Disease profile and outcomes of neonates admitted to the paediatric intensive care unit at the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa
Article Sidebar
Main Article Content
Abstract
Background. Neonatal healthcare is a key area in reducing global child mortality. Unwell neonates are usually managed in the neonatal intensive care unit (NICU), but may also be admitted to paediatric intensive care unit (PICU).
Objectives. To describe the profile of neonates admitted to a South African PICU and to identify risk factors associated with mortality.
Methods. This was a prospective observational study of patients with a post-menstrual age of <44 weeks admitted to the PICU between November 2018 and October 2019. Associations with mortality were evaluated with univariate and multivariate logistic regression analyses.
Results. A cohort of 266 neonates were included, accounting for 18.4% of PICU admissions. Median birth weight was 2 210 g, with an interquartile range (IQR) of 1 397 - 2 995 g. Chronological and post-menstrual age (IQR) at admission was 11 (2 - 28) days and 38 (35 - 40) weeks, respectively. The largest referral source was tertiary NICUs. Surgical admissions accounted for most patients. Congenital abnormalities occurred in 50.4% of the cohort. Neonatal mortality at ICU discharge was 10.9% compared with 3.8% in older patients (odds ratio=3.08, 95% confidence interval 1.89 - 5.02; p<0.001). The most common condition associated with mortality was congenital abnormalities, followed by necrotising enterocolitis and infections. Logistic regression analysis showed that the only variables independently associated with death/palliation were oscillatory ventilation and feeds received.
Conclusion. Findings on the patient profile of this cohort may help policy-makers and unit managers improve neonatal care, with directions for further research.
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJCH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
1. United Nations Inter-Agency Group for Child Mortality Estimation. Levels and Trends in Child Mortality 2020. New York: United Nations Children’s Fund; 2020.
2. Bhagwanjee S, Scribante J. National audit of critical care resources in South
Africa - unit and bed distribution. S Afr Med J 2007;97(12 Pt 3):1311-1314.
3. Khasawneh W, Sindiani A, Rawabdeh SA, Aleshawi A, Kanaan D. Indications and clinical profile of neonatal admissions: A cross-sectional descriptive analysis from a single academic center in Jordan. J Multidiscip Health
2020;13:997-1006. https://doi.org/10.2147/JMDH.S275267.
4. WHO Recommendations for conducting an external inspection of a body and filling in the Medical Certificate of Cause of Death. Geneva: World Health
Organization; 2022.
5. Vasudevan A, Malhotra A, Lodha R, Kabra SK. Profile of neonates admitted in
pediatric ICU and validation of Score for Neonatal Acute Physiology (SNAP).
Indian Pediatr 2006;43(4):344-348.
6. Mangiza M, Ehret DEY, Edwards EM, Rhoda N, Tooke L. Morbidity and
mortality in small for gestational age very preterm infants in a middle- income country. Front Pediatr 2022;10:915796. https://doi.org/10.3389/ fped.2022.915796.
7. Woldesenbet SA, Lombard C, Manda S, et al. The 2019 National Antenatal Sentinel HIV Survey, South Africa. Pretoria: National Department of Health, 2021.
8. Goga AE, Dinh TH, Jackson DJ, et al. First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa. J Epidemiol Community Health 2015;69(3):240-248. https://doi.org/10.1136/jech-2014-204535.
9. Malherbe HA, C Woods D, Christianson, A. The contributions of congenital disorders to child mortality in South Africa. In: Padarath A, King J, Mackie E, Casciola J, eds. South African Health Review. Durban: Health Systems Trust; 2016:137-152. https://www.hst.org.za/publications/Pages/South-African- Health-Review-2016.aspx.
10. Saggers RT, Ballot DE, Grieve A. An analysis of neonates with surgical diagnoses admitted to the neonatal intensive care unit at Charlotte Maxeke Johannesburg Academic Hospital, South Africa. S Afr Med J 2020;110(6):497-501. https://doi. org/10.7196/SAMJ.2020.v110i6.14326.
11. Zolfizadeh F, Ghorbani M, Soltani M, et al. Factors associated with infant mortality due to congenital anomalies: A population-based case-control study. Iran J Public Health 2022;51(5):1118-1124. https://doi.org/10.18502/ ijph.v51i5.9411.
12. South African National Department of Health. Policy Guidelines for the Management and Prevention of Genetic Disorders, Birth Defects and Disabilities. Pretoria: NDoH; 2001.
13. Gomes MCM, Malherbe HL. The impact of COVID-19 on patients affected by rare diseases and congenital disorders in South Africa: A scoping review. S Afr Med J 2024;114(9):e1795. https://doi.org/10.7196/SAMJ.2024. v114i9.1795.
14. Ahmed T, Rahman AE, Amole TG, et al. The effect of COVID-19 on maternal newborn and child health (MNCH) services in Bangladesh, Nigeria and South Africa: Call for a contextualised pandemic response in LMICs. Int J Equity Health 2021;20(1):77. https://doi.org/10.1186/s12939-021-01414-5.
15. McDermott H, Sherlaw-Sturrock C, Baptista J, Hartles-Spencer L, Naik S. Rapid exome sequencing in critically ill children impacts acute and long- term management of patients and their families: A retrospective regional evaluation. Eur J Med Genet 2022;65(9):104571. https://doi.org/10.1016/j. ejmg.2022.104571.
16. Beaman M, Fisher K, McDonald M, et al. Rapid whole genome sequencing in critically ill neonates enables precision medicine pipeline. J Pers Med 2022;12(11):1924. https://doi.org/10.3390/jpm12111924.
17. AlKadhem SM, AlKhwaitm S, Alkhars AZ, et al. The association between admission sources and outcomes at a pediatric intensive care unit in Al-Ahsa, Saudi Arabia: A retrospective cohort study. Cureus 2020;12(11):e11356. https://doi.org/10.7759/cureus.11356.
18. Kapil D, Bagga A. The profile and outcome of patients admitted to a pediatric intensive care unit. Indian J Pediatr 1993;60(1):5-10. https://doi.org/10.1007/ BF02860496.
19. Jeena PM, Wesley AG, Coovadia HM. Admission patterns and outcomes in a paediatric intensive care unit in South Africa over a 25-year period (1971–1995). Intensive Care Med 1999;25(1):88-94. https://doi.org/10.1007/ s001340050792.
20. Basnet S, Shrestha S, Ghimire A, et al. Development of a PICU in Nepal: The experience of the first year. Pediatr Crit Care Med 2014;15(7):e314-e320. https://doi.org/10.1097/PCC.0000000000000201.
21. Embu HY, Yiltok SJ, Isamade ES, Nuhu SI, Oyeniran OO, Uba FA. Paediatric admissions and outcome in a general intensive care unit. Afr J Paediatr Surg 2011;8(1):57-61. https://doi.org/10.4103/0189-6725.78670.
22. Mesquita Ramirez MN, Godoy LE, Alvarez Barrientos E. SNAP II and SNAPPE II as predictors of neonatal mortality in a pediatric intensive care unit: Does postnatal age play a role? Int J Pediatr 2014;2014:298198. https:// doi.org/10.1155/2014/298198.
23. Ballot DE, Davies VA, Cooper PA, Chirwa T, Argent A, Mer M. Retrospective cross-sectional review of survival rates in critically ill children admitted to a combined paediatric/neonatal intensive care unit in Johannesburg, South Africa, 2013-2015. BMJ Open 2016;6(6):e010850. https://doi.org/10.1136/ bmjopen-2015-010850.
24. Mansour MS. Mortality rates and associated factors in a mixed neonatal and pediatric intensive care unit admissions at Zawia Medical Center, Libya. AlQalam J Med Applied Sci 2025;8(3):1750-1756. https://doi.org/doi.org/ 10.54361/ajmas.258369.
25. Solomon LJ, Naidoo KD, Appel I, et al. Pediatric Index of Mortality – an evaluation of function among ICUs in South Africa. Pediatr Crit Care Med 2021;22(9):813-821. https://doi.org/10.1097/PCC.0000000000002693.
26. Basha S, Surendran N, Pichichero M. Immune responses in neonates. Expert Rev Clin Immunol 2014;10(9):1171-1184. https://doi.org/10.1586/174466 6X.2014.942288.
27. Green RJ, Zar HJ, Jeena PM, Madhi SA, Lewis H. South African guideline for the diagnosis, management and prevention of acute viral bronchiolitis in children. S Afr Med J 2010;100(5):322-325. https://doi.org/10.7196/ samj.4016.
28. Nada A, Bonachea EM, Askenazi DJ. Acute kidney injury in the fetus and neonate. Semin Fetal Neonatal Med 2017;22(2):90-97. https://doi. org/10.1016/j.siny.2016.12.001.
29. McCulloch MI, Adabayeri VM, Goka S, et al. Perspectives: Neonatal acute kidney injury (AKI) in low and middle income countries (LMIC). Front Pediatr 2022;10:870497. https://doi.org/10.3389/fped.2022.870497.
30. Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Curr Opin Pediatr 2012;24(2):191-196. https://doi.org/10.1097/ MOP.0b013e32834f62d5.