BMC Pediatr. 2025 Feb 24;25(1):131. doi: 10.1186/s12887-025-05432-y.
ABSTRACT
BACKGROUND: Inborn babies in many Ghana facilities who need any monitoring or therapy above Essential Newborn Care (ENC) are often separated from postnatal ward dyadic care and sent to Neonatal Units (NUs) due to personnel workload, training gaps or both.
OBJECTIVES: Describe (1) care of inborn newborns in NUs at 2 hospitals in Ghana and (2) outcomes, including breastfeeding. We identified stable babies who could potentially be managed by midwives in postnatal wards with appropriate additional training and staffing.
METHODS: We conducted a retrospective study from January to December 2022 on inborn newborns in NUs at Greater Accra Regional Hospital (GARH) and Tamale Teaching Hospital (TTH), and the Special Baby Ward at TTH. Data collected included monitoring (glucose), interventions (phototherapy, intravenous antibiotics, thermal and fluid support, oxygen, tube feeds, transfusions) and outcomes (breastfeeding, length of stay, mortality). We used a two-proportion z-test and t-test to test the difference between two proportions and means respectively, with alpha-error of 5% and beta-error 20%. Breastfeeding outcomes were compared between GARH and TTH NUs, and also between babies admitted to the NUs but received no NU interventions and those admitted to the TTH SBW.
RESULTS: Of 2978 inborn newborns admitted to NUs, 11.5% received no NU Interventions. (GARH NU 6.2% (n = 1995) vs. TTH NU 22.1%, (n = 983) p < 0.001). In TTH NU, 3.3% received no listed interventions at all. TTH NU, which administered iv fluids instead of formula to babies during separation, had significantly higher exclusive breastfeeding at discharge. (TTH NU 91.1% vs. GARH NU 66.3%, p < 0.001) Breastfeeding rates were also higher in infants in the TTH SBW vs. infants who received no NU interventions in the TTH NU (TTH SBW 99.3% (n = 261) vs. TTH NU No Intervention group 96.3% (n = 217), p < 0.05).
CONCLUSIONS: Overall, 11.5% of babies admitted to the two neonatal units did not receive any intensive interventions, including 4.8% of infants < 1800 g. Designing dyadic Intermediate Care between Essential Newborn Care and Special/Intensive care could result in lower census in NUs to permit greater focus on preterm, low-birthweight and sick newborns with higher acuity, and also reduce separation and promote breastfeeding.
PMID:39994663 | DOI:10.1186/s12887-025-05432-y
