Abstract
Background : Globally, 46% of all deaths under the age of 5 are in newborns and 16% are due to complications from preterm births (UNICEF, 2017). In Liberia, the neonatal mortality rate for 2015 was 24.1/1,000 live births with preterm birth accounting for 14% of all births. Historically, many neonatal units have a discharge weight criteria of 1.8 to 2.0 kg. However, in resource-limited settings, preterm infants often leave the hospital before these target weights are reached due to family preferences and space constraints. Recent data from other innovative Kangaroo Mother Care (KMC) programs suggests that earlier discharges may be safe. Since October, 2017, Partners In Health (PIH) Liberia in collaboration with the Ministry of Health and staff at JJ Dossen Hospital (JJD) in Harper, Liberia has developed an intensive community-based nursing program that has facilitated safe early discharges and longitudinal follow-up for these vulnerable infants. Methods: Infants born at, referred to, or admitted to JJD with a birth weight of <1.8kg were eligible for enrollment. Hospital KMC included frequent skin-to-skin contact, breastfeeding support, and nasogastric or syringe feeds for infants too weak to breastfeed. Following hospital discharge, weekly home visits were made where infants were weighed and assessed for any danger signs including jaundice, poor feeding, sepsis, and cord infection. Ongoing KMC and breastfeeding mentorship was offered. Further social support including bed nets, mattresses, and blankets were provided when indicated. Children graduate from the intensive weekly monitoring program after reaching a weight of >3.5kg and receiving their 10 week old vaccines. Results: Within the first 6 months of the program, 29 infants were enrolled with an average birth weight of 1.55 +/-0.19 kg, an average initial hospital stay of 21.7 +/-14.88 days, and an average hospital discharge weight of 1.60 +/-0.21 kg. Of the 29 infants, only five remained hospitalized until reaching the 1.8 kg target weight. Eight infants left the hospital against medical advice but were still offered home based follow up services. One infant died prior to hospital discharge, one infant died following hospital discharge, and one infant was lost to follow-up. There have been no readmissions. Four infants have graduated from the intensive monitoring program with an average time from birth to discharge of 98.75 +/-57.54 days. Conclusions: Our program demonstrates that with intensive community-based nursing in conjunction with home-based KMC practices, earlier discharges for low birth weight infants are not only feasible and safe, but are a more realistic option in our setting. While additional work is needed to establish long term outcomes, these early results suggest that programs can be implemented to address the high burden of disease associated with prematurity and low birth weight in resource-limited settings.