Browsing by Author "Ramdin, Tanusha"

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A comparison between raw and predicted mortality in a paediatric intensive care unit in South Africa
(BioMed Central, 2018-11) Ballot, Daynia Elizabeth; Ramdin, Tanusha
Objective: Paediatric intensive care resources are limited in sub-Saharan Africa. The mortality rate in a combined Paediatric/Neonatal Intensive Care Unit in Johannesburg, South Africa was almost double that in a dedicated paediatric intensive care unit in the same country. This study aimed to compare the raw mortality rate with that predicted with the Paediatric Index of Mortality (version 3), by doing a retrospective analysis of an existing database. Results: A total of 530 patients admitted to the intensive care unit between 1 January 2015 and 31 December 2017 were included. The raw mortality rate was 27.1% and the predicted mortality rate was 27.0% (p = 0.971). Cardiac arrest during ICU admission (p < 0.001), non-reactive pupils (0.035), inotropic support (p < 0.001) and renal disease (p = 0.002) were all associated with an increased risk of mortality. These findings indicate that the high mortality rate is due to the severity of illness in the patients that are admitted. It also indicates that the quality of care delivered is acceptable.
An audit of neonates admitted to the general ward at Charlotte Maxeke Johannesburg academic hospital
(2013) Ramdin, Tanusha
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.
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.