“Assessing Today for a Better Tomorrow”: An observational cohort study about quality of care, mortality and morbidity among newborn infants admitted to neonatal intensive care in Guinea

Neonatal mortality in Guinea accounts for about 30% of all fatalities in children younger than five years. Countrywide, specialized neonatal intensive care is provided in one single clinic with markedly limited resources. To implement targeted measures, prospective data on patient characteristics an...

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Bibliographic Details
Published in:	PloS one Vol. 16; no. 8; p. e0254938
Main Authors:	Merscher Alves, Maria Bea, Conté, N'Fanly, Diallo, Boubacar, Mamadou, Moustapha, Delamou, Albert, John, Oliver, von Felten, Stefanie, Diallo, Ibrahima Sory, Roth-Kleiner, Matthias
Format:	Journal Article
Language:	English
Published:	San Francisco Public Library of Science 30-08-2021 Public Library of Science (PLoS)
Subjects:	Antibiotics Asphyxia Biology and Life Sciences Births Children Children & youth Childrens health Cohort analysis Death Evaluation Fatalities Hazard assessment Health aspects Health care Health hazards Hospitals Hypothermia Infant mortality Infants Infants (Newborn) Infections Intensive care Medical care Medicine and Health Sciences Morbidity Mortality Neonatal intensive care Neonates Newborn babies Nutrition Observational studies Obstetrics Patient outcomes Patients People and Places Phototherapy Poverty Quality assessment Quality management Quality of care Resuscitation Sepsis Guinea Switzerland Conakry Guinea
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Summary:	Neonatal mortality in Guinea accounts for about 30% of all fatalities in children younger than five years. Countrywide, specialized neonatal intensive care is provided in one single clinic with markedly limited resources. To implement targeted measures, prospective data on patient characteristics and factors of neonatal death are needed. To determine the rates of morbidity and mortality, to describe clinical characteristics of admitted newborns requiring intensive care, to assess the quality of disease management, and to identify factors contributing to neonatal mortality. Half of the 168 admitted newborns underwent postnatal cardiopulmonary resuscitation. Reasons for admission included respiratory distress (49.4%), poor postnatal adaptation (45.8%), prematurity (46.2%), and infections (37.1%). 101 newborns (61.2%) arrived in serious/critical general condition; 90 children (53.9%) showed clinical signs of neurological damage. Quality of care was poor: Only 59.4% of the 64 newborns admitted with hypothermia were externally heated; likewise, 57.1% of 45 jaundiced infants did not receive phototherapy. Death occurred in 56 children (33.3%) due to birth asphyxia (42.9%), prematurity (33.9%), and sepsis (12.5%). Newborns in serious/critical general condition at admission had about a fivefold higher hazard to die than those admitted in good condition (HR 5.21 95%-CI 2.42-11.25, p = <0.0001). Hypothermia at admission was also associated with a higher hazard of death (HR 2.00, 95%-CI 1.10-3.65, p = 0.023). Neonatal mortality was strikingly high. Birth asphyxia, prematurity, and infection accounted for 89.3% of death, aggravated by poor quality of in-hospital care. Children with serious general condition at admission had poor chances of survival. The whole concept of perinatal care in Guinea requires reconsideration.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0254938