The impact of improved neonatal intensive care facilities on referral pattern and outcome at a teaching hospital in Ghana

Abstract

Objective: Evaluate the impact of improved neonatal intensive care facilities on survival and referral patterns at a teaching hospital in Ghana. Study Design: Retrospective cohort comparing birth weight-specific survival and referral pattern of newborns requiring intensive care before and after improvement of facilities. Result: 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 ≥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 ≥2500 g. Conclusion: Improved facilities significantly improved survival of newborns <2500 g, but was of no benefit for newborns ≥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.