MORBIDITY AND MORTALITY OF NEONATES ADMITTED IN GENERAL PAEDIATRIC WARDS AT KENYATTA NATIONAL HOSPITAL

Abstract

ABSTRACT
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.