Frontiers in Pediatrics (Sep 2024)

Identifying and quantifying initial post-discharge needs for clinical review of sick, newborns in Kenya based on a large multi-site, retrospective cohort study

  • John Wainaina,
  • Esther Lee,
  • Grace Irimu,
  • Grace Irimu,
  • Jalemba Aluvaala,
  • Jalemba Aluvaala,
  • Mike English,
  • Mike English,
  • The Clinical Information Network Author Group,
  • Dolphine Mochache,
  • Juma Vitalis,
  • Arnest Namayi,
  • Nyumbile Bonface,
  • Dolphine Mochache,
  • Samuel Soita,
  • Christine Manyasi,
  • Jane Mbungu,
  • Joan Baswetty,
  • Caren Emadau,
  • Josephine Aritho,
  • Beatrice Njambi,
  • Esther Mwangi,
  • Charles Nzioki,
  • Wagura Mwangi,
  • Lucy Kinyua,
  • Alfred Wanjau,
  • Magdalene Kuria,
  • Alice Oguda,
  • Otieno George Obop,
  • Esther Njiru,
  • Pauline Njeru,
  • Penina Mwangi,
  • Nancy Mburu,
  • Mary Nguri,
  • Rachel Inginia,
  • Celestine Muteshi,
  • Jeska Kuya,
  • Emma Namulala,
  • Salome Okisa Muyale,
  • Susan Wanjala,
  • Grace Ochieng,
  • Lydia Thuranira,
  • Faith Mueni,
  • Margaret Waweru,
  • Felistus Makokha,
  • Rosemary Mututa,
  • Josephine Ojigo,
  • Joyce Oketch,
  • Beth Maina,
  • Orina Nyakina,
  • Faith Njeru,
  • Judith Onsongo,
  • Bernadette Lusweti,
  • Margaret Wanjiku Mwaura,
  • Peter Muigai,
  • Amilia Ngoda,
  • Zainab Kioni,
  • Esther Muthiani,
  • Loise N. Mwangi,
  • Seline Kulubi,
  • John Ollongo,
  • Joseph Ng’ang’a,
  • Benjamin Tanui

DOI
https://doi.org/10.3389/fped.2024.1374629
Journal volume & issue
Vol. 12

Abstract

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BackgroundProgress in neonatal care has resulted in a 51% decrease in global neonatal mortality rates from 1990 to 2017. Enhanced survival will put pressure on health care systems to provide appropriate post-discharge, follow-up care but the scale of need for such care is poorly defined.MethodsWe conducted a retrospective cohort study of newborns discharged from 23 public hospital neonatal units (NBUs) in Kenya between January 2018 and June 2023 to identify initial follow-up needs. We first determined pragmatic follow-up categories based on survivors’ clinical conditions and morbidities. We then used individual phenotypes of individual babies to assign them to needing one or more forms of specialized clinical follow-up. We use descriptive statistics to estimate proportions of those with specific needs and patterns of need.FindingsAmong 136,249/159,792 (85.3%) neonates discharged, around one-third (33%) were low birth weight (<2,500 g), and a similar 33.4% were preterm (<37 weeks). We estimated 131,351 initial episodes of follow-up would be needed across nine distinct follow-up categories: general pediatrics, nutrition, growth & development (40.4%), auditory screening (38.8%), ophthalmology for retinopathy of prematurity (9.6%), neurology (8.0%), occupational therapy (1.3%), specialized nutrition (0.9%), surgery (0.8%), cardiology (0.2%), and pulmonary (<0.1%). Most neonates met the criteria for two (52.3%, 28,733), followed by three (39.6%, 21,738) and one follow-up episodes (5.6%, 3,098). In addition to prematurity and very low birth weight (≤1,500 g), severe infections with extended gentamicin treatment, severe jaundice managed with phototherapy, and hypoxic-ischemic encephalopathy (HIE) contributed substantially to the pattern of need for post-discharge follow-up.ConclusionsAlmost half of surviving NBU infants have multiple specialty post-discharge follow-up needs. More urgent attention needs to be focused on healthcare planning now to guide strategies to address the varied medical and developmental needs that we outline in resource-constrained contexts like Kenya.

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