Journal Article

Changes in the Process of Care and Outcome Over a 10-year Period in a Neonatal Nursery in a Developing Country

Jacqueline J. Ho and Alvin S. M. Chang

in Journal of Tropical Pediatrics

Volume 53, issue 4, pages 232-237
Published in print August 2007 | ISSN: 0142-6338
Published online June 2007 | e-ISSN: 1465-3664 | DOI: http://dx.doi.org/10.1093/tropej/fmm050
Changes in the Process of Care and Outcome Over a 10-year Period in a Neonatal Nursery in a Developing Country

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Background: Over a 10-year period there was increasing involvement by clinicians in the generation and implementation of evidence-based practices in the neonatal intensive care unit (NICU). For two cohorts of very low birth weight (VLBW) babies admitted 10 years apart to a developing country, NICU were compared and changes occurring in process of care that might have contributed to any change in outcome were documented.

Methods: Prospective data were collected on characteristics, management and complications of all VLBW infants admitted over the same 6-month period in 1993 and 2003 and examined for changes in evidence-based practices and outcome.

Results: Compared to the first cohort of 69 babies, 60 babies in the second cohort were significantly more likely to have been inborn (p < 0.001), born by Caesarean section (p = 0.035), to have received antenatal corticosteroids (p < 0.001), to be intubated at birth (p < 0.001) and have a 5 min Apgar score above 6 (p = 0.034). They were also significantly lighter and of lower gestation (p = 0.005). They were significantly more likely to have received surfactant (p < 0.001), to have been ventilated and to have had double prong nasal continuous positive pressure either as a mode of ventilation or for weaning (p < 0.001). Hypothermia on admission was more common in the second cohort (p < 0.001). Survival increased from 62.3% to 81.6% (p = 0.015).

Conclusions: Although causality cannot be established, an increase in the use of evidence-based practices was associated with a significant improvement in outcomes. In spite of greater barriers to implementation there are evidence-based strategies that can be put into neonatal practice in developing countries.

Keywords: evidence-based medicine; developing countries; neonatal intensive care; very low birth weight

Journal Article.  3025 words. 

Subjects: Paediatrics

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