Background Neonatal mortality rates in Haiti are among the highest in the Western hemisphere. Few mothers deliver with a skilled birth attendant present, and there is a significant lack of pediatricians. The neonatal intensive care unit (NICU) at St. Damien Pediatric Hospital, a national referral center, is one of only five neonatology departments in Haiti. In order to target limited resources toward improving outcomes, this study seeks to describe clinical care in the St. Damien NICU. Methods A retrospective medical record review was performed on available medical records on all admissions to the NICU between April 2016 and April 2017. Results 220 neonates were admitted to the NICU within the study epoch. The mortality rate was 14.5%. Death was associated with a maternal diagnosis of hypertension (p = 0.03) and neonatal diagnoses of lower gestational age (p<0.0001), lower birth weight (p<0.0001), prematurity (p = 0.002), RDS p = 0.01), sepsis (p<0.0001) and kernicterus (p = 0.04). The most common diagnoses were sepsis, chorioamnionitis, respiratory distress syndrome, jaundice, prematurity and perinatal asphyxia. Conclusions This study demonstrates that preterm birth, sepsis, RDS and kernicterus are key contributors to neonatal mortality in a Haitian national pediatric referral center NICU and as such are promising interventional targets for reducing the neonatal mortality rate in Haiti.

Background: Socioeconomic factors, such as insurance status, have been shown to affect outcomes following emergency injuries. Dual-eligible bene ciaries, receiving both Medicare and Medicaid, constitute a vulnerable population. There is a lack of data on the impact of dual-eligible status on hemorrhagic stroke outcomes. The aim of our study was to compare hemorrhagic stroke outcomes among dualeligible patients compared to Medicare, Medicaid, privately insured, and no charge (free or charity) patients.Study Design: We conducted a 10-year span retrospective analysis of the National Inpatient Sample. Adult patients who were emergently hospitalized for intracranial hemorrhage were included. Multivariable logistic regression was used to adjust for confounders. Primary clinical outcomes of interest included mortality (in-hospital), complications (any), and favorable discharge (home/home with services).Results: A total of 410,621 patients met inclusion of which 6.8% were dual-eligible. Dual-eligibles had higher odds of in-hospital mortality compared to no-charge (adjusted odds ratio (aOR)=1.61, 95% CI= [1.04 -2.49]) and increased odds of complications compared to ) and privately insured patients (aOR=1. 19 [1.11 -1.28]), both p<0.001. Dual-eligibles had lower odds of favorable discharge compared to all other groups (all p<0.001), and underwent shorter lengths of stay, an 18% decrease, compared to Medicaid patients (p<0.001). In ation adjusted admission costs among dualeligibles were 24% lower compared to Medicaid patients (p<0.