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.
Enweronu-Laryea
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CC
Department of Child Health, University of Ghana Medical School, Accra, Ghana. chikalaryea@yahoo.com
Nkyekyer
K
K
Rodrigues
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OP
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