A standardised neonatal admission record (NAR) - increasing quality of neonatal care in Rwanda-a retrospective observational study

Abstract

INTRODUCTION: The neonatal period is the most vulnerable time for a child’s survival. It is well established that high-quality medical records are needed for the provision of high-quality care and that neonatal medicine is well suited to a standardised approach to care. The objective of this study was to describe the implementation of a Neonatal Admission Record (NAR) and to retrospectively compare discharge outcomes (length of hospital stay, mortality and weight gain) for neonates born before and after implementation. METHODS: A retrospective observational study was undertaken. A NAR was implemented, in combination with an education package, in an urban, tertiary neonatal unit in Kigali, Rwanda. Length of stay, mortality and weight gain were compared before and after the implementation of the NAR. RESULTS: Five hundred and fifteen pre-NAR and 863 post-NAR cases were included. There was a small, non-significant, increase in the mean LoS from 13.7 to 14.2 days. All-cause mortality decreased from 22% to 18% after the implementation of the NAR (OR=0.76, p=0.049). Surviving neonates gained 4.1 and 6.1g/kg/day before and after the implementation of the NAR (p=0.031). CONCLUSION: The use of a standardised Neonatal Admission Record, in combination with an educational package, can improve care. A NAR provides a structured approach to managing infants on a neonatal unit in the resource-limited setting.