Outcomes of babies born before arrival at a tertiary hospital in Johannesburg, South Africa

Abstract

Background. Babies born before arrival to hospital (BBBAs) constitute a high-risk newborn population. The literature demonstrates that BBBAs have increased perinatal mortality and morbidity. Objectives. To describe the maternal and neonatal characteristics of BBBAs presenting to Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa, and assess whether they have increased morbidity and mortality compared with inborn babies. Methods. This was a matched case-controlled retrospective record review of newborns presenting to the neonatal unit of CMJAH between 1 January 2011 and 31 January 2013. BBBAs were matched 1:1 with the next consecutive inborn on birth-weight category and gender. Results. A total of 356 neonates were analysed. BBBAs had higher mortality than inborn controls within the first 24 hours of hospital presentation (7.9% v. 3.9%; p=0.05). Mothers of BBBAs were more likely to be unbooked (58.4% v. 10.7%; p<0.001) and of higher parity (p=0.0008). HIV prevalence was similar amongst cases and controls (24% v. 28.7%), however there were significantly more unknown HIV status in mothers of BBBA’s (49.6% v. 32%; p=0.01). Cases had a higher prevalence of early sepsis (22.9% v. 3.6%; p=0.03) and birth asphyxia (14.5% v. 0.8%; p<0.001) than controls. Overall, more deaths occurred in the very-lowbirth- weight (VLBW) (24% v. 10%; p=0.06) and low-birth-weight (LBW) (7.46% v. 0%; p=0.02) BBBA’s compared to controls. Conclusion. We demonstrated higher mortality in the immediate postnatal period and in the VLBW and LBW categories compared with hospital-delivered neonates. Once admitted, there was no difference in mortality, length of stay or number of ICU admissions between cases and controls. Mothers who delivered out of hospital were more likely to be multiparous and unbooked and to have unknown HIV, RPR and Rh results. Neonatal resuscitation, transport and immediate care on arrival at the hospital should be prioritised in the management of BBBAs.