Impact of prematurity on admissions to the neonatal nursery of a rural South African district hospital

Abstract

The objectives of this study were to determine causes of admission to a district hospital neonatal nursery; to describe outcomes; and to determine risk factors for these outcomes. The study was based at the neonatal nursery of Hlabisa hospital, KwaZulu/Natal; 149 consecutive admissions to the nursery between May and November 1995 were audited. The main outcome measures were diagnosis, gestational age, birthweight, critical event during admission (sepsis, severe vomiting, diarrhoea, jaundice, fits, apnoea), and outcome (discharged alive, death, discharged with deficit). Most admitted neonates (73; 54 per cent) were aged less than 37 weeks at birth, and 123 (84 per cent) weighed less than 2.5 kg. Prematurity and low birthweight accounted for 114 (81 per cent) admissions. In all, 58 (39 per cent) neonates experienced a total of 72 critical events, the most frequent being sepsis (39; 54 per cent). Although most (114; 77 per cent) were discharged well, 20 (15 per cent) died and three (3 per cent) were discharged with a significant deficit. Sepsis and apnoea were most frequent among the lightest and most immature babies, while fits were more frequent among heavier, mature babies. In a multivariate model, experiencing any critical event (odds ratio [OR] 15.6; 95 per cent CI 3.0-82.6, p = 0.001) was the only significant independent risk factor for mortality, although birthweight (p = 0.068) and gestational age (26-30 vs. > or = 37 weeks; OR 5.6, 95 per cent confidence internal [CI] 0.3-95.7, p = 0.23), further contributed to risk of death. We conclude that a substantial proportion (around 27 per cent) of district perinatal mortality occurs in the neonatal nursery. Several simple and effective interventions exist to minimize neonatal loss in district hospitals in South Africa.