Audit of feeding practices in the neonatal wards at the Charlotte Maxeke Johannesburg academic hospital

This research report is submitted in partial fulfillment of the requirements for the degree of Master of Medicine in the Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg. June 2015 (amended September 2015)Background Breastfeeding is the preferred choice of feeding babies. The Baby-Friendly-Hospital-Initiative (BFHI) is a ten step plan to establishing successful breastfeeding and is adopted by public sector hospitals in Gauteng. Despite this, rates of breastfeeding in sick and preterm babies remain low. Aim To determine feeding practices for babies discharged from the neonatal wards of the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methodology A retrospective review of the CMJAH neonatal database on the type of milk feed for babies discharged between 01/01/2013- 30/04/2013. Results There were 404 babies in the study, 98(24%) were very-low-birth weight, 120(29.7%) were low birth weight and 186(46%) were bigger babies. Only 94(23.2%) babies were discharged on exclusive breast milk feeds, 232(57.4%) babies were discharged on exclusive formula milk feeds and 78(19.3%) discharged on mixed feeds. Significant variables associated with feeding choices were HIV exposure, perinatal asphyxia and the need for resuscitation at birth. Conclusion Despite the fact that the CMJAH is involved in the BFHI, rates of exclusive breastfeeding remain low. This needs to be urgently addressed with employment of lactation consultants and improved counselling of mothers exposed to HIV, on the importance and benefits of breastfeeding

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 observational study of acute kidney injury in critically ill neonates at Chris Hani Baragwanath Academic Hospital, South Africa

Background: Acute kidney injury (AKI) is common in critically ill, hospitalised neonates. Epidemiological data on AKI in children are scarce in South Africa. This study aimed to determine the incidence and outcomes of AKI in critically ill neonates.Methods: This single-centre, prospective, observational study was conducted in the neonatal unit of the Chris Hani Baragwanath Academic Hospital, a tertiary-level hospital in Johannesburg, South Africa. Neonates with AKI, defined using the AKI Network criteria, were recruited over a three-month period in 2019. Risk factors and demographic data were collected for all study participants, who were followed up over the period to observe an outcome of either recovery or death.Results: Fifty-one cases of AKI were identified, representing 7.8% of all admissions (95% CI 5.9–10.2%). The overall mortality of enrolled patients was 29.4% (95% CI 26.3–56.1%). Mortality was significantly associated with extremely low birth weight (OR 11.4, p < 0.01), umbilical catheterisation (OR 6.3, p = 0.01), sepsis (OR 5.4, p = 0.01), phototherapy (OR 4.4, p = 0.03) and prematurity (p = 0.04). The most frequent risk factor associated with AKI was intravenous nephrotoxic medication.Conclusion: The incidence of AKI in our study was higher than expected. Further epidemiological and interventional studies are warranted to identify and improve the long-term outcome of AKI in the newborn in our setting