Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 1;35(6):921-931.
doi: 10.1097/QAD.0000000000002856.

Preterm birth and severe morbidity in hospitalized neonates who are HIV exposed and uninfected compared with HIV unexposed

Kim Anderson  1 , Emma Kalk  1 , Hlengiwe P Madlala  2 , Dorothy C Nyemba  1   2 , Nisha Jacob  3 , Amy Slogrove  4 , Mariette Smith  1   5 , Max Kroon  6 , Michael C Harrison  6 , Brian S Eley  7 , Andrew Boulle  1   3   5 , Landon Myer  2 , Mary-Ann Davies  1   3   5
Affiliations

Preterm birth and severe morbidity in hospitalized neonates who are HIV exposed and uninfected compared with HIV unexposed

Kim Anderson et al. AIDS. .

Abstract

Objectives: Infants who are HIV exposed but uninfected (HEU) compared with HIV unexposed uninfected (HUU) have an increased risk of adverse birth outcomes, morbidity and hospitalization. In the era of universal maternal antiretroviral treatment, there are few insights into patterns of neonatal morbidity specifically.

Design: A prospective cohort study.

Methods: We compared neonatal hospitalizations among infants who were HEU (n = 463) vs. HUU (n = 466) born between 2017 and 2019 to a cohort of pregnant women from a large antenatal clinic in South Africa. We examined maternal and infant factors associated with hospitalization using logistic regression.

Results: Hospitalization rates were similar between neonates who were HEU and HUU (13 vs. 16%; P = 0.25). Overall, most hospitalizations occurred directly after birth (87%); infection-related causes were identified in 34%. The most common reason for hospitalization unrelated to infection was respiratory distress (25%). Very preterm birth (<32 weeks) (29 vs. 11%; P = 0.01) as well as very low birthweight (<1500 g) (34 vs. 16%; P = 0.02) occurred more frequently among hospitalized neonates who were HEU. Of those hospitalized, risk of intensive care unit (ICU) admission was higher in neonates who were HEU (53%) than HUU (27%) [risk ratio = 2.1; 95% confidence interval (95% CI) 1.3-3.3]. Adjusted for very preterm birth, the risk of ICU admission remained higher among neonates who were HEU (aRR = 1.8; 95% CI 1.1-2.9).

Conclusion: Neonates who were HEU (vs. HUU) did not have increased all-cause or infection-related hospitalization. However, very preterm birth, very low birthweight and ICU admission were more likely in hospitalized neonates who were HEU, indicating increased severity of neonatal morbidity.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: No conflicts of interest are declared by the authors.

Figures

Figure 1:
Figure 1:. Flow diagram of pregnant women enrolled, pregnancy losses and infants followed up from birth
* One woman in each group had a multiple pregnancy that resulted in one twin born alive and the other twin stillborn.
See this image and copyright information in PMC

Comment in

References

    1. Woldesenbet SA, Kufa T, Lombard C, Manda S, Ayalew K, Cheyip M, et al. The 2017 National Antenatal Sentinel HIV Survey Key Findings, South Africa, National Department of Health [NICD website]. July 2019. Available at: https://www.nicd.ac.za/wp-content/uploads/2019/07/Antenatal_survey-repor.... Accessed August 12, 2020.
    1. Sherman GG, Lilian RR, Bhardwaj S, Candy S, Barron P. Laboratory information system data demonstrate successful implementation of the prevention of mother-to-child transmission programme in South Africa. South African Med J 2014. January 20;104(3):235. - PubMed
    1. Slogrove AL, Powis KM, Johnson LF, Stover J, Mahy M. Estimates of the global population of children who are HIV-exposed and uninfected, 2000–18: a modelling study. Lancet Glob Heal 2020. January 1;8(1):e67–75. - PMC - PubMed
    1. Evans C, Humphrey JH, Ntozini R, Prendergast AJ. HIV-Exposed Uninfected Infants in Zimbabwe: Insights into Health Outcomes in the Pre-Antiretroviral Therapy Era. Front Immunol 2016. June 6;7:190. - PMC - PubMed
    1. Chen JY, Ribaudo HJ, Souda S, Parekh N, Ogwu A, Lockman S, et al. Highly active antiretroviral therapy and adverse birth outcomes among HIV-infected women in Botswana. J Infect Dis 2012. December 1;206(11):1695–705. - PMC - PubMed

Publication types