An Appraisal of the Medical Records of Critically Ill Neonates in Lagos, Nigeria

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Objectives: To examine age- and gender-specific presentations and assess clinicians’ subjective prognosis and outcome of illnesses of critically ill neonates in the emergency room. Design: A hospital-based retrospective appraisal of medical records of neonates in emergency room. Participants: Neonates admitted into the emergency room of a second-tier pediatric hospital in Lagos, Nigeria, between March 2005 and February 2007. Intervention: Appraisal of the medical records of newly-born ill infants. Results: There was no statistically significant difference in the mean weight of the neonates in each age group (df=4, p=0.5). Failure-to-cry (23.3%) and fever (37%, 52%, 54.2%, and 70%) were the main presentations in the first day of life and in all other age groups respectively. The most frequent diagnosis among the day old was birth asphyxia (21/30; 70%); among those 2-7 days old was neonatal jaundice (66/135; 48.9%); among those 8-14 days old (17/25, 68.0%) and those 15-21 days old (23/24, 92.0%) was neonatal septicemia and among those 22-28 days old was bronchopneumonia (5/10, 50.0%) respectively. Full blood count was the most repeated laboratory investigation requested for and antibiotics the most frequently-prescribed medication. Overall, there was a positive correlation (r=0.28, p=0.00) between clinicians’ subjective prognosis and outcome of illness although this was not reflected among the day-old neonates. The highest mortality rate (30.0%) was among the day-old neonates. Conclusion: Birth asphyxia was the dominant illness that brought 24-hour old neonates to the Intensive Care Unit in the health facility of study. Mortality was also highest in this age group. Jaundice, septicemia and bronchopneumonia were other leading causes of neonatal morbidity and mortality according to the age group. Clinicians’ prognosis directly correlated with disease outcome.