Understanding Neonatal Unit Admission Patterns to Facilitate Optimal Resource Utilization in Low- and Middle-Income Countries

Understanding Neonatal Unit Admission Patterns to Facilitate Optimal Resource Utilization in Low- and Middle-Income Countries | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Understanding Neonatal Unit Admission Patterns to Facilitate Optimal Resource Utilization in Low- and Middle-Income Countries Onwona-Agyeman Kwabena, Alhassan Abdul-Mumin, Ganga Lakshmi Srinivas, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4295242/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Feb, 2025 Read the published version in BMC Pediatrics → Version 1 posted 11 You are reading this latest preprint version Abstract Background: Inborn babies in Ghana facilities who need any monitoring or therapy above Essential Newborn Care (ENC) are often separated out of dyadic care in postnatal wards to Neonatal Units (NUs) due to personnel workload, gaps in training or both. Objectives: Describe 1) care of inborn newborns in NUs at 2 hospitals in Ghana and 2) their outcomes, including breastfeeding. The purpose was to identify stable babies who could potentially be managed by midwives in postnatal wards with appropriate additional training and staffing. Methods: We conducted a retrospective study from January to December 2022 on inborn newborns in NUs at Greater Accra Regional Hospital (GARH), Tamale Teaching Hospital (TTH), and the Special Baby Ward at TTH. Data included monitoring (glucose), interventions (phototherapy, intravenous antibiotics, thermal and fluid support, oxygen, tube feeds, transfusions) and outcomes (breastfeeding, length of stay, mortality). Descriptive statistics was primarily used for the analysis, with z-test and t-test testing the difference between two proportions and means respectively from independent hospitals. Results: Of 2978 inborn newborns admitted to NUs, 11.5% received no NU Interventions (6.2% at GARH vs 22.1% at TTH, p<0.001). In TTH NU, 3.3% received no listed interventions at all. Exclusive breastfeeding at discharge was significantly higher from the TTH NU (96.3% vs GARH NU 57.3%, p<0.001), where babies were started on iv fluids instead of formula during the period of separation. Conclusions: Nearly a quarter of all babies admitted to the two neonatal units did not receive any intensive interventions , and this included 2% of infants <2500g. A model of dyadic Intermediate Care between Essential Newborn Care and Special/Intensive care could result in lower census in NUs that would promote greater focus on preterm, low-birthweight and sick newborns with higher acuity, and also promote breastfeeding and reduce separation. Levels of neonatal care small and sick newborns preterm babies low birthweight babies intermediate neonatal care resource utilization Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Feb, 2025 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 07 Nov, 2024 Reviews received at journal 06 Nov, 2024 Reviewers agreed at journal 20 Oct, 2024 Reviews received at journal 16 Oct, 2024 Reviewers agreed at journal 06 Oct, 2024 Reviewers agreed at journal 05 Oct, 2024 Reviewers invited by journal 04 Oct, 2024 Editor assigned by journal 16 Sep, 2024 Editor invited by journal 08 May, 2024 Submission checks completed at journal 08 May, 2024 First submitted to journal 19 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4295242","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":301374888,"identity":"f05a064a-c5d8-45bd-97c1-07badf31053c","order_by":0,"name":"Onwona-Agyeman Kwabena","email":"","orcid":"","institution":"Greater Accra Regional Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Onwona-Agyeman","middleName":"","lastName":"Kwabena","suffix":""},{"id":301374889,"identity":"8a679874-9139-479a-95e8-c84f99fa47b3","order_by":1,"name":"Alhassan Abdul-Mumin","email":"","orcid":"","institution":"University for Development 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Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Levels of neonatal care, small and sick newborns, preterm babies, low birthweight babies, intermediate neonatal care, resource utilization","lastPublishedDoi":"10.21203/rs.3.rs-4295242/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4295242/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eInborn babies in Ghana facilities who need any monitoring or therapy above Essential Newborn Care (ENC) are often separated out of dyadic care in postnatal wards to Neonatal Units (NUs) due to personnel workload, gaps in training or both.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eDescribe 1) care of inborn newborns in NUs at 2 hospitals in Ghana and 2) their outcomes, including breastfeeding. The purpose was to identify stable babies who could potentially be managed by midwives in postnatal wards with appropriate additional training and staffing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe conducted a retrospective study from January to December 2022 on inborn newborns in NUs at Greater Accra Regional Hospital (GARH), Tamale Teaching Hospital (TTH), and the Special Baby Ward at TTH. \u0026nbsp;Data included monitoring (glucose), interventions (phototherapy, intravenous antibiotics, thermal and fluid support, oxygen, tube feeds, transfusions) and outcomes (breastfeeding, length of stay, mortality). Descriptive statistics was primarily used for the analysis, with z-test and t-test testing the difference between two proportions and means respectively from independent hospitals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003e\u0026nbsp;Of 2978 inborn newborns admitted to NUs, 11.5% received no NU Interventions (6.2% at GARH vs 22.1% at TTH, p\u0026lt;0.001). In TTH NU, 3.3% received no listed interventions at all. Exclusive breastfeeding at discharge was significantly higher from the TTH NU (96.3% vs GARH NU 57.3%, p\u0026lt;0.001), where babies were started on iv fluids instead of formula during the period of separation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eNearly a quarter of all babies admitted to the two neonatal units did not receive any intensive interventions\u003cstrong\u003e, \u003c/strong\u003eand this included 2% of infants \u0026lt;2500g. A model of dyadic Intermediate Care between Essential Newborn Care and Special/Intensive care could result in lower census in NUs that would promote greater focus on preterm, low-birthweight and sick newborns with higher acuity, and also promote breastfeeding and reduce separation.\u003c/p\u003e","manuscriptTitle":"Understanding Neonatal Unit Admission Patterns to Facilitate Optimal Resource Utilization in Low- and Middle-Income Countries","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-15 02:22:23","doi":"10.21203/rs.3.rs-4295242/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-08T01:17:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-06T22:45:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"12005690174205446792888736256730223708","date":"2024-10-21T02:27:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-17T03:14:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2024-10-07T02:08:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204530017916760179856418013573456195906","date":"2024-10-06T02:07:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-04T07:27:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-16T04:09:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-08T15:17:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-08T15:16:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2024-04-19T22:58:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"978b5d6a-cc37-4905-9d50-82955382f442","owner":[],"postedDate":"May 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-03T16:05:53+00:00","versionOfRecord":{"articleIdentity":"rs-4295242","link":"https://doi.org/10.1186/s12887-025-05432-y","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2025-02-24 15:58:13","publishedOnDateReadable":"February 24th, 2025"},"versionCreatedAt":"2024-05-15 02:22:23","video":"","vorDoi":"10.1186/s12887-025-05432-y","vorDoiUrl":"https://doi.org/10.1186/s12887-025-05432-y","workflowStages":[]},"version":"v1","identity":"rs-4295242","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4295242","identity":"rs-4295242","version":["v1"]},"buildId":"pf3fE39SIOqb-0xH_OWvX","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}