Assessment of neonatal referral infrastructure and clinical characteristics of referred neonates in three first referral hospitals in Nairobi County, Kenya

Abstract

Background Almost one in five newly born babies in Nairobi County, Kenya, may need some form of inpatient neonatal care. Prior work showed many facilities are inadequately prepared to provide sick newborn care, however, only 16.6% of babies from facilities were referred to a better-equipped facility. We sought to examine referrals to and from three busy first-level referral public hospitals in Nairobi and what infrastructure and systems are available to support neonatal transport from these first-referral level hospitals to the main tertiary care center. Methods Patient-level data of newborns over 13 months were retrospectively abstracted from routinely collected patient data and examined to characterize those referred into and out of three newborn units in the study hospitals. Structural assessments using a checklist completed during hospital visits were used to describe hospitals’ readiness to support newborn referral and transport. Results Five percent (398/7720) of the cohort studied were referrals either out or to the hospitals. 68% (272/398) were referred to these hospitals. A majority (397/398) and two-thirds (268/398) of patients had their sex and gestation age documented respectively. Among both referrals in and out, 63% (251/397) were male and 44% (118/268) were preterm infants. Among those referred in, 26% (69/272) died and 2.6% (7/272) were further referred to a tertiary-care newborn unit in Nairobi County. Equipment, drugs, and medical supplies needed to provide safe in-transit care in the ambulance, including oxygen and infant warmers were unavailable. Conclusion Neonatal transport from first-referral hospitals to the tertiary center in Nairobi County is poor and likely to be unsafe for newborn transfer services. This jeopardizes their well-being and survival. There is a need to develop, equip and maintain a high-quality referral and newborn transport system which can support the continuum of newborn care across referral care pathways into and from first-referral level hospitals.