Improved referral and survival of newborns after scaling up of intensive care in Suriname

• Main Authors: Rens Zonneveld, Natanael Holband, Anna Bertolini, Francesca Bardi, Neirude P. A. Lissone, Peter H. Dijk, Frans B. Plötz, Amadu Juliana
• Format: Article
• Language: English
• Published: BMC 2017-11-01
• Series: BMC Pediatrics
• Subjects: NICU; Low-resource setting; Developing country; Neonatal mortality; Suriname
• Online Access: http://link.springer.com/article/10.1186/s12887-017-0941-6

Abstract Background Scaling up neonatal care facilities in developing countries can improve survival of newborns. Recently, the only tertiary neonatal care facility in Suriname transitioned to a modern environment in which interventions to improve intensive care were performed. This study evaluates impact of this transition on referral pattern and outcomes of newborns. Methods A retrospective chart study amongst newborns admitted to the facility was performed and outcomes of newborns between two 9-month periods before and after the transition in March 2015 were compared. Results After the transition more intensive care was delivered (RR 1.23; 95% CI 1.07–1.42) and more outborn newborns were treated (RR 2.02; 95% CI 1.39–2.95) with similar birth weight in both periods (P=0.16). Mortality of inborn and outborn newborns was reduced (RR 0.62; 95% CI 0.41–0.94), along with mortality of sepsis (RR 0.37; 95% CI 0.17–0.81) and asphyxia (RR 0.21; 95% CI 0.51–0.87). Mortality of newborns with a birth weight <1000 grams (34.8%; RR 0.90; 95% CI 0.43–1.90) and incidence of sepsis (38.8%, 95% CI 33.3–44.6) and necrotizing enterocolitis (NEC) (12.5%, 95% CI 6.2–23.6) remained high after the transition. Conclusions After scaling up intensive care at our neonatal care facility more outborn newborns were admitted and survival improved for both in- and outborn newborns. Challenges ahead are sustainability, further improvement of tertiary function, and prevention of NEC and sepsis.