Is facility based neonatal care in low resource setting keeping pace? A glance at Uganda's National Referral Hospital.
OBJECTIVE
To identify reasons for neonatal admission and death with the aim of determining areas needing improvement.


METHODS
A retrospective chart review was conducted on records for neonates admitted to Mulago National Referral Hospital Special Care Baby Unit (SCBU) from 1(st) November 2013 to 31(st) January 2014. Final diagnosis was generated after analyzing sequence of clinical course by 2 paediatricians.


RESULTS
A total of 1192 neonates were admitted. Majority 83.3% were in-born. Main reasons for admissions were prematurity (37.7%) and low APGAR (27.9%).Overall mortality was 22.1% (Out-born 33.6%; in born 19.8%). Half (52%) of these deaths occurred in the first 24 hours of admission. Major contributors to mortality were prematurity with hypothermia and respiratory distress (33.7%) followed by birth asphyxia with HIE grade III (24.6%) and presumed sepsis (8.7%). Majority of stable at risk neonates 318/330 (i.e. low APGAR or prematurity without comorbidity) survived. Factors independently associated with death included gestational age <30 weeks (p 0.002), birth weight <1500g (p 0.007) and a 5 minute APGAR score of < 7 (p 0.001). Neither place of birth nor delayed and after hour admissions were independently associated with mortality.


CONCLUSIONS
Mortality rate in SCBU is high. Prematurity and its complications were major contributors to mortality. The management of hypothermia and respiratory distress needs scaling up. A step down unit for monitoring stable at risk neonates is needed in order to decongest SCBU.
Department of Paediatrics and Child Health, Makerere University College of Health Sciences.
Yaser
Y
Abdallah
Department of Paediatrics and Child Health, Makerere University College of Health Sciences.
Flavia
F
Namiiro
Department of Paediatrics and Child Health, Makerere University College of Health Sciences.
Jamir
J
Mugalu
Department of Paediatrics and Child Health, Makerere University College of Health Sciences.
Jolly
J
Nankunda
Department of Pediatrics, Division of Neonatal/Perinatal Medicine, School of Medicine, University of California at San Diego, USA.
Yvonne
Y
Vaucher
Department of Pediatrics, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada.
Douglas
D
McMillan
D003422:Critical Care / Q000191:economics / Q000379:methods*; D003906:Developing Countries; D005260:Female; D006295:Health Resources / Q000191:economics*; D006301:Health Services Needs and Demand; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000191:economics; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D017063:Outcome Assessment, Health Care; D011203:Poverty; D012017:Referral and Consultation / Q000191:economics* / Q000592:standards; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014454:Uganda
Neonatal care; Uganda's National Referral Hospital