Referral pattern and outcomes of neonates from secondary care setting of Aga Khan University Hospital to tertiary care centers in Pakistan

Objective:To determine the reasons of neonatal referrals from secondary-care to tertiary-care setting, and to assess neonatal outcomes for the referred cases. Method: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from July 2015 to June 2019 Related to all neonates born after 32 weeks of gestation at the satellite secondary-care centres in Kharadar, Garden and Karimabad who had been referred to the main tertiary care hospital. The reason for referral, need of mechanical ventilation, referral place and neonatal outcome were noted. Data was analysed using SPSS 22. Results: Of the 348 cases, 211(60.6%) were boys. The overall mean gestational age was 36.42 +/- 2.61 weeks and the mean birth weight was 2.54 +/- 0.67 kg. The outcome was neonatal mortality in 42(12%) cases. Of the remaining 306(88%) cases, 284(92.81%) were discharged from the hospital and 22(7.18%) left against medical advice. Overall, mechanical ventilation was needed in 63(18.1%) patients. There was a significant association of mechanical ventilation with low Appearance, Pulse, Grimace, Activity, and Respiration score at 1 and 5 minutes (p<0.001), shorter duration of stay (p=0.007), and aggressive resuscitation requirement at birth (p<0.001). Conclusion: The most common reasons for referral of newborns to tertiary care hospital were respiratory diseases requiring respiratory support and surgical intervention.