Health Outcomes of Neonates Admitted to Palestinian Ministry of Health Neonatal Intensive Care Units and referred to Neonatal Intensive Care Units outside the Palestinian Ministry of Health in the West Bank in 2020 رسالة ماجستير

Abstract

The neonatal period is the first 28 days of a newborn’s life that is the most critical period, where neonates face the most significant risk of death, especially in the first week of life. In 2019, globally, 47% of all under-five deaths occurred in the neonatal period. In 2019 in the West Bank, the reported infant mortality rate was 11.1 per 1,000 live births (870 cases). Based on the Palestinian Ministry of Health (PMoH) annual report, the top three causes of reported infant mortality were conditions in the perinatal period (e.g., low birth weight, prematurity, and complications regarding the placenta, cord, and membranes) (77%), congenital malformation (19%), and sudden infant death syndrome (3%). This study examined the characteristics of the neonates admitted to neonatal intensive care units (NICU) in the governmental hospitals during the period from 1st January 2020 to the 31st of December 2020 as well as the health outcome of those neonates. In addition, the study examined all neonatal referrals to the NICUs in the non-governmental hospitals outside the Palestinian Ministry of Health (PMoH) in 2020. The study extracted data from both Avicenna HIS (Health Information System used and operated by the governmental hospitals) and e-Referral (Computerized system operated by the Service Purchase Unit in the Palestinian Ministry of Health). The data collected from the Avicenna system was extracted as excel files by executing proper SQL queries on the database by the database administrator to meet the research requirements. The extracted data were validated by the system administrator. Collected excel files were merged into one sheet by matching the unique patient identifier in all data files. The data collected from the e-referral system was imported as an excel sheet by a predefined report in the system. SPSS was used for data analysis. V Based on study findings, in 2020, 3146 neonatal admissions were registered in the Palestinian Ministry of Health (PMoH) NICUs (2963 neonates). Around 90% of admitted neonates to PMoH NICU were single births, 2.7% were IVF, and the readmission rate for the neonates in the NICUs in the PMoH hospitals was 5%. The top causes of admission to PMoH NICU were respiratory diseases, for observation, hematology (mostly jaundice), and sepsis. Low birth weight and prematurity were not the leading causes of admission to NICU to PMoH hospitals in 2020. More than half of the admitted newborns had average birth weight (61.4%) and were full-term babies (58.7%), around 41.2% were premature, and 35.6% of neonates had low birth weight. Most admitted neonates to the NICUs inside governmental hospitals were improved and discharged, while 8% died. As to referrals to NICU outside MoH, in 2020, there were 1,913 referrals. There was no data available on the cause of the neonatal referrals outside PMoH, other than 90% of referrals were for emergency and follow-up. Only 0.6% of these referrals were issued by Service Purchase Unit, 57.2% were issued by the Palestinian governmental hospitals, and 42.2% by the non-governmental hospitals in the West Bank. Referral departments (the department that issue the referral request) were either the pediatric department or the NICU department. Top referral hospitals (the hospital that issue the referral request) in 2020 were Specialized Arab Hospital, Al Mizan, and Al Makased hospital. Around 68% of referrals outside PMoH were for treatments not found at PMoH neonatal units. Sepsis was among the top causes of admission to PMoH NICU that could have been prevented by applying early essential newborn care at the time of birth. Based on study findings, survival was high among neonates admitted to NICU; the mortality rate was less than that reported in previous studies in Ethiopia and Egypt; 8% vs. 14.4% and 29.1%, respectively. 18.8% of admitted and 10% of readmitted were for observation. If Normal Newborn Nursery units were VI available in the PMoH hospitals, there would have been no need to admit the newborn to the NICU and save the incubators for critical cases. There was no data on morbidity, whether for neonates at PMoH NICU or at NICU outside PMoH.