n South African Journal of Child Health - Treatment and outcome of hospitalised, very young, HIV-infected children




. The aim of this study was to describe the disease severity and clinical course and outcome of hospitalised HIV-infected children aged <6 months.

. A retrospective case review was completed at Red Cross Children's Hospital (RCCH) during the middle of 2006. Perinatal management, disease severity and hospital outcomes were analysed. In a sub-analysis, the disease profile and outcome of admitted children aged less than and more than 6 months were compared over the latter 3 months of the study.
. Seventy-five out of 121 (43.86%) of all HIV infected children admitted over the study period were <6 months of age. Sixty-nine out of 72 (95.83%) of the children not receiving highly active antiretroviral therapy (HAART) at admission, qualified according to current WHO treatment criteria. The most frequent cause for admission was pneumonia (54.67%). The inpatient fatality rate was 28%, pneumonia being the most frequent cause of death (61.9%). Fifty-two out of 75 (69.33%) of the mothers reported having been tested for HIV during pregnancy. Thirty-four out of 37 (91.89%) who tested HIV-positive during pregnancy received prevention of mother-to child transmission (PMTCT) prophylaxis. Children with confirmed / presumed pneumonia (PJP) were less likely to have mothers who received PMTCT prophylaxis (18.51% . 61.7%, =0.0004), and less likely to be receiving cotrimoxazole prophylaxis (14.81% . 46.81%, =0.006) at admission. Children >6 months were more likely to be receiving cotrimoxazole prophylaxis (65.4% . 31.1%, =0.0008) and HAART (42.3% . 6.7%, =0.00007) at the time of admission. Of those not on HAART, 27 out of 30 (90%) had WHO stage 3 or 4 disease. Inpatient fatality in this group was 13.5%.
. Young children constitute a sizeable proportion of the inpatient paediatric HIV workload. Comprehensive PMTCT interventions and earlier introduction of HAART may reduce morbidity, hospitalisation rates and mortality.


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