One Year Outcome of High-risk Newborn Infants Discharged from the Neonatal Care Unit of the National Maternal and Child Health Center in Cambodia

Background: In the National Maternal and Child Health Center in Cambodia, about 7,500 newborn infants are born every year. Around 10% of them are admitted to the neonatal care unit. After recovery from the acute phase that presented neonatal care unit admissions, they are discharged even if they are very low birth weight infants, but there is no official follow-up system available after discharge. This research aims to identify the prognosis of high-risk infants one year after discharge using regular telephone interviews, identifying the factors that may determine their prognosis.

Methods: When a small and sick newborn infant was admitted to and discharged from the neonatal care unit, we collected health information from medical records. After discharge, we interviewed their caretakers by telephone when the infants were one, six, and 12 months (one year) old. We used structured questionnaires on feeding, history of illness, and development of growth and gross motor skills.

Findings: Between September 2014 and April 2015, 175 infants were discharged. At one year old, 111 (63%) had survived, 12 (6.9%) had died, and 52 (30%) were lost to follow-up. Nine cases died within one month of discharge. Our data suggested low birth weight may lead to re-hospitalization. Infants vaccinated less than twice at six months old were more likely to be re-hospitalized. According to results of our telephone interview, three infants showed psychomotor retardation at one year old. Among the 50 cases lost to follow-up, 26 (52%) of these patients were discharged without permission by doctors.

Interpretation: After one year, we noted that 63% of discharged infants survived, although 30% were lost to follow-up. There was a limitation of collecting more detailed data by telephone interview than questions about survival. The follow-up for high-risk newborn infants is an important challenge in Cambodia.