Neonatal Survival Improvement in Dominican Republic through effective Collaboration of the Iberoamerican Society of Neonatology (SIBEN)

Background: The Iberoamerican Society of Neonatology (SIBEN) dedicates efforts to facilitate the dissemination of knowledge and contributes to the well-being of NB in the Latin American region. In the Dominican Republic, the neonatal mortality rate was 17‰ in 2018, among the highest in Latin America. Through an agreement between the National Health System (NHS) of the country and SIBEN, actions were planned, developed and implemented to improve care of sick newborns (NB) at risk of dying.

Objective: To describe the actions implemented and to present the results obtained in the first year of collaborative work.

Methods: Multidimensional interventions in the context of continuous quality improvement of care in all public hospitals of the country where neonatal care is delivered. The main components of the comprehensive program were: detailed monitoring of vital statistics; situational diagnosis working in the field, including assessment of clinical management and procedures, education, NB and family issues, staff issues, infrastructure, equipment, and legal/regulatory and ethical issues, in order to institute an appropriate “hierarchy of interventions”. In addition, we performed root cause analysis (RCA) in deceased NB and incorporated data collection system in the neonatal units through SIBEN’s neonatal network. Finally, we also performed a preliminary cost analysis.

Results: The country’s neonatal mortality rate decreased from 17‰ in 2018 to 12.1‰ in 2019, with a relative risk reduction of 26%. There were improvements in infrastructure, equipment and staffing, together with modifications in clinical management and procedures and education and training. More than 600 neonatal health care professionals were trained, including nurses, neonatologists and neonatology residents.

By root cause analysis (RCA), of 511 infants who died, 54% were <1500 grams and pulmonary hemorrhage (PH) was the most frequent cause.

During 2019, 3,347 NB were admitted to 11 neonatal intensive care units (NICU) hospitals and reported to SIBEN’s Network. Comparing data from the first semester of 2019 with the second semester, mortality in the NICU’s decreased from 22.5% to 19%, detection of significant patent ductus arteriosus improved and PH frequency decreased. The cost of the program was approximately 1,100 dollars per each of the newborn whose life was saved.

Conclusion: One year after the collaborative agreement between SIBEN and NHS started, organization and delivery of care to sick NB in public hospitals of the Dominican Republic improved, and has led to a significant increase in neonatal survival. This was due to education and to definite improvements in the provision of neonatal intensive care, in a cost-effective manner.

Keywords: Neonatal mortality; Education; Neonatal health services

Abbreviations: NHS: National Health Service of the Dominican Republic; SIBEN: Iberoamerican Society of Neonatology; NB: Newborn; PH: Pulmonary hemorrhage; RCA: Root cause analysis; NICU: Neonatal intensive care unit