Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, Kenya.
BMC Public Health. 2010 Oct 6;10:591. doi: 10.1186/1471-2458-10-591.
Most of the global neonatal deaths occur in developing nations, mostly in rural homes. Many of the newborns who receive formal medical care are treated in rural district hospitals and other peripheral health centres. However there are no published studies demonstrating trends in neonatal admissions and outcome in rural health care facilities in resource poor regions. Such information is critical in planning public health interventions. In this study we therefore aimed at describing the pattern of neonatal admissions to a Kenyan rural district hospital and their outcome over a 19 year period, examining clinical indicators of inpatient neonatal mortality and also trends in utilization of a rural hospital for deliveries.
Prospectively collected data on neonates is compared to non-neonatal paediatric (≤ 5 years old) admissions and deliveries' in the maternity unit at Kilifi District Hospital from January 1(st) 1990 up to December 31(st) 2008, to document the pattern of neonatal admissions, deliveries and changes in inpatient deaths. Trends were examined using time series models with likelihood ratios utilised to identify indicators of inpatient neonatal death.
The proportion of neonatal admissions of the total paediatric ≤ 5 years admissions significantly increased from 11% in 1990 to 20% by 2008 (trend 0.83 (95% confidence interval 0.45-1.21). Most of the increase in burden was from neonates born in hospital and very young neonates aged < 7 days. Hospital deliveries also increased significantly. Clinical diagnoses of neonatal sepsis, prematurity, neonatal jaundice, neonatal encephalopathy, tetanus and neonatal meningitis accounted for over 75% of the inpatient neonatal admissions. Inpatient case fatality for all ≤ 5 years declined significantly over the 19 years. However, neonatal deaths comprised 33% of all inpatient death among children aged ≤ 5 years in 1990, this increased to 55% by 2008. Tetanus 256/390 (67%), prematurity 554/1,280(43%) and neonatal encephalopathy 253/778(33%) had the highest case fatality. A combination of six indicators: irregular respiration, oxygen saturation of <90%, pallor, neck stiffness, weight < 1.5 kg, and abnormally elevated blood glucose > 7 mmol/l predicted inpatient neonatal death with a sensitivity of 81% and a specificity of 68%.
There is clear evidence of increasing burden in neonatal admissions at a rural district hospital in contrast to reducing numbers of non-neonatal paediatrics' admissions aged ≤ 5 years. Though the inpatient case fatality for all admissions aged ≤ 5 years declined significantly, neonates now comprise close to 60% of all inpatient deaths. Simple indicators may identify neonates at risk of death.
大多数全球新生儿死亡发生在发展中国家，主要发生在农村家庭。许多接受正规医疗护理的新生儿在农村地区医院和其他周边保健中心接受治疗。然而，没有发表的研究表明资源匮乏地区农村卫生保健机构中新生儿入院和结局的趋势。此类信息对于规划公共卫生干预措施至关重要。因此，在这项研究中，我们旨在描述肯尼亚农村地区医院新生儿入院的模式及其 19 年来的结局，检查住院新生儿死亡率的临床指标，并研究农村医院分娩利用情况的趋势。
从 1990 年 1 月 1 日至 2008 年 12 月 31 日，前瞻性收集基利菲区医院新生儿和≤ 5 岁儿科（≤ 5 岁）入院和分娩的资料，以记录新生儿入院、分娩和住院死亡的变化模式。使用似然比时间序列模型检查趋势，以确定住院新生儿死亡的指标。
新生儿入院占≤ 5 岁儿科总入院人数的比例从 1990 年的 11%显著增加到 2008 年的 20%（趋势 0.83（95%置信区间 0.45-1.21））。负担的大部分增加来自于在医院出生的新生儿和年龄< 7 天的非常小的新生儿。医院分娩也显著增加。新生儿败血症、早产、新生儿黄疸、新生儿脑病、破伤风和新生儿脑膜炎的临床诊断占所有≤ 5 岁住院新生儿入院的 75%以上。所有≤ 5 岁儿童的住院病死率在 19 年中显著下降。然而，1990 年，≤ 5 岁儿童中新生儿死亡占所有住院死亡的 33%，到 2008 年增加到 55%。破伤风 256/390（67%）、早产 554/1,280（43%）和新生儿脑病 253/778（33%）病死率最高。呼吸不规则、氧饱和度< 90%、面色苍白、颈部僵硬、体重< 1.5 公斤和异常升高的血糖> 7 mmol/l 等 6 项指标的组合预测住院新生儿死亡的敏感性为 81%，特异性为 68%。
农村地区医院新生儿入院负担明显增加，而≤ 5 岁的非新生儿儿科入院人数减少。尽管所有≤ 5 岁儿童的住院病死率显著下降，但新生儿现在占所有住院死亡的近 60%。简单的指标可以识别有死亡风险的新生儿。
