Care of referred neonates during transport to the newborn unit at Moi Teaching and Referral Hospital, Eldoret-Kenya

Abstract

Background: Globally, one percent of neonates require transport from one health facility to another with a third of this transfer occurring within twenty four hours of birth. The principles of neonatal transport include: assessment, stabilization before and during transport and care during transport. Care during transport is essential to ensure that the neonate’s hemodynamic status is maintained. Objective: To describe the care offered to referred neonates during transport to the newborn unit at Moi Teaching and Referral Hospital, Eldoret, Kenya. Methods: This was a cross-sectional study carried out at the newborn unit, Moi Teaching and Referral Hospital. Neonates referred from peripheral health facilities were recruited and a consecutive sampling was done. Data were collected from February 2016 to July 2016 with the use of questionnaires, structured data checklists (patient and ambulance) and the patients’ file .The condition of the neonate on admission(temperature, respiratory rate, pulse rate and random blood sugar) was obtained from the file. Data were analyzed using statistical package for social sciences (SPSS®) version 20 at 95% confidence interval. Descriptive statistics were generated for continuous and categorical data. Frequency tables were used to summarize the data. Chi Square tests were used to test for associations. Logistic regression was done to test for independent association. Results were presented in form of graphs, tables and text. Results: A total of 122 neonates were recruited and analyzed. Majority were males 71(58%) and most 60(49%) were referred on the day of birth. The main indication for referral was the lack of a newborn unit at the referring hospital 56(46%) and the main referral diagnosis was prematurity 39(32%).Majority, 96(79%) were transported with an ambulance and were escorted by a health care worker 95(78%).Warmth was provided mainly through the use of clothing in 110(90%) and majority 42(34%) did not receive either enteral feeds or intravenous fluids during transport. On ambulance equipment, none was equipped with transport incubators, 46(48%) had resuscitation equipment, 64(67%) had monitoring equipment and 75(79%) had oxygen cylinders. Majority of the neonates 54 (44%) had hypothermia on admission which was positively associated on bivariate analysis with birth weight of less than 2.5kgs (p=0.034), prematurity (p=0.029) and hypoglycemia (p=0.007). Hypoglycemia was found in 25(21%) of the neonates which was associated on bivariate analysis with prematurity (p=0.002) and lack of enteral feeding or intravenous fluids during transport (p=<0.001).On logistic regression, prematurity (OR 2.251; 95% CI 1.078-4.705; p=0.046) and hypoglycemia (OR 3.445; 95% CI 1.353-8.776; p=0.014) were associated with hypothermia. Lack of enteral feeding or intravenous fluids during transport (OR 7.82; 95% CI 2.9-20.9; p=<0.001), prematurity (OR 4.121, 95% CI 1.61-10.544); p=0.014) and hypothermia (OR 3.446, 95% CI 1.353-8.776; p=0.014) were associated with hypoglycemia on logistic regression. Conclusions: Prematurity was the main referral diagnosis. Despite ambulances being the key mode of transport, the care received by the neonates was inadequate. Recommendations: Care and monitoring of neonates during transport should be improved. Ambulance should be equipped adequately for neonatal transport with transport incubators, resuscitation and monitoring equipment.