Differences between Inborns and Outborns Referred to a Special Neonatal Care Units in Kumasi, Ghana

Background. Neonatal deaths constitute 44% of all deaths in children under 5 years and about 99% of them occur in low and middle-income countries. Based on WHO recommendations, two low-cost Mother-Baby Units (MBU) with Intermediate care facilities were established in 2008 in Kumasi, Ghana, involving a Ghanaian-Israeli cooperation.

Objectives. To compare the differences in outcomes of inborn vs. outborn neonates in the two units.

Methods. A retrospective cohort analysis from a prospectively collected database of neonates admitted to both units within their first three days of life, between October 2016 and October 2017.

Results. Of 1,011 infants fulfilling inclusion criteria, 743 were inborn and 268 were outborn. No significant difference was found in mortality rates between the two groups (3.4% in outborns vs. 4.6% in inborns; p= 0.397). Inborns were more likely to be admitted due to birth asphyxia (22.3% vs. 16.0%, p=0.03), and outborn were more likely to be admitted due to jaundice (16.4% vs. 10.2%, p<0.001). In a multivariable analysis, mortality decreased as birth weight (Kg) increased (OR-0.361, 95%CI: 0.163-0.799; p<0.001), increased with diagnoses of birth asphyxia (OR-9.253, 95%CI: 4.103-20.868; p<0.001), and respiratory distress (OR-5.128, 95%CI: 2.344-11.218; p<0.001). The length of hospitalization was longer in outborns compared to inborns 5.3d vs. 5.7d; p= 0.024), inborns were more likely to be hospitalized earlier in life (p<0.001).

Conclusions. Contrary to high-income countries, we did not find a difference in mortality rates between outborns and inborns. This may be due to a bias in referring more viable infants to the units.