Clinical Profile and Predictors of Severe Illness in young South African Infants (<60 days)

Abstract

Background Most childhood deaths occur in the first two months of life. Simple symptoms and signs that reliably indicate the presence of severe illness, warranting urgent hospital management are of major public health importance.
Objectives: To describe the disease profile of sick young infants aged 0-59 days presenting to King Edward VIII Hospital, Durban, South Africa and to assess the association between clinical features assessed by primary health workers and the presence of severe illness.
Methods: Specific clinical signs were evaluated in young infants by a health worker (nurse), using a standardized list. These signs were compared to an assessment by an experienced pediatrician for the need for urgent hospital-based or clinic-based care.
Results: 925 young infants were enrolled; 61 <7 days of age, 477 7-27 days of age and 387, 28-59 days of age. Illnesses needing urgent hospital management in the age group <7 days were hyperbilirubinaemia (43%) and sepsis (43%); 7-27 days of age, pneumonia (26%), sepsis (17%) and hyperbilirubinaemia (15%), and in the age group 28-59 days, pneumonia (54%) and sepsis (15%). The clinical sign most consistently predictive of needing urgent hospital care across all groups was not feeding well. Among those over 7 days a history of difficult feeding, temperature ≥37.5oC and respiratory rate ≥60 per minute were also important.
Conclusions: Simple features of feeding difficulties, pyrexia, tachypnea and lower chest in-drawing are useful predictors of severity of illness as effective and safe tools for triaging of young infants for urgent hospital management at primary care centres. Neonatal hyperbilirubinaemia, pneumonia and sepsis are the common conditions for which young infants require urgent hospital based management.