342 Trends in the survival of low birth weight neonates to hospital discharge at an academic hospital from 2013 – 2019

Objectives

According to the South Africa District Health Information System (SADHIS), 12 neonates per 1000 live births die annually.¹ The study aimed to explore changes in the survival of low birth weight (LBW) neonates to hospital discharge at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) from 1st January 2013 – 30th June 2019. The prevalence of mortality over time, factors influencing the survival of neonates to hospital discharge and the survival time of LBW neonates according to the length of hospital stay were also investigated.

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

Figure 1 illustrates that there was a decline across the years 2013-2019 in the survival of neonates. 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). Most neonates died within the first seven days of hospital admission.

Conclusion

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.

Reference

Statistics South Africa. Statistical release Perinatal deaths in South Africa [Internet]. 2019. Available from: http://www.statssa.gov.za/publications/P03094/P030942014.pdf