Outcomes of periviable neonates born and admitted to a resource-limited hospital, Cape Town, South Africa

Abstract

Background. Periviability, defined as a gestational age of 20 0/7 to 25 6/7 weeks, is considered the limit of foetal maturity where a reasonable chance of survival exists. The outcome of these neonates in sub-Saharan Africa is poorly described.

Objective. To describe the mortality and morbidities of periviable neonates admitted to a resource-limited public hospital in South Africa (SA).

Methods. This was a retrospective, descriptive study performed at Tygerberg Hospital, Cape Town, SA, between January 2017 and December 2018. Records of all periviable neonates (gestational age ≤27 weeks or birthweight ≤750 g) born at or admitted to Tygerberg Hospital within 24 hours of birth were included.

Results. The study population consisted of 186 periviable neonates, of whom 157 (84.4%) had a gestational age ≤27 weeks, 101  (54.3%) weighed ≤750 g and 72 (38.7%) were ≤27 weeks and weighed ≤750 g at birth. Severe intrauterine growth restriction was noted in  16%  of  cases. Neonatal mortality varied with gestational age. The overall survival rate was 51%, with survival increasing with increasing gestational age. Morbidities are described according to gestational age and birthweight, and also varied with gestational age. Most periviable neonates received comfort care or specific supportive care only, congruent with the provincial policy guidelines.

Conclusion. This is the first study to describe survival and morbidities of neonates delivered at the periviable limit at Tygerberg Hospital, a resource-limited public hospital in SA. Despite restricted resources and limited care, ~50% of these periviable neonates survived.