Browsing by Author "Holgate, S. L."

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    Outcomes of extremely low-birthweight neonates at a tertiary hospital in the Western Cape, South Africa : a retrospective cohort study
    (Health & Medical Publishing Group, 2021-10) Mugyenzi, Grace Musiime; Lloyd, L. G.; McCaul, M.; Van Zyl, N.; Holgate, S. L.
    Background. Neonates of extremely low birthweight (ELBW; <1 000 g) have the highest neonatal mortality in South Africa (SA). Objective. To describe the morbidity and mortality of ELBW neonates treated at a tertiary hospital in SA. Methods. This was a retrospective cohort study including all live-born ELBW neonates treated at Tygerberg Hospital between 1 January and 31 December 2016. Data were extrapolated from a prospectively collected neonatal database and patient records. Multiple logistic regression and survival analysis were performed to identify risk factors of mortality. Results. The sample included 256 neonates. The following morbidities were recorded: respiratory distress syndrome (83.2%); bronchopulmonary dysplasia (8.2%); intraventricular haemorrhage (34.5%); periventricular leukomalacia (0.6%); necrotising enterocolitis (10.5%); and retinopathy of prematurity (31.2%). The survival-to-discharge rate was 63.3%. Cause of death was documented as extreme prematurity in 41% of the inpatient deaths. Birthweight was a significant predictor of mortality (hazard ratio 0.99; 95% confidence interval 0.992 - 0.999). Of the 162 neonates who survived until discharge, 11 died following discharge. Conclusion. Morbidity and mortality rates remain high among ELBW neonates. To improve survival, resources need to be allocated to neonatal resuscitation, surfactant therapy and increasing availability of intensive-care beds.
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    A retrospective review of Listeria monocytogenes infection at Tygerberg Children’s Hospital, Cape Town, South Africa, from 2006 to 2016 : is empirical ampicillin still indicated after the first month of life?
    (Health & Medical Publishing Group, 2018) Oppel, K. B.; Holgate, S. L.; Finlayson, H.
    Background. Ampicillin to treat Listeria monocytogenes (LM) infection is empirically added to the treatment of infants (<3 months) with suspected sepsis or meningitis. Objectives. In view of limited LM cases, the paucity of South African (SA) data and an ampicillin shortage, our objective was to describe the occurrence of LM infections at Tygerberg Hospital (TBH), Cape Town, with the aim of rationalising the paediatric antibiotic policy. Methods. An 11-year (2006 - 2016) retrospective descriptive study of children (<13 years) from TBH and referral hospitals with a positive blood or cerebrospinal fluid (CSF) culture for LM was conducted. Results. Of 26 children with positive cultures for LM, 23 (88.5%) were <3 months of age; all were <10 days old. Approximately half (56.5%, 13/23) were born at or referred to TBH. Presentation was on the day of delivery in 46.2% (6/13), 92.3% were admitted to the neonatal intensive care unit (NICU), and 61.5% (8/13) died. Neonates treated at peripheral hospitals were statistically more likely than those treated at TBH to have a CSF culture obtained (90.0% v. 30.8%; p=0.005), and had higher platelet counts (239 × 109/L v. 107 × 109/L; p=0.004), lower C-reactive protein levels (64 mg/L v. 137 mg/L; p=0.013) and a lower mortality rate (0% v. 61.5%; p=0.002). The incidence of LM at TBH was 0.04/1 000 live births and 2.3/1 000 NICU admissions. Conclusions. As in other countries, the local neonatal LM incidence is low. Neonates present in the first week of life with severe disease and a high mortality rate. These data support a change in antibiotic policy, in keeping with international guidelines, limiting empirical ampicillin prescription to infants <1 month of age.