The impact of improved neonatal intensive care facilities on referral pattern and outcome at a teaching hospital in Ghana.
OBJECTIVE
Evaluate the impact of improved neonatal intensive care facilities on survival and referral patterns at a teaching hospital in Ghana.


METHODS
Retrospective cohort comparing birth weight-specific survival and referral pattern of newborns requiring intensive care before and after improvement of facilities.


RESULTS
Improved survival of newborns <2500 g especially those 1000-1499 g (OR=1.74 (CI 1.38-2.20; P<0.00001) for inborn, OR=2.16 (CI 1.36-3.44; P=0.0006) for out-born). Birth asphyxia, the major indication for >or=2500 g newborn referrals, was associated with reduced survival (OR=0.56 (95% CI 0.40 to 0.78; P=0.0004)). There was fourfold increased referral of out-born >or=2500 g.


CONCLUSIONS
Improved facilities significantly improved survival of newborns <2500 g, but was of no benefit for newborns >or=2500 g. A scaling-up approach with investments that improve emergency obstetric services, referral systems, human resources and neonatal resuscitation practices will save more newborn lives.
Department of Child Health, University of Ghana Medical School, Accra, Ghana. chikalaryea@yahoo.com
C C
CC
Enweronu-Laryea
K
K
Nkyekyer
O P
OP
Rodrigues
D001238:Asphyxia Neonatorum; D015331:Cohort Studies; D005869:Ghana; D006784:Hospitals, Teaching; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D010360:Patient Transfer; D012017:Referral and Consultation; D012189:Retrospective Studies; D016019:Survival Analysis