Morbidity and mortality of neonates admitted in general paediatric wards at Kenyatta National Hospital.

BACKGROUND Neonatal morbidity and mortality is high in developing countries. Facilities for specific neonatal care are limited in Kenya with no neonatal intensive care unit in the public health institutions. The new born unit at Kenyatta National Hospital (KNH) cannot accommodate all neonates so a number of these are admitted to the general paediatric wards. OBJECTIVES To establish the morbidity and mortality of neonates admitted to the general wards at KNH and to review the medical interventions applied in the management and make recommendations that will improve on this. DESIGN A retrospective study. SETTING Kenyatta National Hospital general paediatric wards-Nairobi, Kenya. SUBJECTS All babies who were admitted to the general paediatric wards at KNH from January to December 2000. RESULTS A total of 308 records of neonates admitted to the general paediatric wards at KNH in the year of study were found and retrieved. The mortality was 315/1000 neonates admitted. Of the 308 admissions, 33.4% were low birth weight (LBW), 5% being very low birth weight (VLBW). The common diagnoses at admission or discharge were suspected sepsis 71% (confirmed sepsis 8.4%), jaundice 35%, pneumonia 32%, omphalitis 28%, dehydration 14%, apnoec attacks 13%, and hypothermia 6%. Eighty nine (29%) of the infants were not investigated at all. The mean duration of stay was nine days for those who lived to discharge and four days for those who died. Of those who died, 49% died within 24 hours of admission. The frequently cited cause of death was suspected sepsis, pneumonia, dehydration and hypothermia. There were only six admissions to the general purpose intensive care unit referred from the wards. The independent predictors of mortality were low birth weight, apnoec attacks, hypothermia and dehydration(p < 0.05). CONCLUSION The mortality rate for neonates admitted to the general paediatric wards is high with almost half the deaths occurring in the first twenty four hours of admission. While the wards are doing commendable work, they need support by improving laboratory back up for improved diagnostic ability and to improve supportive care such as maintenance of fluid electrolyte balance, temperature regulation and access to intensive care facilities.