Survival of Very Low Birth Weight Babies Born at Chris Hani Baragwanath Academic Hospital: A Retrospective Study

Abstract

Background: Prematurity remains a leading cause of neonatal deaths, particularly in resource limited settings. Very low birth weight (VLBW) neonates face significant challenges in adapting to extrauterine life. Survival outcomes vary based on the quality and availability of neonatal care. Objective: To assess the survival outcomes and associated risk factors of neonates with birth weights less than 1500g admitted to Chris Hani Baragwanath Academic Hospital (CHBAH) in 2020. Methods: A retrospective, descriptive study at CHBAH’s neonatal unit. All neonates weighing between 750g and 1500g admitted between January and December 2020 were included. Potential maternal and neonatal risk factors were analysed. Results: Of 756 neonates, 280 (37%) were extremely low birth weight (ELBW) and 476 (63%) VLBW. The mean gestational age was 32 weeks (SD 5.2), with a median birthweight of 1162g (IQR 9701355g). Majority of the neonates were inborn 560 (74.1%). The mean length of stay was 33 days (SD 36.8), with a median of 25 days (IQR 7-47 days). Neonates were at greater risk of death if they had IVH [OR 3.20 (95% CI: 1.47 – 6.93); p=0.003), sepsis [OR 5.73 (95% CI: 3.02 – 10.88); p<0.001], were lower birthweight or ELBW (<1000g) [OR 5.40 (95% CI: 3.05- 9.57); p<0.001], had received surfactant [OR 1.94 (95% CI: 1.13-3.32); p=0.01], had lower Apgar scores [OR 2.16 (95% CI: 1.20-3.88); p=0.01] and a hospital stay of less than 7 days [OR 31.93 (95% CI: 14.84-68.72); p<0.001]. ELBW neonates had lower gestational ages [OR 0.16 (95% CI: 0.10-0.26); p<0.001], lower 5 min Apgar scores of < 7 [OR 1.67, (95% CI: 1.04–2.65); p=0.03) and shorter length of ICU stays (<7 days) [OR 2.26 (95% CI 1.30-3.97); p=0.004]. The risk of dying in ELBW neonates was 4.9 times greater than the VLBW neonates when adjusting for these confounding factors [OR 4.90 (95% CI: 2.91 – 8.23); p<0.001]. Conclusion: This study identified key factors associated with improved survival in VLBW neonates, including absence of culture-positive sepsis, timely surfactant administration and longer hospital stay. These findings reinforce the importance of early intervention, effective infection control and comprehensive neonatal care in improving outcomes for premature neonates. Strengthening these clinical practices may contribute to reducing mortality in this vulnerable population.