Browsing by Subject "Newborn"

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    A centile chart for birth weight for an urban population of the Western Cape
    (1995) Theron, G B; Thompson, M L
    Evidence from large epidemiological studies has supported concern that being born light for gestational age (LiGA) may be detrimental. The incidence of LiGA babies is an important indicator of the health of women of reproductive age in deprived communities. In the assessment of LiGA in the Western Cape, centile charts constructed for populations in other parts of the world are generally used. These charts, however, may not be appropriate. Patients residing in the area served by the Tygerberg Hospital obstetric service, who booked early with singleton pregnancies, had their gestational age confirmed by early ultrasound and delivered between 1 March 1989 and 28 February 1990 were included in the study. The sample consisted of 3 643 patients. The mean birth weight was 2 995 g (SD 573 g) and the range 760 - 5 080 g. The distribution of birth weight at each week of gestation from 28 to 42 weeks was not normal. The 4-parameter Johnson family of densities was used to model the distribution of birth weight at each gestational age. A comparison of the distribution of birth weight in the study relative to the perinatal growth chart for international reference constructed by Dunn was also made. In addition to considering an overall chart, the sample was subdivided according to a number of characteristics (e.g. gender, firstborn and latter-born babies, smoking habit, hypertensive disorders and induction of labour) in order to explore their impact on the distribution of birth weight. Having explored the potential impact of all these factors, it was concluded that a single chart including all patients could be constructed.
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    Open Access
    Diagnostic utility of lung ultrasound in preterm neonates with respiratory distress at a tertiary neonatal intensive care unit in the Western Cape
    (2025) Mpisane-Jama, Fefekazi; Horn, Alan
    Background: Accumulating data suggest the potential for lung ultrasound (LUS) to diagnose lung pathology and predict the need for surfactant administration in preterm babies, but there are no published data from South Africa. Objectives: The objectives were to describe LUS diagnoses and outcomes in preterm babies receiving non-invasive respiratory support in a South African neonatal unit, and to compare LUS with clinical diagnoses and surfactant administration. Methods: We conducted a prospective, observational study of babies 27–34 weeks' gestation, birth weight ≥ 800 grams, receiving non-invasive respiratory support who had LUS at age ≤ 3 hours. Surfactant was administered at fraction of inspired oxygen (FiO2) 0.35–0.45 and was not influenced by LUS findings. Results: Over a 4-month period, 51 babies were included – eight (16%) received surfactant, all of whom had respiratory distress syndrome (RDS) as their only clinical diagnosis, compared to overlapping diagnoses in the non-surfactant group; RDS (93%), TTN (16%) and pneumonia (14%). Lung ultrasound suggested less RDS in the non-surfactant group (42% vs. 88%; p=0.002), and more TTN (79% vs. 38%; p=0.002) and TTN plus pneumonia (65% vs. 25%; p=0.03). The LUS score (LUSS) predicted surfactant administration (Area under the curve 0.8 [95% confidence interval 67-94%]). A LUSS of 7 had the best combined sensitivity (75%) and specificity (72%) but low positive predictive value (33%). A LUSS of 8 identified 8/43 (19%) additional babies for surfactant who did not need treatment. Conclusion: Lung ultrasound suggested a higher frequency of alternative and additional diagnoses than clinical assessment but was not an adequate single indicator of surfactant requirement, compared to FiO2 threshold. The high frequency of LUS features of TTN in the non-surfactant group, highlights the need to consider TTN as an alternative diagnosis in similar preterm neonates.
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    Open Access
    Exploring barriers to and facilitators of immediate postpartum and newborn care by midwives in Uganda
    (2026) Ssemwanga, Nassifu; Clow, Sheila; Walker, Sonja
    Background: The postnatal period is a critical phase in the lives of mothers and newborn babies, and almost half of the maternal and neonatal deaths occur in the first 24 hours after birth. However, the barriers and facilitators to immediate postpartum and newborn care by midwives have received little attention, most especially in developing countries, including Uganda. This study explored the barriers to and facilitators of immediate postpartum and newborn care by midwives in Central Uganda. Methods: This was a qualitative descriptive study conducted among purposively sampled midwives at Gombe District Hospital, Central Uganda. Information was gathered through three focus group discussions and four key informant interviews. Data were analysed using the inductive thematic approach of Colaizzi. Results: All participants were females aged between 23 and 59 years. Three themes emerged: “Optimising birth outcomes”, which reflects midwives understanding of the components of immediate postpartum and newborn care; “Overwhelming experience”, which highlights barriers such as a disabling work environment, demotivating conditions, and an uninformed practice; and “Comprehensive support system”, which encompasses facilitators such as an enabling work environment, effective leadership and management, and professional competence. An overarching theme, “Contradictions in Perspectives”, highlights the inconsistencies between the viewpoints of frontline midwives, who deal with daily realities, and midwifery managers, whose perspectives seem more aspirational. Conclusion: These findings emphasise the need for specific interventions to address barriers and strengthen facilitators, enhancing the overall quality of maternal care and birth outcomes.