| dc.description.abstract | Back ground:
The introduction of NICU has led to a dramatic fall in neonatal mortality and in particular increased survival of the VLBW preterm babies in developed countries. In Kenyatta National Hospital (KNH), studies done prior to the establishment of NICU looking at the trends of mortality in NBU showed high neonatal mortality. Now that NICU has been established with the aim of reducing morbidity and mortality of such neonates, increased survival of LB W and very sick neonates would be expected. Currently, there is no data on the pattern of admission or outcome of neonates managed in NICU to ascertain the benefit of the unit.
Objective
To determine pattern of admission, care received and outcome of neonates managed in KNH NICU.
Methodology
This was a prospective cohort study conducted in NICU, Kenyatta National Hospital. Consecutive newborn infants admitted to NICU during the study period of six months, were enrolled into the study daily if a written informed consent was obtained. Babies were followed for 28 days of NICU stay or until discharge or death before that time. Data was collected using data collection sheet, entered into customized MS Access databases, cleaned and exported to SPSS version 17.0. The main outcome was calculated as percentage of babies who died during NICU stay. The chi-square test was used to compare percentage of babies with the main outcome by different socio-demographic variables. Statistical significance was determined at the level p < 0.05. In addition, odds for mortality was calculated in the univariate analysis and the odds ratio and 95% confidence interval calculated.
Results:
A total of 135 neonates were admitted to NICU, of those 118 (87.4%) were studied. 71.2% were less than lweek old. There was slight male predominance, 54.2% and 51.6% being term. The out born neonates constituted 42.4% while 21.2% were SGA in general. Reasons for admission included requirement for mechanical ventilation in 104 (81.25%) and the need for NICU monitoring in 18.75%. The main diagnoses at admission were perinatal asphyxia, neonatal sepsis and RDS in that order respectively. Mortality outcome was .. ~ery high at 75.8%. The odds of NICU deaths was 83% lower among those admitted to NICU for monitoring compared to those admitted for mechanical ventilation (OR = 0.17, 95% CI 0.06 to 0.46). Other studied factors were not statistically associated with NICU outcome. Clinical support in terms of investigations and supportive care was found to be sub-optimal. Mortality in this study was very high compared to outcome reported in other NICUs. This could be due to multiple factors and may be complicated by poor prognosis by virtue of their primary diagnosis and or with late NICU admission in their course of disease.
Conclusion:
In conclusion, NICU in KNH received a wide range of neonates; the majority of them were within 6 days of life, term and of male sex. The main reason for admission was requirement for mechanical ventilation. The mortality was very high at 75.8% and there was sub-optimal clinical support in terms of investigation and supportive care.
Recommendation:
1. There is need to have NICU admission protocols and to enhance supportive care particularly in terms of laboratory work-up.
2. Use of neonatal severity scoring system at admission would compliment this study and provide valuable information in making admission protocols. | en_US |
