A retrospective study of neonatal case management and outcomes in rural Rwanda post implementation of a national neonatal care package for sick and small infants

Nyishime, Merab; Borg, Ryan; Ingabire, Willy; Hedt-Gauthier, Bethany; Nahimana, Evrard; Gupta, Neil; Hansen, Anne; Labrecque, Michelle; Nkikabahizi, Fulgence; Mutaganzwa, Christine; Biziyaremye, Francois; Mukayiranga, Claudine; Mwamini, Francine; Magge, Hema

doi:10.1186/s12887-018-1334-1

Table 3 Clinical management and interim outcomes of neonates with birth weight recorded upon admission to neonatology units at two rural district hospitals in Rwanda (N = 1518)

From: A retrospective study of neonatal case management and outcomes in rural Rwanda post implementation of a national neonatal care package for sick and small infants

	All neonates (N = 1518)		Low birth weight (< 2500 g) (N = 701)		Normal birth weight (≥2500 g) (N = 817)		p-value
	n	%	n	%	n	%
Vital signs
Vital signs checked every 3 h for the first 48 h of admission	N = 1168		N = 556		N = 612
Yes (≥15 times)	965	82.6	478	86.0	487	79.6	0.004
No (< 15 times)	203	17.4	78	14.0	125	20.4	0.004
Thermoregulation
Initial temperature measured within 30 min of admission	N = 1476		N = 683		N = 793
Yes	812	55.0	367	53.7	445	56.1	0.373
No	664	45.0	316	46.3	348	43.9	0.373
Initial temperature < 36 °C	N = 1480		N = 684		N = 796
Yes	435	29.4	249	36.4	186	23.4	< 0.001
No	1045	70.6	435	63.6	610	76.6	< 0.001
If initial temperature < 36 °C, temperature improved from < 36 °C to > 36 °C within 2 h	N = 402		N = 234		N = 168
Yes	156	38.8	99	42.3	57	33.9	0.097
No	246	61.2	135	57.7	111	66.1	0.097
Hypoglycemia
Low blood sugar (< 40/< 45 mg/dl)	N = 871		N = 418		N = 453
Yes	31	3.6	21	5.0	10	2.2	0.028
No	840	96.4	397	95.0	443	97.8	0.028
If blood sugar low, improved to > 40/> 45 mg/dl within 1 h	N = 12		N = 7		N = 5
Yes	2	16.7	1	14.3	1	20	> 0.999
No	10	83.3	6	85.7	4	80	> 0.999
Infectious diseases
Received antibiotics (ampicillin and gentamicin)^a	N = 334		N = 69		N = 265
Yes	312	93.4	68	98.6	244	92.1	0.053
No	22	6.6	1	1.4	21	7.9	0.053
Ampicillin received at correct dose and interval	N = 301		N = 66		N = 235
Yes	204	67.8	36	54.6	168	71.5	0.009
No	97	32.2	30	45.4	67	28.5	0.009
Gentamicin received at correct does and interval	N = 286		N = 64		N = 222
Yes	146	51.0	23	35.9	123	55.4	0.006
No	140	49.0	41	64.1	99	44.6	0.006
Fluid electrolytes and nutrition
Regained birth weight within 2 weeks^b	N = 225		N = 169		N = 56
Yes	126	56.0	88	52.1	38	67.9	0.044
No	99	44.0	81	47.9	18	32.1	0.044
Respiratory distress
Received caffeine^c			N = 548
Yes			206	37.6
No			342	62.4
Received oxygen therapy	N = 1491		N = 690		N = 801
Yes	603	40.4	278	40.3	325	40.6	0.916
No	888	59.6	412	59.7	476	59.4	0.916
Method of oxygen therapy	N = 540		N = 247		N = 293
Mask/nasal cannula	449	83.1	185	74.9	264	90.1	< 0.001
bCPAP	91	16.9	62	25.1	29	9.9	< 0.001
If eligible, received bCPAP^d			N = 107
Yes			13	12.2
No			94	87.8
Duration of oxygen therapy in hours	Median	IQR	Median	IQR	Median	IQR
Mask/nasal cannula	24	20, 96	48	24, 120	24	14, 72	0.050
bCPAP	60	24, 120	72	24, 144	48	24, 72	0.093

^aFor neonates with primary diagnosis of infection; ^bRestricted to neonates that were hospitalized for at least 2 weeks; ^cRestricted to preterm neonates (< 33 weeks) or LBW (< 1500 g); ^dRestricted to preterm (< 33 weeks) or LBW (< 1500 g) neonates with any sign of respiratory distress
^oC degrees centigrade, gm/dl grams per decilitre, bCPAP bubble continuous positive airway pressure, IQR inter-quartile range

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