title: Maternal human immunodeficiency virus status and morbidity and mortality in very low birthweight infants.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) remains a common cause of infection in pregnant women. The effect of HIV exposure on growth, morbidity and mortality in very low-birthweight infants (VLBWI) is under-reported.
  
  
  OBJECTIVE
  To determine anthropometry at birth, morbidity during hospital stay and mortality at hospital discharge of VLBWI stratified according to HIV-exposure in a tertiary public government hospital in Johannesburg, South Africa.
  
  
  METHODS
  Retrospective descriptive study. Records of VLBWI were reviewed for maternal HIV status, infant characteristics, diagnosis and outcome to hospital discharge. Anthropometry, morbidity and mortality were compared according to HIV-exposure.
  
  
  RESULTS
  Of 302 VLBWI,103 (34.1%)were HIV-exposed. Among the 103mothers, 38 (36.9%)were on combined anti-retroviral therapy (cART), 41 (39.8%) were on zidovudine (AZT) and 24 (23%) were not on either. More HIV-exposed VLBWI weighed v1000 g (41.2 vs 23.1%, Pv0.01). There were no differences in incidence or number of episodes of sepsis between HIV-exposed and -unexposed. More HIV-exposed VLBWI had severe intraventricular haemorrhage (IVH) (57.1 vs 11.4%, Pv0.01). The overall mortality rate was 27%, with HIV-exposed VLBWI having a mortality rate of 38.6% compared with 21% of the HIV-unexposed (Pv0.01). On multivariate analysis, the predictor of mortality was birthweight (Pv0.01).
  
  
  CONCLUSIONS
  HIV-exposed VLBWI are more likely to have extremely low birthweights. Morbidity in VLBWI is not affected by HIV-exposure, except for severe IVH. Birthweight is a predictor of mortality in VLBWI, irrespective of maternal HIV status.
authors.affiliation: a Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Mayowa
authors.initials: M
authors.lastname: Tiam
authors.affiliation: a Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Sithembiso
authors.initials: S
authors.lastname: Velaphi
mesh_terms: D000293:Adolescent; D000328:Adult; D000886:Anthropometry; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D009017:Morbidity; D009026:Mortality; D011247:Pregnancy; D012189:Retrospective Studies; D013019:South Africa; D055815:Young Adult
keywords: Human immunodeficiency virus; Intraventricular haemorrhage; Mortality; Necrotising enterocolitis; Nosocomial infections; Very low birthweight infants