3. Electronic Theses and Dissertations (ETDs) - All submissions

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Subject: search.filters.subject.Infant, Very Low Birth Weight

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    Causes and consequences of sodium imbalances in the first week of life in very low birthweight infants
    (2018) Ramaboea, Ngwako Innocent
    Background. Sodium imbalance is common in the first week of life in very low birth weight (VLBW) infants and may be associated with poor outcome. Objectives. To determine the incidence and outcomes of both hypo and hypernatraemia in VLBW (500g - 1500g birth weight) infants in the first week of life. [Abbreviated Abstract. Open document to view full version]
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    Prevalence of and risk factors for cranial ultrasound abnormalities in very low birth weight infants at CMJAH
    (2018) Ghoor, Azra
    Background. Intraventricular haemorrhage (IVH) and cystic periventricular leukomalacia (cPVL) contribute to neonatal mortality and morbidity. Low birth weight and gestational age are amongst the risk factors for IVH and cPVL. Objectives. To assess how many very low birth weight (VLBW) infants had cranial ultrasound screening at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and to determine the prevalence of cranial ultrasound abnormalities. In addition, to compare the characteristics and risk factors of those VLBW infants with cranial ultrasound abnormalities to those with normal cranial ultrasound findings. Methods. This was a retrospective case-controlled study of infants < 1 500g admitted to CMJAH from 1 January 2013 to 31 December 2015. Cases were identified as infants with IVH or cPVL. Controls were matched 1:2 based on birth weight and gender. Results. Only 55% (856/1562) of VLBW infants had undergone cranial ultrasound screening. The prevalence of IVH was 26% (219/856). A total of 197 cases were identified and matched with 394 controls. Antenatal care was lower in cases (71% vs 79%; P=0.039). Sepsis, ventilation, metabolic acidosis and patent ductus arteriosus were all significantly higher in cases. The use of antenatal steroids was significantly higher in the grade I-II IVH/no IVH group vs grade III-IV IVH group (44% vs 25%; P=0.017). Conclusion. The prevalence of IVH is consistent with that of developed countries. Improving antenatal care, infection control and adequate early resuscitation could decrease the incidence of IVH and cPVL. All VLBW infants should undergo cranial ultrasound screening.
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    An evaluation of retinopathy in very low birth weight babies at Charlotte Maxeke Johannesburg academic hospital
    (2016) Dadoo, Zahedah
    Background. Retinopathy of prematurity (ROP) is a leading cause of blindness for very low birth weight (VLBW, <1500g) babies. ROP screening identifies babies that require treatment to prevent major visual impairment. Objectives. To evaluate the screening for ROP at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) by reviewing the number of babies screened according to the CMJAH guidelines, the grades of ROP found and the treatment modality received. Methods. This was a retrospective record review of VLBW babies born between 1 January 2013 and 31 December 2013 at CMJAH, whether inborn or transferred in. The babies were divided into 2 groups based on age at final outcome. Final outcome was defined as death, discharge or transfer out of the unit. The ‘early’ outcome group had their final outcome before day 28 of life. The ‘late’ outcome group had their final outcome at day 28 or more of life. The early outcome group qualified for outpatient ROP screening and the late outcome group qualified for inpatient ROP screening. Results. There were a total of 572 VLBW babies at CMJAH during this time period. The babies had a mean birth weight of 1127g (SD 244.75) and gestational age of 29 weeks (SD 2.743). The mean duration of stay was 29 days (SD 21.66) and there were 309 female babies. Of these 572 babies, 304 comprised the early outcome group and 268 comprised the late outcome group. 7 In the early outcome group babies that were transferred out of the unit or died were excluded, therefore the remaining 147 babies discharged home qualified for outpatient ROP screening. Inpatient ROP Screening was carried out in 36/147 (24.4%) of these babies (not in accordance with ROP screening guidelines). ROP was documented in 4/36 (11.1%). Outpatient ROP screening records were unavailable. Exclusions from the late outcome group included 5 babies. In the late outcome group 111/263 (42.2%) were screened for ROP. ROP was found in 17%. One baby required treatment with intravitreal anti-VEGF and 3 babies required surgery. Conclusions. More than half of the babies in the late outcome group were not screened during their stay (57.8%). More than one third of babies were discharged prior to reaching the current recommended age for screening. Efforts need to be intensified to identify and screen all eligible babies prior to discharge. Outpatient ROP screening is not well documented, therefore prevalence cannot be established.
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    Birth weight recovery among very low birth weight infants surviving to discharge from Charlotte Maxeke Johannesburg academic hospital, neonatal unit
    (2016-10-17) Mudahemuka, Jean Claude
    Background: The recommended growth velocity of very low birth weight (VLBW) infants is 15 g/kg/day. Several factors have been associated with poor postnatal weight gain. Objective: The aim of the present study is to provide current information on the postnatal growth of VLBW infants at Charlotte Maxeke Johannesburg Academic Hospital. Methods: This is a retrospective longitudinal study of VLBW infants surviving to discharge from Charlotte Maxeke Johannesburg Academic Hospital, Neonatal Unit from August 2013 to October 2013. Results: Sixty nine infants were included in the study. The mean growth velocity was 13.2 g/kg/day, the median weight loss was 7.69% and the median time for regaining birth weight was 16 days. Fifty one infants (73.9%) regained their birth weight at or before 21 days. There was a decrease in mean Z scores for weight from -0.32±1.25 at birth to -1.94±1.35 at discharge. A multiple linear regression showed a negative association between Z scores for weight at discharge and number of days nil per os without parenteral nutrition. Antenatal steroids were associated with poor growth velocity. There were no factors associated with regaining birth weight after 21 days on multiple logistic regression. Conclusion: This study shows a growth velocity in VLBW infants approaching recommended standards. The number of days without parenteral nutrition and use of antenatal steroids are associated with poor postnatal growth.
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