4 research outputs found
Incidence and prognosis of critical congenital heart disease in neonates at Charlotte Maxeke Johannesburg Academic Hospital
Background: A significant number of neonates with congenital heart disease present with a life-threatening illness in the neonatal period where survival depends on timely diagnosis, management and referral.
Objectives: To determine the incidence and prognosis of critical congenital heart disease in neonates admitted to Charlotte Maxeke Johannesburg Academic Hospital, and to compare it with international data.
Method: This was a retrospective, descriptive study of neonates with critical and non-critical congenital heart disease admitted to Charlotte Maxeke Johannesburg Academic Hospital between 01 January 2006 and 31 December 2014.
Results: There were 284 neonates diagnosed with congenital heart disease during the study period - 133 with critical congenital heart disease (8.2 per 1000 neonatal admissions) and 151 with non-critical congenital heart disease (9.3 per 1000 neonatal admissions). The mortality rate for neonates with critical congenital heart disease was 61/133 (45.9%).
Conclusion: Critical congenital heart disease is not commonly diagnosed in neonates, however the mortality rate is high. Increased awareness and screening programs may improve early diagnosis and allow timeous intervention.LG201
Characteristics and outcomes of neonates with intrapartum asphyxia managed with therapeutic hypothermia in a public tertiary hospital in South Africa
AVAILABILITY OF DATA AND MATERIALS : The datasets used and/or analyzed during the current study are available from
the corresponding author on reasonable request.BACKGROUND : In randomized clinical trials, therapeutic hypothermia (TH) has been shown to reduce death and/or
moderate-to-severe disability in neonates with hypoxic ischemic encephalopathy (HIE) in high-income countries,
while this has not consistently been the case in low-and middle-income countries (LMICs). Many studies reporting
on outcomes of neonates with HIE managed with TH are those conducted under controlled study conditions, and
few reporting in settings where this intervention is offered as part of standard of care, especially from LMICs. In this
study we report on short-term outcomes of neonates with moderate-to-severe HIE where TH was offered as part of
standard of care.
OBJECTIVE : To determine characteristics and mortality rate at hospital discharge in neonates with moderate-to-severe
HIE.
METHODS : Hospital records of neonates with intrapartum asphyxia were reviewed for clinical findings, management
with TH (cooled or non-cooled) and mortality at hospital discharge. Inclusion criteria were birthweight ≥ 1800 g, gestational
age ≥ 36 weeks and moderate-to-severe HIE. Comparisons were made between survivors and non–survivors
in cooled and/or non-cooled neonates.
RESULTS Intrapartum asphyxia was diagnosed in 856 neonates, with three having no recorded HIE status; 30%
(258/853) had mild HIE, and 595/853 (69%) with moderate-to-severe HIE. The overall incidence of intrapartum
asphyxia was 8.8/1000 live births. Of the 595 with moderate-to-severe HIE, three had no records on cooling and 67%
(399/592) were cooled. Amongst 193 non-cooled neonates, 126 (67%) had documented reasons for not being cooled
with common reasons being a moribund neonate (54.0%), equipment unavailability (11.1%), pulmonary hypertension
(9.5%), postnatal age > 6 h on admission (8.7%), and improvement in severity of encephalopathy (8.7%). Overall
mortality was 29.0%, being 17.0% and 53.4% in cooled and non-cooled infants respectively. On multivariate analysis,
the only factor associated with mortality was severe encephalopathy.
CONCLUSION : Overall mortality in neonates with moderate-to-severe HIE was 29.0% and 17.0% in those who were
cooled. Cooling was not offered to all neonates mainly because of severe clinical illness, equipment unavailability and
delayed presentation, making it difficult to assess overall impact of this intervention. Prospective clinical studies need
to be conducted in LMIC to further assess effect of TH in short and long-term outcomes.https://bmcpediatr.biomedcentral.comam2024ImmunologySDG-03:Good heatlh and well-bein
An outbreak of infection due to severe acute respiratory corona virus-2 in a neonatal unit from a low and middle income setting
IntroductionThe provision of kangaroo mother care (KMC) involving continuous skin-to-skin care (SSC) is an important intervention in neonatal care, which is recommended even when women are infected with severe acute respiratory syndrome coronavirus (SARS-CoV-2). We report on a nosocomial outbreak of SARS-CoV-2 infections in a KMC ward.MethodsContact tracing was conducted following the diagnosis of SARS-CoV-2 in a mother lodging in the KMC ward. All mother-newborn dyads in the KMC and healthcare workers (HCW) were tested for SARS-CoV-2 within 24–72 h of diagnosing the index case. Nasopharyngeal swab samples were obtained and tested from contacts, with a nucleic acid amplification test (NAAT) assay. Next-generation sequencing was done on positive samples. The secondary attack rate (SAR) was calculated assuming that the mother who presented with symptoms was the source of infection.ResultsTwelve (70.6%) of 17 mothers and 8 (42.1%) of 19 neonates who were in the KMC ward with the index case were found to be positive with SARS-CoV-2. Seven (87.5%) of the 8 neonates who tested positive had mothers who also tested positive. Seventy-five percent (9/12) of the mothers and 62.5% (5/8) of the neonates who tested positive were asymptomatic. Eight (27.6%) of 29 HCW were found to be positive and were all asymptomatic. One neonate died from Acinetobacter baumannii sepsis, and his post-mortem lung histopathology showed features compatible with SARS-CoV-2 pneumonia. The sequencing of 13 specimens, which included 1 mother-newborn dyad, indicated clustering to the same phylogenetic lineage with identical mutations. In assessing for factors contributing to this outbreak, it was found that spaces between beds were less than 1 m and mothers had their meals around the same table at the same time.ConclusionWe report on a nosocomial outbreak of SARS-CoV-2 in a KMC ward, affecting a high number of mothers and neonates, and to a lesser extent HCWs. Although it is difficult to point to the index case as the source of this outbreak, as asymptomatic individuals can spread infection, the inadequate adherence to non-pharmaceutical interventions was assessed to have contributed to the spread of infection. This highlights the need for awareness and adherence to mitigation strategies to avoid SARS-CoV-2 outbreaks