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Prematurity is a major risk factor for morbidity and mortality, with preterm birth complications being the leading cause of death in children <5 years.[1] In the Cape Town Metro West geographical service area of Western Cape Province, South Africa (SA), prematurity is the third leading cause of death; accounting for 9.3% of all under-5 deaths in the region.[2] There have been dramatic advancements in the knowledge and care of premature infants, with associated improvements in survival, even in cases which would previously have been considered futile. These interventions include the use of incubators, surfactant and continuous positive airway pressure.[3] However, these premature infants may survive with significant morbidity,[4] with associated increased demands on the healthcare system and family. Studies conducted in well-resourced countries have identified premature infants as being at high risk of requiring readmission to hospital,[5,6] with those readmitted to the neonatal or paediatric intensive care unit (PICU) being at increased risk of poor clinical outcomes (prolonged PICU stay and mortality) compared with the general PICU population.[7] Male sex,[5,8-12] chronic lung disease/ bronchopulmonary dysplasia,[8,11,13] lower gestational age (GA) at birth and lower birthweight (BW)[5,9,13,14] have been associated with an increased risk of rehospitalisation, particularly a BW<1 000 g.[5,13] Kuint et al.[15] found that the presence of any morbidity associated with prematurity increased the rate of rehospitalisation in very low-birthweight infants (VLBW) until 18 years of age in Israel. Breastfeeding has been identified as a protective factor [8,16] reducing the likelihood of rehospitalisation. Acute respiratory illnesses, particularly lower respiratory tract infections, have consistently been reported to be a common reason for readmission into ICU.[17] Across 16 centres in the USA,[7] premature infants had a high rate of rehospitalisations (18.7%), especially during the first year of life, and required prolonged ICU stays. There are limited data on the characteristics, outcomes and impact on the healthcare system of infants requiring readmission to PICU in lowand middleincome countries, with no studies from sub-Saharan Africa. A study from India found that infections (sepsis, pneumonia and acute gastroenteritis) lead to rehospitalisation in the majority of cases in extremely low-birthweight (ELBW) infants in the first year of life.[18] Forty-four percent of their cohort of ELBW infants were rehospitalised and 11% of these died within the first year of life. It is particularly important to identify infants at increased risk of poor clinical outcomes in resource-constrained environments, as they may require closer surveillance and support. The present study aims to describe the incidence, demographics, clinical course and outcomes of premature infants admitted to a South African PICU, following initial hospital discharge, within the first 6 months of life.

A description of premature and ex-premature infants admitted to the paediatric intensive care unit in the first six months of life