Background: Inborn babies in Ghana facilities who need any monitoring or therapy above Essential Newborn Care (ENC) are often separated out of dyadic care in postnatal wards to Neonatal Units (NUs) due to personnel workload, gaps in training or both.
Objectives: Describe 1) care of inborn newborns in NUs at 2 hospitals in Ghana and 2) their outcomes, including breastfeeding. The purpose was to identify stable babies who could potentially be managed by midwives in postnatal wards with appropriate additional training and staffing.
Methods: We conducted a retrospective study from January to December 2022 on inborn newborns in NUs at Greater Accra Regional Hospital (GARH), Tamale Teaching Hospital (TTH), and the Special Baby Ward at TTH. Data included monitoring (glucose), interventions (phototherapy, intravenous antibiotics, thermal and fluid support, oxygen, tube feeds, transfusions) and outcomes (breastfeeding, length of stay, mortality). Descriptive statistics was primarily used for the analysis, with z-test and t-test testing the difference between two proportions and means respectively from independent hospitals.
Results: Of 2978 inborn newborns admitted to NUs, 11.5% received no NU Interventions (6.2% at GARH vs 22.1% at TTH, p<0.001). In TTH NU, 3.3% received no listed interventions at all. Exclusive breastfeeding at discharge was significantly higher from the TTH NU (96.3% vs GARH NU 57.3%, p<0.001), where babies were started on iv fluids instead of formula during the period of separation.
Conclusions: Nearly a quarter of all babies admitted to the two neonatal units did not receive any intensive interventions, and this included 2% of infants <2500g. A model of dyadic Intermediate Care between Essential Newborn Care and Special/Intensive care could result in lower census in NUs that would promote greater focus on preterm, low-birthweight and sick newborns with higher acuity, and also promote breastfeeding and reduce separation.