title: Demographics, clinical characteristics and neonatal outcomes in a rural Ugandan NICU.
abstract: BACKGROUND
  Ninety-six percent of the world's 3 million neonatal deaths occur in developing countries where the majority of births occur outside of a facility. Community-based approaches to the identification and management of neonatal illness have reduced neonatal mortality over the last decade. To further expand life-saving services, improvements in access to quality facility-based neonatal care are required. Evaluation of rural neonatal intensive care unit referral centers provides opportunities to further understand determinants of neonatal mortality in developing countries. Our objective was to describe demographics, clinical characteristics and outcomes from a rural neonatal intensive care unit (NICU) in central Uganda from 2005-2008.
  
  
  METHODS
  The NICU at Kiwoko hospital serves as a referral center for three rural districts of central Uganda. For this cross sectional study we utilized a NICU clinical database that included admission information, demographics, and variables related to hospital course and discharge. Descriptive statistics are reported for all neonates (<28 days old) admitted to the NICU between December 2005 and September 2008, disaggregated by place of birth. Percentages reported are among neonates for which data on that indicator were available.
  
  
  RESULTS
  There were 809 neonates admitted during the study period, 68% (490/717) of whom were inborn. The most common admission diagnoses were infection (30%, 208/699), prematurity (30%, 206/699), respiratory distress (28%, 198/699) and asphyxia (22%, 154/699). Survival to discharge was 78% (578/745). Mortality was inversely proportional to birthweight and gestational age (P-value test for trend <0.01). This was true for both inborn and outborn infants (p < 0.01). Outborn infants were more likely to be preterm (44%, (86/192) vs. 33%, (130/400), P-value <0.01) and to be low birthweight (58%, (101/173) vs. 40%, (190/479), P-value <0.01) than inborn infants. Outborn neonates had almost twice the mortality (33%, 68/208) as inborn neonates (17%, 77/456) (P-value <0.01).
  
  
  CONCLUSIONS
  Understanding determinants of neonatal survival in facilities is important for targeting improvements in facility based neonatal care and increasing survival in low and middle income countries.
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, USA. hedstrom@uw.edu.
authors.forename: Anna
authors.initials: A
authors.lastname: Hedstrom
authors.forename: Tove
authors.initials: T
authors.lastname: Ryman
authors.forename: Christine
authors.initials: C
authors.lastname: Otai
authors.forename: James
authors.initials: J
authors.lastname: Nyonyintono
authors.forename: Ryan M
authors.initials: RM
authors.lastname: McAdams
authors.forename: Deborah
authors.initials: D
authors.lastname: Lester
authors.forename: Maneesh
authors.initials: M
authors.lastname: Batra
mesh_terms: D000293:Adolescent; D000328:Adult; D001238:Asphyxia Neonatorum / Q000453:epidemiology; D001724:Birth Weight; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005865:Gestational Age; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007234:Infant, Premature; D007239:Infections / Q000453:epidemiology; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D019035:Rural Health Services / Q000706:statistics & numerical data*; D015996:Survival Rate; D014454:Uganda; D055815:Young Adult