Sithembiso Velaphi

University of Colorado, Denver, Colorado, United States

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Publications (23)249.05 Total impact

  • Susan Niermeyer, Sithembiso Velaphi
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    ABSTRACT: Delayed clamping of the umbilical cord is recommended for term and preterm infants who do not require resuscitation. However, the approach to the newly born infant with signs of fetal compromise, prematurity and extremely low birthweight, or prolonged apnea is less clear. Human and experimental animal data show that delaying the clamping of the umbilical cord until after the onset of respirations promotes cardiovascular stability in the minutes immediately after birth. Rather than regarding delayed cord clamping as a fixed time period before resuscitation begins, a more physiologic concept of transition at birth should encompass the relative timing of onset of respirations and cord occlusion. Further research to explore the potential benefits of resuscitation with the cord intact is needed.
    Seminars in Fetal and Neonatal Medicine 09/2013; · 3.51 Impact Factor
  • Sithembiso Velaphi, Jeffrey Perlman
    The Lancet 07/2013; · 39.21 Impact Factor
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    ABSTRACT: Background Babies with low birthweight (<2500 g) are at increased risk of early mortality. However, low birthweight includes babies born preterm and with fetal growth restriction, and not all these infants have a birthweight less than 2500 g. We estimated the neonatal and infant mortality associated with these two characteristics in low-income and middle-income countries. Methods For this pooled analysis, we searched all available studies and identifi ed 20 cohorts (providing data for 2 015 019 livebirths) from Asia, Africa, and Latin America that recorded data for birthweight, gestational age, and vital statistics through 28 days of life. Study dates ranged from 1982 through to 2010. We calculated relative risks (RR) and risk diff erences (RD) for mortality associated with preterm birth (<32 weeks, 32 weeks to <34 weeks, 34 weeks to <37 weeks), small-for-gestational-age (SGA; babies with birthweight in the lowest third percentile and between the third and tenth percentile of a US reference population), and preterm and SGA combinations. Findings Pooled overall RRs for preterm were 6·82 (95% CI 3·56–13·07) for neonatal mortality and 2·50 (1·48–4·22) for post-neonatal mortality. Pooled RRs for babies who were SGA (with birthweight in the lowest tenth percentile of the reference population) were 1·83 (95% CI 1·34–2·50) for neonatal mortality and 1·90 (1·32–2·73) for post-neonatal mortality. The neonatal mortality risk of babies who were both preterm and SGA was higher than that of babies with either characteristic alone (15·42; 9·11–26·12). Interpretation Many babies in low-income and middle-income countries are SGA. Preterm birth aff ects a smaller number of neonates than does SGA, but is associated with a higher mortality risk. The mortality risks associated with both characteristics extend beyond the neonatal period. Diff erentiation of the burden and risk of babies born preterm and SGA rather than with low birthweight could guide prevention and management strategies to speed progress towards Millennium Development Goal 4—the reduction of child mortality.
    The Lancet 06/2013; 382:417–25. · 39.21 Impact Factor
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    ABSTRACT: HIV-exposed newborns may be at higher risk of sepsis because of immune system aberrations, impaired maternal antibody transfer and altered exposure to pathogenic bacteria. We performed a secondary analysis of a study (clinicaltrials.gov, number NCT00136370) conducted between April 2004 and October 2007 in South Africa. We used propensity score matching to evaluate the association between maternal HIV infection and (1) vaginal colonization with bacterial pathogens; (2) vertical transmission of pathogens to the newborn; and (3) sepsis within 3 days of birth (EOS) or between 4-28 days of life (LOS). Colonization with group B Streptococcus (17% vs 23%, P = .0002), Escherichia coli (47% vs 45%, P = .374), and Klebsiella pneumoniae (7% vs 10%, P = .008) differed modestly between HIV-infected and uninfected women, as did vertical transmission rates. Maternal HIV infection was not associated with increased risk of neonatal EOS or LOS, although culture-confirmed EOS was >3 times higher among HIV-exposed infants (P = .05). When compared with HIV-unexposed, neonates, HIV-exposed, uninfected neonates (HEU) had a lower risk of EOS (20.6 vs 33.7 per 1000 births; P = .046) and similar rate of LOS (5.8 vs 4.1; P = .563). HIV-infected newborns had a higher risk than HEU of EOS (134 vs 21.5; P < .0001) and LOS (26.8 vs 5.6; P = .042). Maternal HIV infection was not associated with increased risk of maternal bacterial colonization, vertical transmission, EOS, or LOS. HIV-infected neonates, however, were at increased risk of EOS and LOS.
    PEDIATRICS 08/2012; 130(3):e581-90. · 4.47 Impact Factor
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    ABSTRACT: Factors associated with neonatal sepsis, an important cause of child mortality, are poorly described in Africa. We characterized factors associated with early-onset (days 0-2 of life) and late-onset (days 3-28) -sepsis and perinatal death among infants enrolled in the Prevention of Perinatal Sepsis Trial (NCT00136370 at ClinicalTrials.gov), Soweto, South Africa. Secondary analysis of 8011 enrolled mothers and their neonates. Prenatal and labor records were abstracted and neonatal wards were monitored for hospitalized Prevention of Perinatal Sepsis-enrolled neonates. Endpoint definitions required clinical and laboratory signs. All univariate factors associated with endpoints at P < 0.15 were evaluated using multivariable logistic regression. About 10.5% (837/8011) of women received intrapartum antibiotic prophylaxis; 3.8% of enrolled versus 15% of hospital births were preterm. Among 8129 infants, 289 had early-onset sepsis, 34 had late-onset sepsis, 49 had culture-confirmed neonatal sepsis and 71 died in the perinatal period. Factors associated with early-onset sepsis included preterm delivery [adjusted relative risk (aRR) = 2.6; 95% confidence interval (CI): 1.4-4.8]; low birth weight (<1500 g: aRR = 6.5, 95% CI: 2.4-17.3); meconium-stained amniotic fluid (MSAF) (aRR = 2.8, 95% CI: 2.2-3.7) and first birth (aRR = 1.8; 95% CI: 1.4-2.3). Preterm, low birth weight, MSAF and first birth were similarly associated with perinatal death and culture-confirmed sepsis. MSAF (aRR = 2.4, 95% CI: 1.1-5.0) was associated with late-onset sepsis. Preterm and low birth weight were important sepsis risk factors. MSAF and first birth were also associated with sepsis and death, warranting further exploration. Intrapartum antibiotic prophylaxis did not protect against all-cause sepsis or death, underscoring the need for alternate prevention strategies.
    The Pediatric Infectious Disease Journal 05/2012; 31(8):821-6. · 3.57 Impact Factor
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    ABSTRACT: Guidelines for the techniques of resuscitating newly born infants have undergone major revisions over the past 25 years. The International Liaison Committee on Resuscitation (ILCOR) is committed to "periodically developing and publishing a consensus on resuscitation science" every five years with the most recent Consensus on Science and Treatment Recommendations (CoSTR) statement published in 2010. The CoSTR document is used as a basis for developing specific resuscitation guidelines felt to be appropriate for implementation in respective countries. A "gaps in knowledge" summary is created at the conclusion of a cycle. It is a goal that identification of these knowledge gaps will stimulate investigators to pursue more targeted studies to help close the gaps. The current document is based on the "gaps in knowledge" summary for neonatal resuscitation that was created at the conclusion of the 2005-2010 ILCOR cycle.
    Resuscitation 01/2012; 83(5):545-50. · 4.10 Impact Factor
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    ABSTRACT: BACKGROUND: Factors associated with neonatal sepsis, an important cause of child mortality, are poorly described in Africa. We characterized factors associated with early-onset (days 0-2 of life) and late-onset (days 3-28) -sepsis and perinatal death among infants enrolled in the Prevention of Perinatal Sepsis Trial (NCT00136370 at ClinicalTrials.gov), Soweto, South Africa. METHODS: Secondary analysis of 8011 enrolled mothers and their neonates. Prenatal and labor records were abstracted and neonatal wards were monitored for hospitalized Prevention of Perinatal Sepsis-enrolled neonates. Endpoint definitions required clinical and laboratory signs. All univariate factors associated with endpoints at P < 0.15 were evaluated using multivariable logistic regression. RESULTS: About 10.5% (837/8011) of women received intrapartum antibiotic prophylaxis; 3.8% of enrolled versus 15% of hospital births were preterm. Among 8129 infants, 289 had early-onset sepsis, 34 had late-onset sepsis, 49 had culture-confirmed neonatal sepsis and 71 died in the perinatal period. Factors associated with early-onset sepsis included preterm delivery [adjusted relative risk (aRR) = 2.6; 95% confidence interval (CI): 1.4-4.8]; low birth weight (<1500 g: aRR = 6.5, 95% CI: 2.4-17.3); meconium-stained amniotic fluid (MSAF) (aRR = 2.8, 95% CI: 2.2-3.7) and first birth (aRR = 1.8; 95% CI: 1.4-2.3). Preterm, low birth weight, MSAF and first birth were similarly associated with perinatal death and culture-confirmed sepsis. MSAF (aRR = 2.4, 95% CI: 1.1-5.0) was associated with late-onset sepsis. CONCLUSIONS: Preterm and low birth weight were important sepsis risk factors. MSAF and first birth were also associated with sepsis and death, warranting further exploration. Intrapartum antibiotic prophylaxis did not protect against all-cause sepsis or death, underscoring the need for alternate prevention strategies.
    The Pediatric Infectious Disease Journal 01/2012; 31(8):821-6. · 3.57 Impact Factor
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    Dharmapuri Vidyasagar, Sithembiso Velaphi, Vishnu B Bhat
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    ABSTRACT: Since the first successful report of surfactant replacement therapy (SRT) in infants with respiratory distress syndrome (RDS), numerous randomized clinical trials have shown that SRT reduces mortality and morbidity in RDS. Surfactant is now a standard therapy for RDS. However, the use of SRT in the developing world has been extremely slow. The objective of this paper is to review the published information regarding the usage and barriers encountered in the use of SRT in developing countries. We reviewed the available literature and also gathered information from countries with a high burden of prematurity and high infant mortality rate regarding replacement therapy and the barriers to use of SRT. We reviewed the available literature and found that developing countries bear a high burden of prematurity and RDS that contribute to high neonatal and infant mortality rates. Based on the effectiveness of SRT in RDS, surfactant preparations were included in the Essential Drug List of WHO in 2008. However, the use of SRT in developing countries is still limited because of (1) high cost, (2) lack of skilled personnel to administer SRT, and (3) lack of support systems after the SRT. The cost of SRT may exceed the per-capita GNP (300-500 USD) in some countries. Data from India and South Africa suggests that SRT is limited to rescue therapy in babies with potential for better survival, usually >28 weeks' gestation. Recent studies show that infants with RDS respond well to initial continuous positive airway pressure (CPAP) followed by SRT for those who do not respond. In developing countries, CPAP may be used as the primary mode of management of RDS. SRT may be reserved for non-responders to CPAP. Alternate simpler methods of delivery of surfactant (aerosol technique) are also being explored. There is a need for further studies to develop and assess efficient and less expensive methods of application of CPAP and SRT in developing countries.
    Neonatology 01/2011; 99(4):355-66. · 2.57 Impact Factor
  • Resuscitation 10/2010; 81 Suppl 1:e260-87. · 4.10 Impact Factor
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    ABSTRACT: Nearly 1 million sepsis-related deaths per year occur in developing countries, primarily in the first week of life. In 2 nonrandomized studies in Africa, intravaginal washes during labor with cotton wipes soaked in chlorhexidine, a commonly available wide-spectrum antibiotic, were associated with reductions of 50% to 75% in neonatal sepsis-related morbidity and mortality. The lack of a definitive randomized, controlled trial has impeded widespread acceptance and use of chlorhexidine wipes. The results of a meta-analysis including randomized or quasi-randomized trials showed that chlorhexidine significantly reduced vertical transmission of group B streptococcus, but not early-onset neonatal infection caused by this bacterium or other neonatal pathogens. This randomized controlled trial investigated the efficacy of intravaginal chlorhexidine in reducing early-onset neonatal sepsis (the first 3 days of life) and vertical transmission of group B streptococcus. The study was conducted between 2004 and 2007 at a hospital in Soweto, South Africa. A total of 8011 pregnant women (age, 12–51 years) in active labor, were randomly assigned to intravaginal washes with either chlorhexidine wipes (interventional group) or external genitalia water wipes (control group); their 8129 newborn babies were assigned to either full-body (intervention group, n = 4072) or foot (control group, n = 4057) washes at birth, respectively. After delivery, swabs of the maternal lower vagina and neonatal skin were obtained from a maternal subset (n = 5144) to assess colonization with potentially pathogenic bacteria. The analysis was according to intention to treat. A total of 289 cases of early-onset sepsis occurred, with no difference in rates of neonatal sepsis between the chlorhexidine (34.6 per 1000 births) and control groups (36.5 per 1000 births). Similarly, the rates of colonization with group B streptococcus in neonates born to mothers in the chlorhexidine (54%, 217/401) and control groups (55%, 234/429) did not differ and there was no substantial reduction in vertical transmission. These findings demonstrate that the use of maternal and neonatal chlorhexidine wipes does not prevent the occurrence of early-onset sepsis or affect vertical transmission of one of the main sepsis-causing pathogens.
    Obstetrical and Gynecological Survey 03/2010; 65(4):215-216. · 2.51 Impact Factor
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    ABSTRACT: About 500,000 sepsis-related deaths per year arise in the first 3 days of life. On the basis of results from non-randomised studies, use of vaginal chlorhexidine wipes during labour has been proposed as an intervention for the prevention of early-onset neonatal sepsis in developing countries. We therefore assessed the efficacy of chlorhexidine in early-onset neonatal sepsis and vertical transmission of group B streptococcus. In a trial in Soweto, South Africa, 8011 women (aged 12-51 years) were randomly assigned in a 1:1 ratio to chlorhexidine vaginal wipes or external genitalia water wipes during active labour, and their 8129 newborn babies were assigned to full-body (intervention group) or foot (control group) washes with chlorhexidine at birth, respectively. In a subset of mothers (n=5144), we gathered maternal lower vaginal swabs and neonatal skin swabs after delivery to assess colonisation with potentially pathogenic bacteria. Primary outcomes were neonatal sepsis in the first 3 days of life and vertical transmission of group B streptococcus. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00136370. Rates of neonatal sepsis did not differ between the groups (chlorhexidine 141 [3%] of 4072 vs control 148 [4%] of 4057; p=0.6518). Rates of colonisation with group B streptococcus in newborn babies born to mothers in the chlorhexidine (217 [54%] of 401) and control groups (234 [55%] of 429] did not differ (efficacy -0.05%, 95% CI -9.5 to 7.9). Because chlorhexidine intravaginal and neonatal wipes did not prevent neonatal sepsis or the vertical acquisition of potentially pathogenic bacteria among neonates, we need other interventions to reduce childhood mortality. US Agency for International Development, National Vaccine Program Office and Centers for Disease Control's Antimicrobial Resistance Working Group, and Bill & Melinda Gates Foundation.
    The Lancet 10/2009; 374(9705):1909-16. · 39.21 Impact Factor
  • Eckhart J Buchmann, Sithembiso C Velaphi
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    ABSTRACT: Hypoxic ischaemic encephalopathy (HIE) may be regarded as a near miss marker for perinatal death resulting from intrapartum hypoxia. Considering the serious long-term consequences of HIE and issues of blame and liability for clinicians, regional or national audit of HIE might best be done using confidential enquiries. These are conducted by independent multidisciplinary panels, and should identify weaknesses in delivery of health care. A confidential enquiry into HIE may determine intrapartum factors that could have caused the poor outcome. It should also consider the role of associated preconceptual and antepartum factors, which may predispose the fetus to intrapartum damage. The enquiry should also assess avoidable factors and suboptimal care. These may involve patient- and family-related problems, administration-related suboptimal care, and health worker-related suboptimal care. The dissemination of the results of confidential enquiries should result in an improvement in quality of health care, including better allocation of health resources and health worker education.
    Best practice & research. Clinical obstetrics & gynaecology 07/2009; 23(3):357-68. · 1.87 Impact Factor
  • International Journal of Infectious Diseases 12/2008; 12. · 2.36 Impact Factor
  • Sithembiso Velaphi, Dharmapuri Vidyasagar
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    ABSTRACT: Routine oronasopharyngeal suctioning (ONPS) of the infant at delivery is a common practice in the delivery room. ONPS is performed to remove lung fluid, meconium, or other secretions from the airway, thereby improving oxygenation and/or preventing aspiration. However, there are controversies regarding this practice, as it seems to be associated with complications. In the presence of clear amniotic fluid, routine ONPS in infants born vaginally and by cesarean section is associated with bradycardia, apnea, and delays in achieving normal oxygen saturations, with no benefit. Intrapartum ONPS and post-natal endotracheal suctioning of vigorous infants born through meconium-stained amniotic fluid (MSAF) does not prevent meconium aspiration syndrome (MAS). Although depressed infants born through MSAF are at risk of developing MAS, there is no evidence that endotracheal suctioning of these infants reduces MAS.
    Seminars in Fetal and Neonatal Medicine 06/2008; 13(6):375-82. · 3.51 Impact Factor
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    ABSTRACT: South Africa is one of the few developing countries with a national confidential inquiry into maternal deaths. 164 health facilities obtain audit data for stillbirths and neonatal deaths, and a new audit network does so for child deaths. Three separate reports have been published, providing valuable information about avoidable causes of death for mothers, babies, and children. These reports make health-system recommendations, many of which overlap and are intertwined with the scarcity of progress in addressing HIV/AIDS. The leaders of these three reports have united to prioritise actions to save the lives of South Africa's mothers, babies, and children. The country is off-track for the health-related Millennium Development Goals. Mortality in children younger than 5 years has increased, whereas maternal and neonatal mortality remain constant. This situation indicates the challenge of strengthening the health system because of high inequity and HIV/AIDS. Coverage of services is fairly high, but addressing the gaps in quality and equity is essential to increasing the number of lives saved. Consistent leadership and accountability to address crosscutting health system and equity issues, and to prevent mother-to-child transmission of HIV, would save tens of thousands of lives every year. Audit is powerful, but only if the data lead to action.
    The Lancet 05/2008; 371(9620):1294-304. · 39.21 Impact Factor
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    ABSTRACT: To compare the effects of a biologically and chemically acidified formula with or without probiotics with a standard formula on growth of infants negative for human immunodeficiency virus (HIV). This was a double-masked, randomized, clinical trial. Infants born to consenting HIV-positive women who had decided not to breast-feed before being approached for participating in the study were randomized to receive one of four milk formulas: a chemically acidified formula with or without probiotics (Bifidobacterium lactis), a biologically acidified formula, or a standard whey formula. Infants who subsequently became HIV-positive according to polymerase chain reaction at 6 wk were excluded. Their growth and biochemical status were monitored for 4-6 mo. The z scores at the last visit of infants in each of the four formula groups were compared using analysis of covariance correcting for the z scores at baseline. Blood gases and pH were analyzed using a two-way analysis of variance corrected for center. One hundred thirty-two HIV-negative infants were monitored for growth and biochemical parameters for 4-6 mo. There was an improvement of z scores for all formulas, and there were no differences in weight for age (P = 0.22), length for age (P = 0.56), head circumference for age (P = 0.66), or weight for length (P = 0.13). There were no differences in blood pH and biochemical parameters among the formula groups. The growth of infants fed one of the three acidified formulas was not inferior to the standard formula. Growth and metabolism in HIV-negative infants fed the acidified formulas were not affected by the method of milk acidification.
    Nutrition 04/2008; 24(3):203-11. · 2.86 Impact Factor
  • Sithembiso Velaphi, Gary Reubenson, Firdose Nakwa
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    ABSTRACT: Two preterm infants with non-immune hydrops fetalis associated with meconium peritonitis are reported. The first presented with a cystic abdominal mass and the second had positive parvovirus B19 serology. The association of meconium peritonitis with hydrops fetalis was through different mechanisms in each patient.
    Annals of Tropical Paediatrics International Child Health 01/2007; 26(4):371-5. · 0.92 Impact Factor
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    Sithembiso Velaphi, Dharmapuri Vidyasagar
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    ABSTRACT: The article reviews and critically evaluates the available evidence to determine whether the current recommendations for the management of infants born through meconium stained amniotic fluid (MSAF) should be maintained. Authors provide evidence-based recommendations regarding the benefits of amnioinfusion prior to delivery, oral suctioning of the newborn prior to delivery of the shoulder, and the practice of routine endotracheal suctioning of the newborn born through MSAF in preventing meconium aspiration syndrome (MAS). Authors also discuss the gaps in knowledge in all the above interventions to prevent MAS.
    Clinics in Perinatology 04/2006; 33(1):29-42, v-vi. · 2.58 Impact Factor
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    ABSTRACT: The number, rates and causes of early neonatal deaths in South Africa were not known. Neither had modifiable factors associated with these deaths been previously documented. An audit of live born infants who died in the first week of life in the public service could help in planning strategies to reduce the early neonatal mortality rate. The number of live born infants weighing 1000 g or more, the number of these infants who die in the first week of life, the primary and final causes of these deaths, and the modifiable factors associated with them were collected over four years from 102 sites in South Africa as part of the Perinatal Problem Identification Programme. The rate of death in the first week of life for infants weighing 1000 g or more was unacceptably high (8.7/1000), especially in rural areas (10.42/1000). Intrapartum hypoxia and preterm delivery are the main causes of death. Common modifiable factors included inadequate staffing and facilities, poor care in labour, poor neonatal resuscitation and basic care, and difficulties for patients in accessing health care. Practical, affordable and effective steps can be taken to reduce the number of infants who die in the first week of life in South Africa. These could also be implemented in other under resourced countries.
    Reproductive Health 09/2005; 2:4. · 1.31 Impact Factor
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    ABSTRACT: To determine the survival rates for infants weighing 500 - 1 499 g according to birth weight (BW) and gestational age (GA). This was a retrospective cohort study. Pregnancy and delivery data were collected soon after birth and neonatal data at discharge or at death. Chris Hani Baragwanath Hospital (CHBH), a public-sector referral hospital, affiliated to the University of the Witwatersrand. Live births weighing between 500 g and 1 499 g delivered at or admitted to CHBH from January 2000 to December 2002. BW and GA-specific survival rates for all live infants born at CHBH and for those admitted for neonatal care. Seventy-two per cent of infants survived until discharge. The survival to discharge rate was 32% for infants weighing < 1 000 g, and 84% for those weighing 1 000 - 1 499 g. Survival rates at 26, 27 and 28 weeks' gestation were 38%, 50% and 65% respectively. Survival rates for infants admitted to the neonatal unit were better than rates for all live births, especially among those weighing < 1 000 g or with a GA < 28 weeks. There was a marked increase in survival between the 900 - 999 g and 1 000 - 1 099 g weight groups. Provision of antenatal care, caesarean section, female gender and an Apgar score more than 5 at 1 or 5 minutes were associated with better survival to hospital discharge. Survival among infants weighing less than 1 000 g is poor. In addition to severe prematurity, the poor survival among these infants (< 1 000 g) is most likely related to the fact that they were not offered mechanical ventilation. Mechanical ventilation should be offered to infants weighing < 1 000 g as it may improve their survival even in institutions with limited resources.
    South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 08/2005; 95(7):504-9. · 1.70 Impact Factor

Publication Stats

449 Citations
249.05 Total Impact Points

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Institutions

  • 2013
    • University of Colorado
      Denver, Colorado, United States
  • 2006–2013
    • University of the Witwatersrand
      • • Faculty of Health Sciences
      • • Department of Obstetrics and Gynaecology
      • • Division of Community Paediatrics
      Johannesburg, Gauteng, South Africa
  • 2002–2013
    • Chris Hani Baragwanath Hospital
      Johannesburg, Gauteng, South Africa
  • 2012
    • American Academy of Pediatrics
      Elk Grove Village, Illinois, United States
    • Centers for Disease Control and Prevention
      Atlanta, Michigan, United States
  • 2010
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
  • 2005
    • University of Pretoria
      • Department of Obstetrics & Gynaecology
      Pretoria, Gauteng, South Africa