation (p = 0.443) or mortality (p=0.292). CONCLUSION: HIV infected children presented with more severe disease requiring longer ventilation and admission. HEU had similar outcomes to HIV negative children.
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    Neurodevelopmental outcome of late preterm infants in Johannesburg, South Africa
    (BioMed Central, 2018-10) Ramdin, Tanusha; Ballot, Daynia
    Background: Late preterm infants, previously considered low risk, have been identified to be at risk of developmental problems in infancy and early childhood. There is limited information on the outcome of these infants in low and middle income countries. Methods: Bayley scales of infant and toddler development, version III, were done on a group of late preterm infants in Johannesburg, South Africa. The mean composite cognitive, language and motor sub-scales were compared to those obtained from a group of typically developed control infants. Infants were considered to be “at risk” if the composite subscale score was below 85 and “disabled” if the composite subscale score was below 70. Infants identified with cerebral palsy were also reported. Results: 56 of 73 (76.7%) late preterm infants enrolled in the study had at least one Bayley assessment at a mean age of 16.5 months (95% CI 15.2–17.6). The mean birth weight was 1.9 kg (95%CI 1.8–2.0) and mean gestational age 33.0 weeks (95% CI 32.56–33.51). There was no difference in the mean cognitive subscales between late preterm infants and controls (95.4 9, 95% CI 91.2–99.5 vs 91.9.95% CI 87.7–96.0). There was similarly no difference in mean language subscales (94.5, 95% CI 91.3–97.7 vs 95.9, 95% CI 92.9–99.0) or motor subscales (96.2, 95% CI 91.8–100.7 vs 97.6, 95% CI 94.7–100.5). There were four late preterm infants who were classified as disabled, two of whom had cerebral palsy. None of the control group was disabled Conclusions: This study demonstrates that overall developmental outcome, as assessed by the Bayley scales of infant and toddler development, was not different between late preterm infants and a group of normal controls. However, 7.1% of the late preterm infants, had evidence of developmental disability. Thus late preterm infants in low and middle income countries require long term follow up to monitor developmental outcome. In a resource limited setting, this may best be achieved by including a parental screening questionnaire, such as the Ages and Stages Questionnaire, in the routine well baby clinic visits.