Reducing length of stay in hospital for very low birthweight infants by involving mothers in a stepdown unit: an experience from Karachi (Pakistan)

Bhutta, Zulfiqar Ahmed; Khan, Imran Ahmed; Salat, Suhail; Raza, Farukh; Ara, Husan

doi:10.1136/bmj.329.7475.1151

Cited by 74 publications

(84 citation statements)

References 19 publications

(14 reference statements)

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“…Successful involvement of mothers for care of their very low birth weight neonates (<1500 g) and resulting into reduced length of hospital stay and reduced sepsis rate was also reported from Pakistan. 19 Excellent survival of small and sick neonates by involving mothers in resource-poor subdistrict hospital was reported from India. 20 Involvement of mothers in care of sick and small neonates can therefore help addressing the crunch of manpower in resource-poor settings.…”

Section: Discussionmentioning

confidence: 99%

Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India

Agarwal

Acharya

et al. 2006

J Perinatol

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Objective: To evaluate impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India.Study design: Before-and-after intervention trial setting: limited resource teaching hospital; Design: Before and after study.Interventions: A package of simple interventions was evolved. The interventions included: rational admissions and early discharge, entrusting mothers in care-giving, enforcing asepsis routines, aggressive enteral feeding, abandoning unnecessary interventions, protocol-based management, rational antibiotics and training and empowerment of nurses.Statistical methods: The categorical and continuous variables were compared with w 2 and two-tailed tests, respectively.Results: Neonatal mortality rate declined significantly during the intervention period as compared to control period (20.3 versus 29.3 per 1000 live births; relative risk 0.69, 95% confidence interval (CI) 0.57 to 0.85). Most significant decline occurred in sepsis-related deaths. The survival of neonates with birth weight 1000 to 1499 improved over two folds (56.7% versus 24.5%, P<0.01). There was a significant decline in antibiotics use (635/878, 72.3% versus 299/897, 23.2%; P ¼ 0.00). The duration of stay in neonatal unit was decreased by a mean of 1.5 day (95% CI 0.9 to 2.8 days) after interventions.Conclusions: Simple interventions can result in a significant decline in neonatal mortality in hospitals with limited resources. This package is likely to be effective in hospitals with a high proportion of the sepsis deaths.

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Section: Discussionmentioning

confidence: 99%

Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India

Agarwal

Acharya

et al. 2006

J Perinatol

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“…The neonatal mortality rates differ by rural, urban, and other locations, even within large demographic surveys [9][10]. Previous studies conducted in Pakistan reported that LBW and maternal illness were the major causes of neonatal mortality [11][12][13][14][15][16], but no direct data is currently available regarding complications and follow-up during the neonatal period of LBW babies.…”

Section: Introductionmentioning

confidence: 99%

Infection remains a leading cause of neonatal mortality among infants delivered at a tertiary hospital in Karachi, Pakistan

Mustufa

Korejo

Shahid

et al. 2014

J Infect Dev Ctries

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Introduction: The current cohort study was conducted to determine the frequency and compare the mortality rate with associated characteristics among low birth weight and normal birth weight infants during the neonatal period at a tertiary healthcare facility, Karachi. Methodology: Close-ended structured questionnaires were used to collect information from the parents of 500 registered neonates at the time of birth. Follow-ups by phone on the 28th day of life were done to determine the mortality among low birth weight and normal birth weight babies during the neonatal period. Results: The neonatal mortality rate ranged from as low as 2.4% in the normal birth weight and 16.4% in the low birth weight categories to as high as 96% in the very low birth weight category. Respiratory distress syndrome (24.2%) and sepsis (18.2%) were reported as the leading causes of neonatal deaths. The babies' lengths of stay ranged from 2 to 24 hours, and around 90% of neonatal deaths were reported in the first seven days of life. More than 6% of neonates died at home, and 7.6% of the deceased babies did not visit any healthcare facility or doctor before their death. In the 12-15 hours before their deaths, 13.6% of the deceased babies had been unattended. Around 90% of the deceased babies were referred from a doctor or healthcare facility. Conclusions: The present estimates of neonatal mortality are very high among low birth weight and very low birth weight categories. Infectious diseases, including respiratory distress syndrome (24.2%) and sepsis (18.2%), were leading causes of neonatal deaths.

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“…4 However, infants in these units are those at moderate risk of serious complications who have problems that are expected to resolve rapidly. 8 …”

Section: What Are the Possible Harms Associated With This Model Of Care?mentioning

confidence: 99%

Parents as primary caregivers in the neonatal intensive care unit

Lee

O’Brien

2014

CMAJ

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Reducing length of stay in hospital for very low birthweight infants by involving mothers in a stepdown unit: an experience from Karachi (Pakistan)

Abstract: Problem

Cited by 74 publications

References 19 publications

Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India

Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India

Infection remains a leading cause of neonatal mortality among infants delivered at a tertiary hospital in Karachi, Pakistan

Parents as primary caregivers in the neonatal intensive care unit

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