559 - Risk Factors Contributing to Neonatal Mortality in Premature Infants ≤ to 2000 Grams in a Neonatal Intensive Care Unit in a Low Resource Setting in the Eastern Cape South Africa

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 559
Publication Number: 559.41

Martha Maria. Mayer, Nelson Mandela Academic Hospital, Mthatha, Eastern Cape, South Africa; Emily Ahn, New York-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Esethu Mntonintshi, Nelson Mandela Academic Hospital, Mthatha, Eastern Cape, South Africa; Namhla Sinoyolo Nqabakazi. Notununu, Nelson Mandela Academic Hospital, Mthatha, Eastern Cape, South Africa; Jeffrey Perlman, Weill Cornell Medicine, New York, NY, United States; Sithembiso C. Velaphi, Chris Hani Baragwanath Academic Hospital, Johannesburg, Gauteng, South Africa

Presenting Author(s)

Emily Ahn, MD (she/her/hers)

Neonatology Fellow
New York-Presbyterian Komansky Children’s Hospital
New York, New York, United States

Background: Neonatal mortality (NM) particularly in premature infants (PI) remains a major problem in the low resource setting (LRS). Nelson Mandela Hospital has a large referral tertiary NICU serving both inborn and outborn infants. Resources include continuous positive airway pressure (CPAP), intubation, surfactant, and intensive medication, however, challenges with staffing and space complicates medical care.

Objective:

To determine risk factors contributing to NM in PI ≤ 2000g.

Design/Methods: Data for this ongoing study was reviewed for PI < 2000g admitted to the NICU between Sept-Dec 2022. Data retrieved included sex, inborn/outborn status, antenatal steroid (ANS) use, preeclampsia (PEC), birthweight (BW), gestational age (GA), initial temperature, 5-minute Apgar score (AS), respiratory distress (RD)/syndrome (RDS), CPAP use, intubation, surfactant use, INSURE strategy for treating RDS, initial pH, inotrope use (dopamine, dobutamine, epinephrine), positive blood cultures (BC) and organisms, and congenital anomalies (CA). Data analysis included t-tests and chi-square test.

Results: The study comprised 66 PI of BW 1460 ± 392g and GA 31 ± 4 weeks with 32 males & 34 females. Primary admitting diagnoses included RDS (n=46), RD (n=4), and prematurity/low BW (n=13). There were 13 (19.7%) deaths. By BW 6/11 (54.5%) died ≤1000g including 3/4 (75%) ≤ 750g, 1/9 (11.1%) died 1001-1250g, 1/12 (8.3%) between 1251-1500g, and 5/34 (14.7%) between 1501-2000g; the latter of which included 3 with lethal CA (Table 1). Factors associated with NM included 5-minute AS < 7 (n=5/5, P=0.001), initial temperature < 36.5°C (P=0.01), initial lower pH (P=0.01), and use of multiple inotropes (n=5/5, P</em>=0.001). There was no relationship between NM and ANS, PEC, CPAP, RDS, intubation, surfactant, or INSURE use (Table 2). Positive BC (n=16, 28.7%) included coagulase negative staphylococcus (CONS) (n=9), gram negative organisms (GNO) (n=5), and other (n=5); 4 (21%) infants died of septic shock. Meropenem was only used in GNO cases.

Conclusion(s): NM was noted in ~14% of PI < 2000g which included four unpreventable deaths (lethal CA) and three PI < 750g not offered CPAP. Risk factors for NM included a 5-minute AS < 7, initial lower temperature, initial lower pH, and multiple inotrope use. Interesting NM was not related to RDS or any respiratory support/interventions. Infection was common mainly due to CONS which may represent a contaminate. To achieve further reductions in NM, targeted strategies i.e., avoiding hypothermia and infectious control measures, and addressing the challenges related to space, staffing, and supply needs are essential.