This research report is submitted in partial fulfillment of the requirements for the degree of
Master of Medicine in the Department of Paediatrics and Child Health, Faculty of Health
Sciences, University of Witwatersrand, Johannesburg
November 2014 / Background. Babies born before arrival to hospital (BBBAs) constitute a high-risk newborn
population. The literature demonstrates that BBBAs have increased perinatal mortality and
morbidity.
Objectives. To describe the maternal and neonatal characteristics of BBBAs presenting to
Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa, and assess whether
they have increased morbidity and mortality compared with inborn babies.
Methods. This was a matched case-controlled retrospective record review of newborns
presenting to the neonatal unit of CMJAH between 1 January 2011 and 31 January 2013. BBBAs
were matched 1:1 with the next consecutive inborn on birth-weight category and gender.
Results. A total of 356 neonates were analysed. BBBAs had higher mortality than inborn
controls within the first 24 hours of hospital presentation (7.9% v. 3.9%; p=0.05). Mothers of
BBBAs were more likely to be unbooked (58.4% v. 10.7%; p<0.001) and of higher parity
(p=0.0008). HIV prevalence was similar amongst cases and controls (24% v. 28.7%), however
there were significantly more unknown HIV status in mothers of BBBA’s (49.6% v. 32%;
p=0.01). Cases had a higher prevalence of early sepsis (22.9% v. 3.6%; p=0.03) and birth
asphyxia (14.5% v. 0.8%; p<0.001) than controls. Overall, more deaths occurred in the very-lowbirth-
weight (VLBW) (24% v. 10%; p=0.06) and low-birth-weight (LBW) (7.46% v. 0%;
p=0.02) BBBA’s compared to controls.
Conclusion. We demonstrated higher mortality in the immediate postnatal period and in the
VLBW and LBW categories compared with hospital-delivered neonates. Once admitted, there
was no difference in mortality, length of stay or number of ICU admissions between cases and
controls. Mothers who delivered out of hospital were more likely to be multiparous and
unbooked and to have unknown HIV, RPR and Rh results. Neonatal resuscitation, transport and
immediate care on arrival at the hospital should be prioritised in the management of BBBAs.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/17430 |
| Date | 17 April 2015 |
| Creators | Bassingthwaighte, Mairi |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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