Outcomes and Patterns of Neonatal Admissions at the Milton Cato Memorial Hospital’s Neonatal Intensive Care Unit (NICU) -St. Vincent and the Grenadines- a four year analysis (2012-2015).

Introduction: Neonatal intensive care has played a major role in the improvement of outcomes of infants, especially those born in developed countries. In recent years, infant mortality rates have decreased and the survival threshold has also decreased. Perinatal management requires specialists and sophisticated equipment, which renders such care as very costly. In developing countries, the high cost of neonatal care and the lack of human resources for health makes the provision of optimal care quite challenging. St. Vincent and the Grenadines is a developing country and its main referral centre, the Milton Cato Memorial Hospital has the only NICU. Research on outcome and disease patterns as well as admission trends is necessary to formulate guidelines that will assist in improving delivery of perinatal care in the country.

Aims: This study aims to describe admission trends by year, gestational age and birthweight and also to explore discharge outcomes, major reasons for admission and length of stay of the infants admitted to the Milton Cato Memorial Hospital’s NICU.

Method: A retrospective cohort study was conducted from 1st May 2012 to 31st December 2015 in the NICU of the Milton Cato Memorial Hospital. Data was collected from the NICU records. Term and preterm infants were followed-up from date of admission to date of discharge or death. Statistical analysis was performed using Cox proportional hazard ratio. Trends in admission by birthweight, gestational age and years were described.

Results: Of the 609 infants included in the analysis, 423 (69.5%) were born at term. The greatest number of admissions analyzed in the sample were from the year 2015 (177, 29.1%). Infants were primarily admitted for neonatal jaundice (308, 50.6%) There was a total of 54 deaths during the study period, of which 36 (66.7%) were preterm. Infant birthweight was significantly associated with outcome (t 8.698, p <0.001). The neonates born to mothers 24 years old and younger had the poorest survival rate (86.4%), while those born to mothers aged 25-34 years had the best survival rate (93.0%). Survival increased with increasing gestational age. Trends in gestational age by birthweight demonstrated a stable mean birthweight in term infants. In preterm infants, there was a drop in the mean birthweight in 2014 and it rose again in 2015. The largest proportion of extremely preterm infants were admitted in 2013.

Conclusion: Low birthweight and reduced gestational age are associated with an increased risk of infant mortality. The majority of the infants were admitted for neonatal jaundice, followed by presumed sepsis. Term infants made up the greater proportion of admitted infants during the research period.