THE neonatal unit at the Lower Umfolozi Regional War Memorial Hospital (LURWMH) is the only maternity and neonatal regional referral centre for an area with a population estimated at 2.5 million – making the unit the biggest facility for newborn babies in the province.
More than 50 000 births occur in the entire area annually, including 10 000 at LURWMH.
These stats were brought to the fore as Thursday marked ‘World Prematurity Day’.
Head of paediatrics at LURWMH, Dr Ndaye Kapongo, said that prematurity is a challenge of survival and quality of life.
‘Prematurity survivors have a range of complications, the more frequent ones being brain injury and chronic breathing problems.
‘Brain injuries range from severe cerebral palsy to subtle learning difficulties (attention deficit disorders) or behaviour problems.
‘Preterm is defined as babies born alive before 37 weeks of pregnancy are completed.
‘There are sub-categories of preterm birth based on gestational age – extremely preterm (< 28 weeks, < 1 000g); very preterm (28 to <32 weeks, < 1 500g) and moderate to late preterm (32 to < 37 weeks),’ says Kapongo.
‘The most vulnerable group is the very low birth weight babies (VLBW) – less than 1 500g.
‘Over one million babies die annually from complications owing to prematurity.
‘Preterm birth is the leading cause of neonatal deaths and the second leading cause of death after pneumonia in children under five years.’
The neonatal service was introduced at the hospital in 1998 with a unit of 15 beds without intensive care facilities.
Between 1999 and 2008 it was expanded to 92 bed neonatal units: 16 neonatal intensive care beds, 40 high care, 16 special care beds and a ‘Kangaroo’ mother care unit of 20 beds.
Staffing and updated equipment are ongoing challenges to keep up with population growth in the hospital’s large service area.
According to Kapongo, between 2011 and 2013 there were approximately 30 000 live deliveries at LURWMH.
During the same period close to 1 686 newborns with VLBW were managed in the neonatal unit.
‘This represented only 5.6% of all live births, however this small number contributed to more than 50% of our deaths and consume almost two thirds of our intensive care budget.
‘The survival rates at 26, 28, 30, and 32 weeks gestation were 40.5%, 74.0%, 84.5% and 92.7%, respectively.
‘The major cause of death is lung complication.’
Prevention
Kapongo noted that preventing preterm birth is still a difficult problem for health workers.
‘Pregnancy induced hypertension accounted for a third of NICU admissions in 2011.
‘Improving management of this obstetric complication may reduce the burden of VLBW infants.
‘The recent launch in South Africa of subcutaneous implant for extended periods of contraception could be a mid-term to long-term leverage in controlling VLBW output as consequence of unwanted or teenage pregnancies.
‘Long-term socio-economic upliftment of the general population and education will contribute to reduce the supply factors associated with preterm birth as happened in developed countries.
‘Until then we have to increase capacity to deal with this important health challenge.’
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