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Thesis MMed (Paediatrics), Faculty of Health Sciences, University of the Witwatersrand / INTRODUCTION: Improved survival of VLBW infants is raising several management issues. An example is that of growth and growth monitoring. AIM OF THE STUDY: To assess the growth of a cohort of VLBW infants born at CMJAH from term CGA to 20 months CGA. METHODS: A retrospective chart review was conducted on 139 VLBW infants (birth weight ≤ 1500g) born at CMJAH between 1 July 2006 and 28 February 2007. RESULTS: Comparison with a term growth reference showed initial growth failure followed by gradual catch up growth but with persistent deficits in length for age. Comparison with international VLBW references showed similar growth for weight and head circumference for age but with deficits in length for age. Growth parameters of the study sample were similar to those of other South African VLBW infants. CONCLUSION: Growth and growth monitoring in VLBW infants is complicated by characteristic growth patterns, high associated morbidity, controversies surrounding ideal growth and lack of an ideal growth reference. Significant deficits in length for age in the study sample may have been due to the large proportion of infants born SGA and the high prevalence of stunting in South African children. Current recommendations for growth monitoring of VLBW infants include the use of a VLBW reference up to two years CGA followed by a term growth reference thereafter

A research report submitted to the Faculty of Health Sciences Witwatersrand University, Johannesburg in partial fulfillment of the requirements for the degree of Master of Medicine in Family Medicine Johannesburg, South Africa 2017 / Background: Low birth weight (LBW) is an important risk factor for infant developmental problems, morbidity and mortality. Low birth weight babies are twenty times more likely to die during the neonatal period than their normal weight counterparts. Although risk factors for low birth weight vary from one community to another, maternal risk factors for low birth weight in the South Rand Hospital (Johannesburg, Gauteng) catchment area have not been investigated. The objective of this study was to determine maternal risk factors for low birth weight in South Rand Hospital, Johannesburg. Method: This 1: 1 matched case-control study was conducted on a total of 480 mothers who delivered babies at South Rand Hospital between 1 January 2013 and 31 December 2014. The cases were 240 mothers who delivered singleton term live LBW babies. They were matched with an equal number of controls. Results: Conditional logistic regression showed that, no anaemia in the third trimester (OR=0.54, 95% CI= 0.30-0.99), immigration status (OR= 0.46, 95% CI= 0.25- 0.85) and four or more antenatal care clinic attendance (OR=0.36, 95% C.I= 0.12- 0.76) were protective factors, while smoking during pregnancy (OR= 8.69, 95% CI= 2.70-28.35) predisposes to delivering a LBW baby. Conclusion: The results showed that smoking during pregnancy is a risk factor for LBW, while maternal third-trimester haemoglobin level of 11g/dl or more, immigrant status, and more than three ANC visits were protective factors for delivering LBW baby. / MT2017

Thesis (M.Med.)--University of the Witwatersrtand, Faculty of Health Sciences, 2013.

Background Human immunodeficiency virus (HIV) sero-prevalence rate during pregnancy was 26% in 2009 in Gauteng. HIV exposure is associated with high morbidity and mortality in infants. Few studies have assessed the effect of HIV exposure on morbidity and mortality in very low birth weight (VLBW) infants. Aim To determine the infant characteristics at birth, morbidity during hospital stay and mortality at hospital discharge of VLBW infants according to maternal HIV status. Methods This was a retrospective cross sectional descriptive study. Hospital records of VLBW infants admitted at the Chris Hani Baragwanath Academic Hospital, Division of Neonatology from 1st January 2011 to 30th June 2011 were reviewed. Data were collected in an Excel spread sheet and imported to STATA version 12 for analysis. Results 302 hospital records of VLBW infants admitted from January to June 2011 were retrieved and reviewed. About a third (34.1%) of VLBW infants were born to mothers who were HIV positive. There were more babies who weighed <1000 grams in the HIV-exposed infants compared to HIV-unexposed infants (p-0.001). HIV exposed infants had a smaller head circumference (p-0.003), a shorter body length (p-0.006) and significantly more severe grades of IVH (p <0.001) compared to HIV unexposed infants. The overall mortality rate in VLBW infants was 27%, with HIV exposed infants having a mortality rate of 38.6% compared to 21% in the HIV-negative infants (p-0.002). Multivariate analysis showed that the main predictor of mortality was birth weight (p<0.001). Conclusion Though on univariate analysis maternal HIV status was associated with mortality in VLBW infants, this effect was not found on multivariate analysis. Therefore the final conclusion from this study is that maternal HIV status has no independent effect on outcomes to hospital discharge in VLBW infants. Birth weight was the predictor of survival in VLBW infants.

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Findings are presented from matched case-control studies of risk factors for diabetes, cryptorchidism and inguinal hernia in children using routine data collected by the Oxford Record Linkage Study since 1965. There were 315 cases born 1965-85 in the diabetes study, 947 and 1449 cases in studies of cryptorchidism diagnosed at birth and at orchidopexy respectively, and 1701 male and 347 female cases in the study of inguinal hernia. Each case was individually matched with up to eight controls on sex, year, and hospital or place of birth. A potential bias caused by differential migration of cases and controls was identified. A sample of 753 controls born in Oxfordshire was checked against the Oxfordshire Family Health Services Authority register to determine migration out of the study area in relation to perinatal risk factors. A general procedure was developed to estimate the strength of the migration bias. Pre-eclampsia was identified as a significant pre-natal risk factor for diabetes. The studies of cryptorchidism identified significantly raised risks with low birth weight, low social class and breech presentation. The results suggested that asymmetric growth retardation in the third trimester may be involved in the aetiology of undescended testes that do not spontaneously descend in later life. Analysis of risk factors among siblings of cases and controls suggested that permanent changes to the mother may occur around the time of the pregnancy involving the affected child. Low birth weight, short gestation and smoking during pregnancy were associated with significantly raised risks of inguinal hernia among boys. Among girls the results were similar, suggesting that mechanisms independent of the sex of the child may be important in the aetiology of this condition. Estimates of disease risk in siblings showed a strong familial aggregation, especially among girls.

DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF REQUIREMENTS FOR A MASTER OF MEDICINE DEGREE IN PAEDIATRICS AND CHILD HEALTH (MMED PAED) / Survival of extremely low birth weight (ELBW) infants in a resource limited public hospital setting is still low in South Africa. The study aimed at establishing the determinants of survival in this weight category of neonates who, due to limited intensive care facilities, were not mechanically ventilated.