Date of Award

January 2011

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Laura R. Ment

Subject Area(s)

Medicine

Abstract

Background: In post-apartheid South Africa, low birth weight, and its associated complications, remains a leading cause of child mortality. While significant data have been collected on infants weighing more than a 1000g, there are no formal statistics yet for extremely low birth weight infants (ELBW), neonates weighing 401-1000g.

Objectives: To assess the neurodevelopmental outcome post-discharge from a neonatal unit with limited resources and to determine risk factors associated with unfavorable outcome.

Study Design: The 171 subjects were born between 22-35 weeks gestation, with weights ranging from 405-1000g. Subjects were treated in the neonatal unit at Groote Schuur Hospital, Cape Town, South Africa, between May 2003 and April 2005. Assessments of speech, cognition, audition, vision and motor function were made by a neurodevelopmental specialist during routine follow up. The Infant Neurological Assessment (a modified Dubowitz test) was performed when available. The mean age at follow up was 7.6 months.

Results: Subjects had a 68% survival to discharge with a 66% follow up rate. 71% were assessed as normal while 17% were assessed as having developmental delays and/or disabilities. For the remaining 12%, no assessment could be made, as data from follow up records were unavailable. Increasing birth weight and gestational age were associated with a greater survival up to discharge (p< 0.0001 for both). The incidence of neurodevelopmental handicap was found to decrease with female gender (p= 0.048) and increasing birth weight (p= 0.050) but not with increasing gestational age (p= 0.607). Necrotizing enterocolitis (NEC) in the neonatal period was associated with unfavorable outcome (p=0.041).

Conclusions: Favorable neurodevelopmental outcome at 7 months was associated with increasing birth weight and female gender.

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