Journal of Tropical Pediatrics Advance Access originally published online on June 19, 2007
Journal of Tropical Pediatrics 2007 53(4):232-237; doi: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
aPenang Medical College and bHospital Ipoh, Ipoh, Malaysia Greentown, Ipoh 30450, Malaysia
Correspondence: Prof Jacqueline J.Ho, Penang Medical College, Jalan Sepoy Lines, 10450 Penang, Malaysia. Tel.: +60 4 2263459; Fax: +60 4 2284285. E-mail < jackie{at}pmc.edu.my>.
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Abstract |
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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.
Key Words: evidence-based medicine • developing countries • neonatal intensive care • very low birth weight
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J Trop Pediatr 2007 53: i.[Full Text]