Reducing length of stay in hospital for very low birthweight infants by involving mothers in a stepdown unit: an experience from Karachi (Pakistan)

doi:10.1136/bmj.329.7475.1151

BMJ 2004;329:1151-1155 (13 November), doi:10.1136/bmj.329.7475.1151

Quality improvement report

Reducing length of stay in hospital for very low birthweight infants by involving mothers in a stepdown unit: an experience from Karachi (Pakistan)

Zulfiqar A Bhutta, professor of paediatrics and child health¹, Iqtidar Khan, professor of paediatrics¹, Suhail Salat, assistant professor of paediatrics¹, Farukh Raza, research medical officer, paediatrics¹, Husan Ara, head nurse, Neonatal Intensive Care Unit¹

¹ Aga Khan University, Karachi 74800, Pakistan

Correspondence to: Z A Bhutta zulfiqar.bhutta{at}aku.edu

Problem Clinical care of infants with a very low birth weight(less than 1500 g) in developing countries can be labour intensiveand is often associated with a prolonged stay in hospital. TheAga Khan University Medical Center in Karachi, Pakistan, establisheda neonatal intensive care unit in 1987. By 1993-4, very lowbirthweight infants remained in hospital for 18-21 days.

Strategies for change A stepdown unit was established in September1994, with mothers providing all basic nursing care for theirinfants before being discharged under supervision.

Key measures for improvement We analysed neonatal outcomes forthe time periods before and after the stepdown unit was created(1987-94 and 1995-2001). We compared these two time periodsfor survival after birth until discharge, morbidity patternsduring hospitalisation, length of stay in hospital, and readmissionrates to hospital in the four weeks after discharge.

Effects of change Of 509 consecutive, very low birthweight infants,494 (97%) preterm and 140 (28%) weighing < 1000 g at birth),391 (76%) survived to discharge from the hospital. The lengthof hospitalisation fell significantly from 1987-90, when itwas 34 (SD 18) days, to 16 (SD 14) days in 1999-2001 (P <0.001). Readmission rates to hospital did not rise, nor didadverse outcomes at 12 months of age.

Lessons learnt Our results indicate that it is possible to involvemothers in the active care of their very low birthweight infantsbefore discharge. This may translate into earlier dischargefrom hospital to home settings without any increase in shortterm complications and readmissions.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to Technorati Technorati What's this?

Relevant Articles

Child health and survival in the Eastern Mediterranean region: Zulfiqar A Bhutta, Asim Belgaumi, Mohammad Abdur Rab, Zein Karrar, Mohamed Khashaba, and Nezha Mouane
BMJ 2006 333: 839-842. [Full Text] [PDF]

The power of women, community, and Bob Geldof: Kamran Abbasi
BMJ 2004 329: 0. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Bhutta, Z. A, Belgaumi, A., Rab, M. A., Karrar, Z., Khashaba, M., Mouane, N. (2006). Child health and survival in the Eastern Mediterranean region. BMJ 333: 839-842 [Full text]