Smart discharges to improve post-discharge survival following admission for infection in newborns and young infants
BACKGROUND: In many African countries, including Uganda, post-discharge mortality following in-hospital treatment of common infections, such as neonatal sepsis, meningitis, pneumonia, diarrhea, and malaria, is a neglected cause of mortality in young infants (<6 months of age).
GAP: Despite the burden of post-discharge mortality, scarce resources within affected health systems mean that the necessary follow-up of vulnerable children is usually not possible. If these health systems could target vulnerable children, then the scarce resources could be better focused towards these children. However, currently no strategies exist to predict post-discharge mortality in newborns and young infants.
HYPOTHESIS: Candidate predictor variables, collected during hospitalization, will be able to predict post-discharge mortality. These can then be integrated into existing mobile health platforms to be used by health workers.
METHODS: Children from birth to 6 months of age will be eligible for enrollment if they are admitted with a proven or suspected infection to four hospital sites in Uganda. All enrolled children will receive routine in-hospital evaluation and care during their admission. Pre-defined candidate predictor variables will be collected on all enrolled children during hospitalization. Post-discharge morbidity and mortality will be determined through patient follow-up. A prediction model will be developed and internally validated using these variables to predict mortality.
IMPACT: Newborn and infant mortality during the post-discharge period contributes to as many deaths as the initial hospitalization period, yet post-discharge care is neglected in virtually all resource constrained settings. This prediction modeling research will lead to the integration of newborns and young infants into a scalable program of Smart Discharges, so those with significant post-discharge vulnerability are identified prior to discharge and targeted to receive life-saving interventions.
Website Link: www.bcchildrens.ca/international- see Project Activity tab, under Uganda
Optional/Additional Comments: For a list of publications associated with earlier phases of this work, please visit the website.
Pediatric post-discharge mortality in resource limited settings: A systematic review
Predictor variables for post-discharge mortality modelling in infants: A Protocol development project.
Predictors of Mortality in Neonates and Infants Hospitalized with Sepsis or Serious Infections in Developing Countries: A Systematic Review