Trends in the survival of low birth weight neonates to hospital discharge at Charlotte Maxeke Johannesburg Academic Hospital from 1st January 2013 – 30th June 2019

Abstract

Introduction: According to the South Africa District Health Information System (SADHIS), 12 neonates per 1000 live births die annually. In order to reduce mortality, especially among the low birth weight (LBW) neonates, hospitals in SA must carry out regular mortality audit among neonates. The audit will track and count mortality among every new-born and LBW babies. Aim and objectives: The present study aims to explore changes in the survival of LBW neonates to hospital discharge at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) from 1st January 2013 – 30th June 2019. Furthermore, the study will identify the prevalence of mortality over time, and the factors influencing the survival of neonates to hospital discharge. Lastly, the study sought to estimate the survival time of LBW neonates according to the length of hospital stay.Methods: We retrospectively reviewed the database of neonates who weighed between 400 g and 2500 g and were either inborn or admitted to the neonatal unit at CMJAH between 1st January 2013 – 30th June 2019. The Pearson’s chi-square test and join point regression were used to determine the prevalence of mortality over time and to identify changes in the survival of LBW babies over time. Additionally, logistic regression and Cox proportional hazard regression was used to explore factors influencing the survival of LBW babies. Results: We classified the birth weight of neonates into extremely low birth weight (ELBW) (≤ 1000 g), very low birth weight (VLBW) (1001-1500 g), and LBW (1501-2500 g). There was a 1.1 % downward trend in the survival of LBW neonates to hospital discharge over time. A 9.8 % downward survival trend was observed among neonates who weighed ≤ 1000 g over time. Overall, the survival rate among LBW neonates in the study was 82.7 %. The main significant factors that were found to be associated with neonatal mortality were birth weight, early-onset sepsis (EOS), and major birth defects. The odds of dying among neonates who weighed 1001-1500 g was 90 % less likely than the odds of dying among neonates who weighed ≤ 1000 g (OR: 0.10; 95 % CI = 0.08; 0.12; p=0.001). The odds of dying among neonates who weighed 1501-2500 g was 97 % less likely than the odds of dying among neonates who weighed ≤ 1000 g (OR: 0.03; 95 % CI = 0.02; 0.04; p=0.001). Additionally, the odds of dying among neonates who presented with EOS was 55 % times higher than those who did not have EOS (OR: 1.55; 95 % CI = 1.06; 2.27; p=0.02). The presence of a birth defect places neonates at higher odds of dying than those who did not have a birth defect (OR: 16.37; 95 % CI = 12.22; 21.93; p=0.001). The majority of neonates died within the first seven days of hospital admission. Conclusion and recommendations: The present study shows that there is a decrease in the survival of LBW babies over time, mostly among neonates who weighed ≤ 1000 g. The study found birth weight, sepsis infection, and birth defects to be the major contributing factors to the survival of a baby to hospital discharge. Also, the majority of the neonates died within the first seven days of hospital admission. Regular mortality audit should be done in health care places to identify areas for direct interventions to reduce mortality among LBW neonates. More trend studies should be done with hospital data to identify the patterns of variation in neonatal mortality over time.