Obstetric causes for delivery of very-low-birth-weight babies at Tygerberg Hospital.

Preterm delivery is the most important cause of perinatal mortality and morbidity in the developed world. 1 The prevalence of preterm delivery in First-World countries is 6-10%. 2 In developed countries very-low-birth-weight (VLBW) babies account for only 1-2.5% of all births. 3,4 However, more than half of prematurity-related deaths, morbidity and economic costs are due to VLBW neonates. 4 The total perinatally related wastage at Tygerberg Hospital is 31.5 per 1 000 deliveries. Sixty per cent of these deaths are babies with a very low birth weight. 5 The mortality rate for severe respiratory distress syndrome is about 50%. The prevalence of other complications are periventricular haemorrhage (30%), patent ductus arteriosus (20%) and necrotising enterocolitis (5-10%). 3 Although the mortality rate for VLBW babies has decreased over the past decades, there is still a high proportion of severely handicapped infants. 4 According to data from the National Institute of Child Health and Human Development (NICHD) neonatal networks, 90% of babies with a birth weight between 1 000 g and 1 500 g survived and only 20% had major handicaps. The survival rate was 77% for babies weighing 731-1 000 g, and the morbidity rate 35%. In the 501-750 g group, 39% survived, but 53% had major morbidity. 4 VLBW babies are a group with heterogenic aetiologies and include neonates who are preterm, small for gestational age, or both. 3 Attempts to reduce the incidence of the delivery of very small babies can only succeed once the causes are identified. We conducted this study to determine the primary reasons for the delivery of VLBW babies at Tygerberg Hospital. A cross-sectional descriptive study was done at Tygerberg Hospital over a 6-month period. The decision that 6 months was sufficiently long was taken after reassessment of available departmental data sets which showed no seasonal variation in the occurrence of VLBW babies. Immediately after delivery, data were collected from files of mothers who delivered babies weighing between 500 g and 1 499 g. Data were charted on a data sheet which was then used for analysis. All live-born babies were also followed up for the first 7 days of the neonatal period. The following primary causes were recorded and clearly defined.