Browsing by Author "Van Niekerk, Anika"

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    Open Access
    A single-centre Preterm infant Retrospective Analysis of post 6-week Immunisation SideEffects, ‘PRAISE' study, in a busy neonatal unit in the Western Cape, South Africa between 2016-2018
    (2023) Petersen, Mishkah; Van Niekerk, Anika
    Background: Vaccine-Preventable Diseases (VPDs) are a leading cause of the high Underfive Mortality Rate (U5MR). Preterm infants are inherently at higher risk of mortality from VPDs. Studies irrefutably show the benefit of vaccinating preterm infants according to their chronological age with the benefit of timely vaccination outweighing unjustified delays. However, later studies have shown an increased risk of adverse events (AEs) following immunisation (AEFI) in preterm infants. This risk has not been uniformly accepted as statistically significant, but the multiple reports have led to subsequent proposed 48–72-hour cardio-respiratory monitoring recommendations which have not been uniformly adopted and may not be feasible in Low-and-Middle Income Countries (LMICs). Objectives: The main objective of this study is to identify the prevalence of major AEs following 6-week immunisation of preterm infants admitted to a busy neonatal unit in Cape Town over a two-year period. AEFI will be scrutinized to ascertain the timing, clinical severity and possible contributing factors. This study aims to identify any consistent variables or a subset of higher-risk preterm infants to inform a safe and practical in-hospital preterm vaccination and monitoring protocol. Methods: A retrospective audit was conducted on 260 eligible, in-patient, preterm infants receiving the 6-week vaccination as per the South African Expanded Programme on Immunisation (EPI) schedule from 01 March 2016 -31 March 2018 at a busy secondarylevel maternity referral hospital, Mowbray Maternity Hospital (MMH). Results: Two hundred and sixty (260) participants were included in the study, the median gestational age (GA) was 29 weeks, median birth weight 1 078 g and the median age at immunisation 44 days. Thirty-eight (38) out of the 260 participants (14.6%) experienced an AEFI with a median birth GA 28 weeks and median birth weight 988 g. Twenty-nine (29) out of 38 were deemed immunisation-related, since no other cause could be identified, with a prevalence of 11.15%. Majority (89.4%) of AEFI occurred within 24 hours. GA was inversely proportional to the risk of an AEFI. Respiratory support was needed by 73.7% and 97% were screened and treated for sepsis. Conclusion: Established benefit exists in vaccinating preterm infants according to chronological age. However, due cognisance should be paid to the early preterm infant's higher risk of AEFI, 11.15% in our study. Our study supports a clear unit-individualised preterm immunisation protocol with a minimum 24 hours of cardio-respiratory monitoring post vaccination, especially in the very preterm infants <32 weeks GA.
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    Open Access
    The burden of antenatally undiagnosed major congenital anomalies in live-born babies at a busy secondary level maternity hospital in the Western Cape
    (2025) Amankrah, Melvin; Van Niekerk, Anika; Kalk, Emma
    Background: Major congenital anomalies (MCA) account for considerable morbidity and disability in South Africa (SA) where there is a predicted birth prevalence of 27.5/1000 live births. There are limited data on MCA prevalence and impact on neonatal services in SA, especially the Western Cape province. Objective: To determine the prevalence, characteristics, and short-term outcomes of antenatally-undiagnosed neonates with MCA at Mowbray Maternity Hospital (MMH) in 2022. Methods: A retrospective, cross-sectional study of live-born neonates with MCA admitted to MMH neonatal services between 1 January- 31 December 2022. Stillbirths and antenatally diagnosed MCA neonates were excluded. Cases identified from the ward register and data collected by folder review using a standardized data collection form and analysed using R and Microsoft Excel. Continuous variables, described as medians and interquartile ranges, compared using the Wilcoxon rank sum test. Categorical variables presented as proportions and assessed using chi2test. Results: With 73 neonates included, the in-facility MCA prevalence rate was 36 per 1000 neonatal admissions and 6/1000 live MMH in-born infants. Most (82%) had a basic antenatal ultrasound and 29% a fetal anomaly scan. Syndromic MCA was present in 36% and non-syndromic MCA in 64%. Non-syndromic MCA included isolated genitourinary (21%), orofacial (19%), gastrointestinal (17%) and cardiovascular defects (15%). The most prevalent syndromic MCA was Trisomy 21 (58%). Syndromic MCA was significantly associated with advanced maternal age (³36 years), increased gravidity (³5) and low birth weight (<2500g), p < 0.001. The in-hospital mortality rate was 15%. Conclusion: In this single hospital-based study, the MCA prevalence was high among in-born and referred neonates. Diagnosis was not made antenatally despite a high proportion of women booking early and receiving antenatal ultrasound. Large collaborative registries and studies are recommended to establish the true impact of CA on children and their outcomes in SA.
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    Open Access
    The burden of antenatally undiagnosed major congenital anomalies in live-born babies at a busy secondary level maternity hospital in the Western Cape
    (2025) Amankrah, Melvin; Van Niekerk, Anika; Kalk, Emma
    Background: Major congenital anomalies (MCA) account for considerable morbidity and disability in South Africa (SA) where there is a predicted birth prevalence of 27.5/1000 live births. There are limited data on MCA prevalence and impact on neonatal services in SA, especially the Western Cape province. Objective: To determine the prevalence, characteristics, and short-term outcomes of antenatally-undiagnosed neonates with MCA at Mowbray Maternity Hospital (MMH) in 2022. Methods: A retrospective, cross-sectional study of live-born neonates with MCA admitted to MMH neonatal services between 1 January- 31 December 2022. Stillbirths and antenatally diagnosed MCA neonates were excluded. Cases identified from the ward register and data collected by folder review using a standardized data collection form and analysed using R and Microsoft Excel. Continuous variables, described as medians and interquartile ranges, compared using the Wilcoxon rank sum test. Categorical variables presented as proportions and assessed using chi2test. Results: With 73 neonates included, the in-facility MCA prevalence rate was 36 per 1000 neonatal admissions and 6/1000 live MMH in-born infants. Most (82%) had a basic antenatal ultrasound and 29% a fetal anomaly scan. Syndromic MCA was present in 36% and non-syndromic MCA in 64%. Non-syndromic MCA included isolated genitourinary (21%), orofacial (19%), gastrointestinal (17%) and cardiovascular defects (15%). The most prevalent syndromic MCA was Trisomy 21 (58%). Syndromic MCA was significantly associated with advanced maternal age (³36 years), increased gravidity (³5) and low birth weight (<2500g), p < 0.001. The in-hospital mortality rate was 15%. Conclusion: In this single hospital-based study, the MCA prevalence was high among in-born and referred neonates. Diagnosis was not made antenatally despite a high proportion of women booking early and receiving antenatal ultrasound. Large collaborative registries and studies are recommended to establish the true impact of CA on children and their outcomes in SA.