Factors determining admission to neonatal units in Jamaica

In order to identify the factors associated with admission to neonatal care units in a developing country, 1,823 newborns admitted to Jamaica's eight neonatal care units over a 6-month period were compared with 9,563 newborns identified during an island-wide population morbidity study. Maternal sociodemographic characteristics, past obstetric history, infant's growth parameters at birth and mode and place of delivery were investigated. Babies of mothers resident in the two regions of the island where specialist paediatric services were available had increased odds of admission (OR= 1.45, 1.22) compared with those living elsewhere (OR=0.70, 0.80). Maternal history of a previous miscarriage, termination or early neonatal death were associated with subsequent admission, but a previous stillbirth or late neonatal death were not. Very low birthweight infants of gestational age 28-31 weeks were more likely to be admitted than those < 28 weeks with ORs of 1.45 and 0.34 respectively. Factors determining neonatal admission in the developing world may be quite different from those of developed countries. The development of guidelines and support services to ensure wider access to these services for those most in need could contribute to more equitable utilisation of services.