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997, 95% CI 0.995 to 0.999), born before arrival (OR 0.21, 95% CI 0.05 to 0.84), maternal HIV exposure (OR 0.54, 95% CI 0.30 to 0.99), resuscitation at birth (OR 0.49, 95% CI 0.25 to 0.94), metabolic acidosis (OR 0.25, 95% CI 0.10 to 0.60) and necrotising enterocolitis (NEC) (OR 0.23, 95% CI 0.12 to 0.46). Discussion This review of admissions to a combined PNICU shows an overall mortality rate of 25.7%. The paediatric mortality Tryptophan synthase rate was 16.2%. This is higher than the mortality rate at the dedicated paediatric ICU at RCWMCH4 but lower than that reported for children admitted to general ICUs in other African countries.8�C10 Possible reasons for the high mortality rate in this study may lie outside the PNICU, such as late referral and inadequate resuscitation, or within, such as insufficient beds and inadequate staffing. The lack of a paediatric intensivist may partly contribute to the mortality rate; dedicated paediatric intensivists have been shown to reduce the mortality rate of children in ICU and improve bed utilisation.17 This PNICU was run mainly as an invasive ventilator unit, with limited high-dependency care admissions; 89% of the paediatric patients and all neonates admitted to PNICU were intubated and ventilated. Therefore, this may represent a sicker cohort of children compared with other PICUs. Mortality prediction risk scores such as the Paediatric see more Index of Mortality (PIM) allow objective comparisons between different units.18 Although PIM data were Alectinib not collected during the study period, the predictors of poor outcome in the current study were similar to the PIM, including postcardiac arrest, inotropic support and metabolic acidosis. The mortality was higher in neonates than paediatric patients. Mortality of ventilated neonates was similar to that reported from units in India.19 The very high mortality of the VLBW group in the PNICU is not surprising as these patients had failed initial NCPAP and were therefore very sick babies. The mortality rate of ventilated VLBW infants was similar to that reported in a study in China.20 Birth weight, the strongest predictor of outcome in VLBW infants in our setting,21 remained a significant factor associated with survival in the ventilated VLBW babies. HIV infection and HIV exposure were significant predictors of outcome in the univariate analysis, but not in the logistic regression. There is, however, selection bias, as only those HIV-exposed infants who were expected to recover were admitted to the PNICU. Other potential sources of bias were considered. The age of paediatric patients was skewed towards younger children who would be expected to have a higher mortality than their older counterparts. There was a slight preponderance of infants (