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Published on: August 25, 2014
Identifying and quantifying initial post-discharge needs for clinical review of sick, newborns in Kenya based on a
John Wainaina1, Esther Lee2, Grace Irimu1,3
1Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
Insights
Nearly half of surviving neonatal intensive care unit infants require multiple follow-up care types. This highlights an urgent need for healthcare planning to address varied medical and developmental needs in resource-limited settings.
Area of Science:
- Neonatal intensive care
- Pediatric follow-up care
- Global health
Background:
- Neonatal care advancements have reduced mortality rates globally.
- Increased infant survival necessitates robust post-discharge follow-up care.
- The scale of follow-up care needs for neonates is not well-defined.
Purpose of the Study:
- To identify and categorize the initial follow-up needs of neonates discharged from Kenyan neonatal units.
- To estimate the proportion of neonates requiring specific types of specialized clinical follow-up.
- To understand the patterns and extent of post-discharge care requirements.
Main Methods:
- Retrospective cohort study of 136,249 neonates discharged from 23 Kenyan neonatal units (January 2018-June 2023).
- Follow-up categories were established based on clinical conditions and morbidities.
- Individual neonatal phenotypes were used to assign needs for specialized follow-up care.
Main Results:
- 33% of neonates were low birth weight and 33.4% were preterm.
- An estimated 131,351 initial follow-up episodes were needed across nine categories, with general pediatrics, nutrition, growth & development (40.4%) and auditory screening (38.8%) being most common.
- Most neonates (52.3%) required two, and many (39.6%) required three, specialized follow-up episodes.
- Prematurity, very low birth weight, severe infections, jaundice, and hypoxic-ischemic encephalopathy were key drivers of follow-up needs.
Conclusions:
- Almost half of surviving neonatal intensive care unit infants have multiple post-discharge follow-up needs.
- Urgent healthcare planning is required to address these varied medical and developmental needs.
- Strategies must be developed to manage follow-up care in resource-constrained settings like Kenya.
Background:
Progress in neonatal care has resulted in a 51% decrease in global neonatal mortality rates from 1990 to 2017. Enhanced survival will put pressure on health care systems to provide appropriate post-discharge, follow-up care but the scale of need for such care is poorly defined.
Methods:
We conducted a retrospective cohort study of newborns discharged from 23 public hospital neonatal units (NBUs) in Kenya between January 2018 and June 2023 to identify initial follow-up needs. We first determined pragmatic follow-up categories based on survivors' clinical conditions and morbidities. We then used individual phenotypes of individual babies to assign them to needing one or more forms of specialized clinical follow-up. We use descriptive statistics to estimate proportions of those with specific needs and patterns of need.
Findings:
Among 136,249/159,792 (85.3%) neonates discharged, around one-third (33%) were low birth weight (<2,500 g), and a similar 33.4% were preterm (<37 weeks). We estimated 131,351 initial episodes of follow-up would be needed across nine distinct follow-up categories: general pediatrics, nutrition, growth & development (40.4%), auditory screening (38.8%), ophthalmology for retinopathy of prematurity (9.6%), neurology (8.0%), occupational therapy (1.3%), specialized nutrition (0.9%), surgery (0.8%), cardiology (0.2%), and pulmonary (<0.1%). Most neonates met the criteria for two (52.3%, 28,733), followed by three (39.6%, 21,738) and one follow-up episodes (5.6%, 3,098). In addition to prematurity and very low birth weight (≤1,500 g), severe infections with extended gentamicin treatment, severe jaundice managed with phototherapy, and hypoxic-ischemic encephalopathy (HIE) contributed substantially to the pattern of need for post-discharge follow-up.
Conclusions:
Almost half of surviving NBU infants have multiple specialty post-discharge follow-up needs. More urgent attention needs to be focused on healthcare planning now to guide strategies to address the varied medical and developmental needs that we outline in resource-constrained contexts like Kenya.
