A prospective analysis of the outcomes of extremely low-birthweight neonates in Bloemfontein, South Africa

Background. Prematurity is a leading cause of neonatal and under‐5 mortality in developing countries. The mortality rate for neonates between 500 g and 999 g in South Africa (2016) was 456.2 per 1 000 live births. Objectives. To describe the short‐term outcomes of ELBW (extremely low‐birthweight) neonates, including the disease profile, associated clinical characteristics and maternal characteristics. Methods. A prospective descriptive study was conducted from 1 August 2021 to 31 July 2022 at Universitas Academic Hospital (UAH) and Pelonomi Tertiary Hospital (PTH). Neonates weighing less than 1 000 g admitted to these units were included in the study after obtaining consent from the mothers. Results. A total of 129 neonates were enrolled (PTH: n=96 and UAH: n=33). Of these, 30 (23.3%) were discharged, 13 (10.1%) were down‐ referred, 80 (62.0%) died, and six (4.6%) remained admitted after the study period. Three down‐referred neonates were lost to follow‐up. Survival was higher at UAH (n=15, 50%) compared with PTH (n=31, 32.3%). Most deaths occurred during the early neonatal period (n=60, 75%), with sepsis being the leading cause of late neonatal deaths (n=11, 55%). One hundred and eight (83.7%) mothers received antenatal care, and 33 mothers (26.0%) did not receive antenatal steroids. Mechanical ventilation was provided to 13 neonates (10.1%), six of whom weighed less than 900 g. Sixty (47.6 %) neonates received surfactant replacement therapy. Conclusion. Mortality and morbidity among ELBW neonates remain high, with neonatal sepsis as the leading cause. Current barriers include inadequate antenatal clinic attendance, presenting to the hospital in established labour and poor antenatal steroid coverage.