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Background <p>The recent establishment of Special Care Baby Units (SCBUs) across regional hospitals in rural Sierra Leone is an important advancement in health system infrastructure promoting high-quality perinatal care. However, there is little evidence documenting their impact. This study aimed to assess neonate-level characteristics and outcomes across the initial years of operation to inform clinical practices and policies.</p> Methods <p>Neonatal chart data for infants with admission dates between June 8, 2021, and December 31, 2024, to the Kono District SCBU were collected by trained nurse researchers. Deidentified data were analyzed in RStudio. Descriptive summaries were conducted to map trends in diagnoses and bivariate analyses explored patterns by year of admission as well as by survival status.</p> Results <p>A total of 3,857 neonatal patients were admitted during the study period with the most common primary diagnoses being ‘risk of neonatal sepsis or infection’ (<i>N</i> = 1,223, 32%), other (<i>N</i> = 606, 16%), and prematurity (<i>N</i> = 434, 11.25%). While there were no significant differences in birthplace by admission year, there were statistically significant fluctuations in referrals, delivery mode, birthweight, infant age at admission, and stay length. There was also a trend of increasing deaths over time with 16 (3%) neonatal deaths in 2021 and 56 (6%) deaths in 2024 (<i>p</i> = 0.042). Asphyxia, very low birthweight, and prematurity were the diagnoses with the highest likelihoods of death (up to 20%) while risk of neonatal sepsis or infection was the only diagnosis associated with survival (OR: 2.926, 95%CI: 1.945–4.592, <i>p</i> &lt; 0.001).</p> Conclusions <p>The early years of SCBU operation saw wide variation in neonatal characteristics and outcomes. Key shifts including the increase in referrals of younger patients may have contributed to the upward trend in deaths, though further exploration is needed. Overall, both the common diagnoses and key drivers of mortality aligned with national trends suggesting continued efforts to mitigate asphyxia and prematurity for SCBU patients are critical. As one of the first detailed characterizations of SCBU operation in a rural, low-income setting in this region, our findings underscore the importance of investing in timely, quality neonatal care.</p>

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Characterizing neonatal survival across the first four years of operation of a special care baby unit in Eastern Sierra Leone

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Ashley Mitchell,
  • Francess Kamara,
  • Patricia Azikwe,
  • Taofik Oluwaseun Ogunkunle,
  • McGeofrey Mvula,
  • Miranda Rouse,
  • Kimberly Baltzell,
  • Alden Hooper Blair

摘要

Background

The recent establishment of Special Care Baby Units (SCBUs) across regional hospitals in rural Sierra Leone is an important advancement in health system infrastructure promoting high-quality perinatal care. However, there is little evidence documenting their impact. This study aimed to assess neonate-level characteristics and outcomes across the initial years of operation to inform clinical practices and policies.

Methods

Neonatal chart data for infants with admission dates between June 8, 2021, and December 31, 2024, to the Kono District SCBU were collected by trained nurse researchers. Deidentified data were analyzed in RStudio. Descriptive summaries were conducted to map trends in diagnoses and bivariate analyses explored patterns by year of admission as well as by survival status.

Results

A total of 3,857 neonatal patients were admitted during the study period with the most common primary diagnoses being ‘risk of neonatal sepsis or infection’ (N = 1,223, 32%), other (N = 606, 16%), and prematurity (N = 434, 11.25%). While there were no significant differences in birthplace by admission year, there were statistically significant fluctuations in referrals, delivery mode, birthweight, infant age at admission, and stay length. There was also a trend of increasing deaths over time with 16 (3%) neonatal deaths in 2021 and 56 (6%) deaths in 2024 (p = 0.042). Asphyxia, very low birthweight, and prematurity were the diagnoses with the highest likelihoods of death (up to 20%) while risk of neonatal sepsis or infection was the only diagnosis associated with survival (OR: 2.926, 95%CI: 1.945–4.592, p < 0.001).

Conclusions

The early years of SCBU operation saw wide variation in neonatal characteristics and outcomes. Key shifts including the increase in referrals of younger patients may have contributed to the upward trend in deaths, though further exploration is needed. Overall, both the common diagnoses and key drivers of mortality aligned with national trends suggesting continued efforts to mitigate asphyxia and prematurity for SCBU patients are critical. As one of the first detailed characterizations of SCBU operation in a rural, low-income setting in this region, our findings underscore the importance of investing in timely, quality neonatal care.