Respiratory management of low birth weight neonates with respiratory distress in rural district and regional hospitals in the Western Cape during 2019

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dc.contributor.advisorSlogrove, Amyen_ZA
dc.contributor.advisorEngelbrecht, Arnolden_ZA
dc.contributor.authorRead, Jo-Marien_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.en_ZA
dc.date.accessioned2023-11-25T12:59:29Zen_ZA
dc.date.accessioned2024-01-08T17:33:53Zen_ZA
dc.date.available2023-11-25T12:59:29Zen_ZA
dc.date.available2024-01-08T17:33:53Zen_ZA
dc.date.issued2023-11en_ZA
dc.descriptionThesis (MMed)--Stellenbosch University, 2023.en_ZA
dc.description.abstractENGLISH ABSTRACT: Background Respiratory distress in low birth weight (LBW; <2500g) neonates is associated with prolonged morbidity and high mortality. Neonatal transport to specialized facilities can lead to complications and increased mortality. Improving care for LBW neonates with respiratory distress at district and regional hospitals and avoiding transport to specialized centres, may improve South Africa's neonatal mortality rate. Objectives This study aimed to compare the respiratory care received by LBW neonates in three rural Western Cape hospitals during 2019, to assess adherence to recommendations and to describe the outcomes. Methods A retrospective cohort study was conducted including LBW neonates with signs of respiratory distress within the first 24 hours of life born in 2019 at three rural hospitals. Neonates were categorised into mutually-exclusive groups: regional (all care at regional hospital), district (all care at district hospital) and transferred (transferred from district to regional hospital). Respiratory management was assessed according to the Western Cape Provincial Peri-viability Decision Support Framework, utilising the Downe score to classify severity of respiratory distress upon admission. The proportion (95% confidence interval) receiving recommended respiratory care was compared between groups. Results Among 210 included neonates, 145 (69%) were in the regional group, 53 (25%) in the district group and 12 (6%) in the transferred group. A total of 197 (94%) neonates received respiratory support as recommended or more with no significant difference between the groups. There was a higher proportion of neonates with moderate or severe distress in the regional (61/145;42%) compared to the district group (18/53;34%). Escalation of respiratory support occurred more frequently in the district (N=8/53;15%) compared to the regional group(N=12/145;8%). Neonates at regional level received a longer period of respiratory support (median 36.5 hours; IQR 13.5-82.5 hours) compared to district level (median 21 hours; IQR 9-48 hours). Specialized interventions were more prevalent at the regional level, with surfactant administration to 35/145 (24%) neonates compared to 4/53 (8%) at district level. However, there was no meaningful difference in mortality between the regional and district groups Conclusion Reassuringly 94% of neonates in rural Western Cape received respiratory support as recommended or more. While the regional hospital cared for neonates with more severe respiratory distress, requiring longer respiratory support and more specialized interventions, no difference in mortality between the regional and district level was observed which requires further investigation.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.af_ZA
dc.description.versionMastersen_ZA
dc.format.extent68 pagesen_ZA
dc.identifier.urihttps://scholar.sun.ac.za/handle/10019.1/128967en_ZA
dc.language.isoen_ZAen_ZA
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.rights.holderStellenbosch Universityen_ZA
dc.subject.lcshBirth weight, Low -- Western Cape (South Africa)en_ZA
dc.subject.lcshRespiratory distress syndrome -- Western Cape (South Africa)en_ZA
dc.subject.lcshPediatric respiratory diseases -- Western Cape (South Africa)en_ZA
dc.subject.lcshNewborn infants -- Diseases -- Western Cape (South Africa)en_ZA
dc.subject.lcshChildren -- Mortality -- Western Cape (South Africa)en_ZA
dc.titleRespiratory management of low birth weight neonates with respiratory distress in rural district and regional hospitals in the Western Cape during 2019en_ZA
dc.typeThesisen_ZA
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