Introduction of neonatal care in a rural Bangladesh hospital: an analysis of the first year's operation.

A neonatal care unit was introduced into a rural hospital in Bangladesh. Emphasis was on simple care to prevent hypothermia, hypoglycaemia and infection, and on involving mothers in caring for their infants as much as possible. The mean birthweight was found to be only 2.44 kg, so that the level of low birthweight requiring special care was fixed at 2.0 kg. At this level, during the first year of operation, 193 low birthweight babies were attended, approximately 20% of total deliveries. Of these, 80% were above 1.5 kg and had a mortality of 25%. Those below 1.5 kg fared worse, and 83% either died or were discharged against medical advice. The main problems were an initial lack of enthusiasm from the nursing staff, high incidence of sepsis (related to poor hygiene of mothers) and difficulty in persuading mothers to keep very low birthweight babies in hospital. However, with minimal expenditure and equipment, appropriate neonatal care saved the lives of many low birthweight infants. Establishing breastfeeding and educating the mothers reduced the subsequent high mortality of low birthweight infants in the first year of life.