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Short-term outcomes of HIV-exposed and HIV-unexposed preterm, very low birthweight neonates: a longitudinal, hospital-based study

Journal of Perinatology volume 40, pages 445–455 (2020)Cite this article

Subjects

Abstract

Objective

To compare short-term outcomes of very low birthweight (VBLW, <1500 g) neonates by maternal HIV status.

Design

Retrospective hospital-based cohort in Cape Town, South Africa.

Results

Of 1579 mothers, 316 (20%) were HIV-positive; 183/316 (58%) received ≥8 weeks of antenatal antiretrovirals. HIV-exposed neonates (HIVE, vs HIV-unexposed, HIVU) had increased risk of necrotising enterocolitis (NEC; OR 1.93, 95% CI 1.27–2.92) and invasive ventilation (OR 1.35, 95% CI 1.01–1.79). Extremely low birthweight (ELBW, <1000 g) modified the HIV-exposure-mortality relationship: among ELBW neonates, HIVE vs HIVU mortality OR 1.75 (95% CI 1.13–2.69); among non-ELBW, OR 0.89 (95% CI 0.54–1.49). Antiretrovirals (≥8 vs <8 weeks/none) reduced NEC (OR 0.46, 95% CI 0.22–0.97) and invasive ventilation risks (OR 0.57, 95% CI 0.32–0.99). HIV-PCR results were available for 228/316 (72%) HIVE neonates; 11/228 (5%) tested positive.

Conclusions

Among VLBW neonates, HIV-exposure was associated with increased risk of adverse short-term outcomes; antenatal antiretrovirals were protective.

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Data and coding availability

The datasets and statistical coding generated during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We are grateful to the Paediatric Management Group, Life Health care for sponsorship of data collection, and to the Vermont Oxford Network for waiving annual membership fees.

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Authors and Affiliations

  1. Department of Neonatology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa

    Linda J. Riemer, Michael C. Harrison & Lloyd Tooke

  2. Department of Paediatrics & Child Health, Red Cross War Memorial Children’s Hospital & University of Cape Town, Cape Town, South Africa

    Linda J. Riemer, Stanzi M. Le Roux, Michael C. Harrison & Lloyd Tooke

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Contributions

LR prepared this article and conducted this study in fulfilment of the requirements of an MMed in Paediatrics. She was included in the conceptualisation and design of the study and supervised while conducting the background literature review, data capturing, preliminary analysis and early drafts. SLR conducted final data analysis and interpretation. LT acted as the primary supervisor with additional input from MH. LT and MH conceptualised this study and have been involved in critical reviewing of the data capture, analysis, interpretation and final editing. All authors contributed to and approved the final manuscript.

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Correspondence to Lloyd Tooke.

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Riemer, L.J., Le Roux, S.M., Harrison, M.C. et al. Short-term outcomes of HIV-exposed and HIV-unexposed preterm, very low birthweight neonates: a longitudinal, hospital-based study. J Perinatol 40, 445–455 (2020). https://doi.org/10.1038/s41372-019-0541-4

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