Effect Of Structured Newborn Clinical Evaluation By Paediatric Residents At Kenyatta National Hospital On Re-Hospitalization Rates Within The First Month Of Life
Obunga, Dr. Veronica A A
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Background: Neonatal morbidity and mortality continues to significantly contribute towards under-5 morbidity and mortality despite significant improvement seen worldwide within this population. Studies at Kenyatta National Hospital have revealed that well-appearing neonates are potentially being discharged with their mothers only to be readmitted with significant illness. This study aimed to define the re-hospitalization rates of neonates delivered at KNH after postnatal discharge, while comparing the effect of two different modes of management. Objectives: To determine the effect of structured newborn clinical evaluation by paediatric registrars at Kenyatta National Hospital on re-hospitalization rates within the first month of life. Methods: Randomized Controlled Study. 600 neonates were recruited from the Kenyatta National Hospital‟s maternity unit. Following consideration of the inclusion and exclusion criteria, an informed consent was obtained followed by simple randomization of neonates. A questionnaire was then administered to the study participants and neonates in the intervention group underwent structured clinical evaluation. The control group on the other hand was managed and discharged as per the current standard modes employed within the maternity unit. Upon discharge, the two groups were followed up via mobile phone, at 7, 14 and 30 days. 246 and 273 neonates completed follow-up in the control and intervention groups respectively. Re-hospitalization, age at re-hospitalization and outcome of re-hospitalization were recorded during follow-up. Univariate analysis was used for categorical variables and descriptive statistics used for continuous variables. Bivariate analysis was used to investigate associations between the two modes of management and the outcomes in terms of re-hospitalization and vital status. Results: Of the neonates who completed the 30-day follow-up period, 19.5% of the control group and 11% of the intervention group were re-hospitalized within the first month of life following birth hospitalization. The calculated Odd‟s Ratio was 0.5093 (p=0.0073, 95% Confidence Interval 0.3110-0.8340) indicating a risk reduction for re-hospitalization of up to 50% within the intervention group. Conclusion: Structured evaluation of neonates following delivery resulted in a reduction of re-hospitalization of these neonates.