Browsing by Subject "Neonates"

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    Anaesthetic complications in gastroschisis
    (2025) Heald, Andrew; Gray, Rebecca; Meyer , Heidi
    Introduction: Patients with gastroschisis (GS) are a vulnerable population who present to the operating theatre for pathology or central venous access related indications. Little is known about anaesthesia-related adverse events (ARAEs) in children from low- and middle-income countries (LMICs). Methods: We performed a single-centre retrospective observational study at Red Cross War Memorial Children's Hospital (RCWMCH), in Cape Town, South Africa. Data was collected from patient folders from the hospital's GS database. Each general anaesthetic exposure (GAE) was treated as an independent event and a binary logistic regression analysis was performed to assess the association between indication for GAE and the odds of an ARAE. A mixed-effects logistic regression model was used to analyse the association between adverse complications and key predictor variables in paediatric anaesthesia. Results: Seventy folders were collected between 2012 and 2021. The median gestational age was 36 weeks and median birthweight 2270g. 56 (80%) patients survived to full enteral feeds and the median duration of TPN was 18 days (IQR 12-29). There were 196 GAEs, of which pathology-related indications comprised 59%. There was a total of 94 ARAEs. At least one ARAE occurred in 79 (40%) of the 196 GAEs. Cardiovascular instability was the most common ARAE, comprising 76% of the total ARAEs. Respiratory events comprised 18% of the ARAEs, with reintubation predominating. Patients presenting for pathology related indications were associated with an unadjusted 6-fold odds increase (95% CI = 3.10, 12.27) in the odds of ARAEs compared to patients with CVC-related indications (p<0.001), however at least one ARAE occurred in 18% of CVC related GAEs. No statistically significant association with ARAE was found for gestational age, birth weight or sex. Conclusion: At RCWMCH, many patients with GS experience a complicated clinical course, requiring multiple general anaesthetic exposures. They have a high prevalence of anaesthetic related adverse events, particularly instances of CVS instability and reintubation. Establishing a multidisciplinary management protocol for these patients may decrease intervention frequency and improve outcomes.
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    Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres
    (Public Library of Science, 2012) Chu, Kathryn; Cortier, Hilde; Maldonado, Fernando; Mashant, Tshiteng; Ford, Nathan; Trelles, Miguel
    Objectives The World Health Organization considers Cesarean section rates of 5-15% to be the optimal range for targeted provision of this life saving intervention. However, access to safe Cesarean section in resource-limited settings is much lower, estimated at 1-2% reported in sub-Saharan Africa. This study reports Cesarean sections rates and indications in Democratic Republic of Congo, Burundi, and Sierra Leone, and describe the main parameters associated with maternal and early neonatal mortality. METHODS: Women undergoing Cesarean section from August 1 2010 to January 31 2011 were included in this prospective study. Logistic regression was used to model determinants of maternal and early neonatal mortality. RESULTS: 1276 women underwent a Cesarean section, giving a frequency of 6.2% (range 4.1-16.8%). The most common indications were obstructed labor (399, 31%), poor presentation (233, 18%), previous Cesarean section (184, 14%), and fetal distress (128, 10%), uterine rupture (117, 9%) and antepartum hemorrhage (101, 8%). Parity >6 (adjusted odds ratio [aOR] = 8.6, P = 0.015), uterine rupture (aOR = 20.5; P = .010), antepartum hemorrhage (aOR = 13.1; P = .045), and pre-eclampsia/eclampsia (aOR = 42.9; P = .017) were associated with maternal death. Uterine rupture (aOR = 6.6, P<0.001), anterpartum hemorrhage (aOR = 3.6, P<0.001), and cord prolapse (aOR = 2.7, P = 0.017) were associated with early neonatal death. CONCLUSIONS: This study demonstrates that target Cesarean section rates can be achieved in sub-Saharan Africa. Identifying the common indications for Cesarean section and associations with mortality can target improvements in antenatal services and emergency obstetric care.
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    Effects of the COVID-19 pandemic on the outcomes of HIV-exposed neonates: a Zimbabwean tertiary hospital experience
    (BioMed Central, 2024-01-05) Gannon, Hannah; Chappell, Elizabeth; Ford, Deborah; Gibb, Diana M.; Chimwaza, Anesu; Manika, Ngoni; Wedderburn, Catherine J.; Nenguke, Zivai M.; Cowan, Frances M.; Gibb, Tom; Phillips, Andrew; Mushavi, Angela; Fitzgerald, Felicity; Heys, Michelle; Chimhuya, Simbarashe; Bwakura-Dangarembizi, Mutsa
    Abstract Introduction The COVID-19 pandemic has globally impacted health service access, delivery and resources. There are limited data regarding the impact on the prevention of mother to child transmission (PMTCT) service delivery in low-resource settings. Neotree ( www.neotree.org ) combines data collection, clinical decision support and education to improve care for neonates. Here we evaluate impacts of COVID-19 on care for HIV-exposed neonates. Methods Data on HIV-exposed neonates admitted to the neonatal unit (NNU) at Sally Mugabe Central Hospital, Zimbabwe, between 01/06/2019 and 31/12/2021 were analysed, with pandemic start defined as 21/03/2020 and periods of industrial action (doctors (September 2019-January 2020) and nurses (June 2020-September 2020)) included, resulting in modelling during six time periods: pre-doctors’ strike (baseline); doctors’ strike; post-doctors’ strike and pre-COVID; COVID and pre-nurses’ strike; nurses’ strike; post nurses’ strike. Interrupted time series models were used to explore changes in indicators over time. Results Of 8,333 neonates admitted to the NNU, 904 (11%) were HIV-exposed. Mothers of 706/765 (92%) HIV-exposed neonates reported receipt of antiretroviral therapy (ART) during pregnancy. Compared to the baseline period when average admissions were 78 per week (95% confidence interval (CI) 70–87), significantly fewer neonates were admitted during all subsequent periods until after the nurses’ strike, with the lowest average number during the nurses’ strike (28, 95% CI 23–34, p < 0.001). Across all time periods excluding the nurses strike, average mortality was 20% (95% CI 18–21), but rose to 34% (95% CI 25, 46) during the nurses’ strike. There was no evidence for heterogeneity (p > 0.22) in numbers of admissions or mortality by HIV exposure status. Fewer HIV-exposed neonates received a PCR test during the pandemic (23%) compared to the pre-pandemic periods (40%) (RR 0.59, 95% CI 0.41–0.84, p < 0.001). The proportion of HIV-exposed neonates who received antiretroviral prophylaxis during admission was high throughout, averaging between 84% and 95% in each time-period. Conclusion While antiretroviral prophylaxis for HIV-exposed neonates remained high throughout, concerning data on low admissions and increased mortality, similar in HIV-exposed and unexposed neonates, and reduced HIV testing, suggest some aspects of care may have been compromised due to indirect effects of the pandemic.
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    Gender differences in homicide of neonates, infants, and children under 5 y in South Africa: results from the cross-sectional 2009 National Child Homicide Study
    (Public Library of Science, 2016) Abrahams, Naeemah; Mathews, Shanaaz; Martin, Lorna J; Lombard, Carl; Nannan, Nadine; Jewkes, Rachel
    Jewkes and colleagues present a cross-sectional study that reveals levels of child homicide in South Africa. Identifying causes and vulnerable mothers will lead to prevention methods and strategies.
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    Incidence and risk factors for neonatal tetanus in admissions to County Hospital, Kenya
    (Public Library of Science, 2015) Ibinda, Fredrick; Bauni, Evasius; Kariuki, Symon M; Fegan, Greg; Lewa, Joy; Mwikamba, Monica; Boga, Mwanamvua; Odhiambo, Rachael; Mwagandi, Kiponda; Seale, Anna C
    BACKGROUND: Neonatal Tetanus (NT) is a preventable cause of mortality and neurological sequelae that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunisation rates and unhygienic cord care practices. We aimed to determine changes in the incidence of NT, characterize and investigate the associated risk factors and mortality in a prospective cohort study including all admissions over a 15-year period at a County hospital on the Kenyan coast, a region with relatively high historical NT rates within Kenya. METHODS: We assessed all neonatal admissions to Kilifi County Hospital in Kenya (1999-2013) and identified cases of NT (standard clinical case definition) admitted during this time. Poisson regression was used to examine change in incidence of NT using accurate denominator data from an area of active demographic surveillance. Logistic regression was used to investigate the risk factors for NT and factors associated with mortality in NT amongst neonatal admissions. A subset of sera from mothers (n = 61) and neonates (n = 47) were tested for anti-tetanus antibodies. RESULTS: There were 191 NT admissions, of whom 187 (98%) were home deliveries. Incidence of NT declined significantly (Incidence Rate Ratio: 0.85 (95% Confidence interval 0.81-0.89), P<0.001) but the case fatality (62%) did not change over the study period (P = 0.536). Younger infant age at admission (P = 0.001) was the only independent predictor of mortality. Compared to neonatal hospital admittee controls, the proportion of home births was higher among the cases. Sera tested for antitetanus antibodies showed most mothers (50/61, 82%) had undetectable levels of antitetanus antibodies, and most (8/9, 89%) mothers with detectable antibodies had a neonate without protective levels. CONCLUSIONS: Incidence of NT in Kilifi County has significantly reduced, with reductions following immunisation campaigns. Our results suggest immunisation efforts are effective if sustained and efforts should continue to expand coverage.
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    Myeloid derived suppressor cells are present at high frequency in neonates and suppress in vitro T cell responses
    (Public Library of Science, 2014) Gervassi, Ana; Lejarcegui, Nicholas; Dross, Sandra; Jacobson, Amanda; Itaya, Grace; Kidzeru, Elvis; Gantt, Soren; Jaspan, Heather; Horton, Helen
    Over 4 million infants die each year from infections, many of which are vaccine-preventable. Young infants respond relatively poorly to many infections and vaccines, but the basis of reduced immunity in infants is ill defined. We sought to investigate whether myeloid-derived suppressor cells (MDSC) represent one potential impediment to protective immunity in early life, which may help inform strategies for effective vaccination prior to pathogen exposure. We enrolled healthy neonates and children in the first 2 years of life along with healthy adult controls to examine the frequency and function of MDSC, a cell population able to potently suppress T cell responses. We found that MDSC, which are rarely seen in healthy adults, are present in high numbers in neonates and their frequency rapidly decreases during the first months of life. We determined that these neonatal MDSC are of granulocytic origin (G-MDSC), and suppress both CD4+ and CD8+ T cell proliferative responses in a contact-dependent manner and gamma interferon production. Understanding the role G-MDSC play in infant immunity could improve vaccine responsiveness in newborns and reduce mortality due to early-life infections.
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    Oropharyngeal dysphagia in neonates; prevalence and risk factors within a South African context
    (2025) Porter, Kirsten; Norman, Vivienne; Rhoda, Natasha
    Background: The prevalence of neonatal oropharyngeal dysphagia (OPD) remains largely unexplored in lower middle-income countries, with limited published research on this topic. In the South African context, factors such as poverty, burden of disease and limited access to healthcare may elevate the risk of OPD among neonates. Improvements in neonatal medical care have led to higher survival rates for neonates with complex medical conditions yet also increased the likelihood of feeding and swallowing difficulties. Contextual information on the prevalence, nature and risk factors for OPD is important for healthcare planning and optimal service delivery. Research aim and objectives: To describe OPD and the associated risk factors in neonates admitted into a neonatal unit in South Africa. The objectives of this research study were to describe the prevalence, nature and risk factors associated with OPD in neonates, including medical conditions, gestational age and birthweight. Method: A prospective, descriptive cross-sectional study design was used to describe OPD and the associated risk factors in 160 (N=160) neonates, 34 weeks or older, who were admitted into a neonatal intensive care unit (NICU) and were considered medically stable. Feeding and swallowing was assessed using a reliable and validated tool, the Neonatal Feeding Assessment Tool (NFAS), which allowed for the description of the nature of OPD. The prevalence of OPD and associations between OPD and various risk factors were analysed statistically. Results: Thirty-two participants (20%; n=32) were diagnosed with OPD according to the NFAS criteria, although more participants (43.1%; n=69) presented with some clinical signs of OPD. More than 80% of neonates with OPD were born premature (n=26; 81.3%) and/or with a low birthweight (n=28; 87.5%), while respiratory (n=23; 71.9%) and neurologic (n=9; 28.1%) complications were the most prevalent medical conditions reported in neonates with OPD in this study. Neonates born premature and/or with a low birthweight as well as those with medical conditions (neurologic, cardiorespiratory, anatomic, genetic and gastrointestinal) were at increased risk for OPD (OR>1.00). A statistically significant association between neonates with gastrointestinal complications and OPD was found (p=0.045). Neonates with OPD presented with suboptimal physiologic functioning (n=27; 84.9%), inadequate state of alertness (n=30; 94%) and stress cues during feeding (n=28; 87.5%). Nearly all neonates with OPD had non-nutritive (n=31; 96.9%) and nutritive suck (n=32; 100%) difficulties and over two-thirds of neonates with OPD presented with signs typical of OPD such as weak and/or delayed initiation of suck, coughing and poor lip closure leading to spillage during feeding. Conclusion: One in five neonates admitted to the neonatal unit presented with OPD, even once medically stable and over 34 weeks gestation. Neonates with multiple medical conditions or risk factors were more likely to present with OPD. The results of this study highlight the complexity of OPD in neonates and the need for timeous inclusion of oral feeding protocols in the management of neonates, and the role of speech-language therapists in the assessment and management of neonates at risk for OPD to ensure optimal management.
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    Protocol for a drugs exposure pregnancy registry for implementation in resource-limited settings
    (BioMed Central Ltd, 2012) Mehta, Ushma; Clerk, Christine; Allen, Elizabeth; Yore, Mackensie; Sevene, Esperanca; Singlovic, Jan; Petzold, Max; Mangiaterra, Viviana; Elefant, Elizabeth; Sullivan, Frank; Holmes, Lewis; Gomes, Melba
    BACKGROUND: The absence of robust evidence of safety of medicines in pregnancy, particularly those for major diseases provided by public health programmes in developing countries, has resulted in cautious recommendations on their use. We describe a protocol for a Pregnancy Registry adapted to resource-limited settings aimed at providing evidence on the safety of medicines in pregnancy.METHODS/DESIGN:Sentinel health facilities are chosen where women come for prenatal care and are likely to come for delivery. Staff capacity is improved to provide better care during the pregnancy, to identify visible birth defects at delivery and refer infants with major anomalies for surgical or clinical evaluation and treatment. Consenting women are enrolled at their first antenatal visit and careful medical, obstetric and drug-exposure histories taken; medical record linkage is encouraged. Enrolled women are followed up prospectively and their histories are updated at each subsequent visit. The enrolled woman is encouraged to deliver at the facility, where she and her baby can be assessed.DISCUSSION:In addition to data pooling into a common WHO database, the WHO Pregnancy Registry has three important features: First is the inclusion of pregnant women coming for antenatal care, enabling comparison of birth outcomes of women who have been exposed to a medicine with those who have not. Second is its applicability to resource-poor settings regardless of drug or disease. Third is improvement of reproductive health care during pregnancies and at delivery. Facility delivery enables better health outcomes, timely evaluation and management of the newborn, and the collection of reliable clinical data. The Registry aims to improve maternal and neonatal care and also provide much needed information on the safety of medicines in pregnancy.