Data sources for estimates of neonatal conditions requiring inpatient care
| Condition | Definition/inclusion | Data source for crude estimate | Study population | Evidence level* | Data source for adjustment |
| <32 weeks preterm | All neonates born <32 weeks gestational age according to ‘best obstetric estimate’ | Unpublished breakdown (Zahida Quresh & Alfred Osoti, personal communication, 2016) of published data from the WHO Multicountry Survey on Maternal and Newborn Health 43 | All (n=6439) births in six hospitals in Nairobi City County May 2010–January 2011 | V | NA |
|
Birth weight (BW) <2000 g | All neonates born with BW <2000 g | Birth data (n=5550) from Pumwani Maternity Hospital newborn unit (Jalemba Aluvaala, personal communication, 2016) | |||
| Large for gestational age | All neonates with BW >4000 g. The term ‘large for gestational age’, rather than foetal macrosomia, is used in the framework as this is more commonly used within the Kenyan medical community | ||||
| Neonatal encephalopathy | Intrapartum-related hypoxia and its complications—Sarnat grades II and III42 | Lee et al, 2013 44 | Sub-Saharan Africa (SSA) modelled estimate for 2012 from global systematic review | IIIb | NA |
| Neonatal respiratory diseases | Respiratory distress syndrome (RDS), transient tachypnoea of the newborn (TTN) and meconium aspiration syndrome (MAS) | RDS/TTN 45 46 MAS* 47 48 | RDS/TTN: Swedish population-based study of 481 416 neonates from 2004 to 2008 MAS: UK population-based study of 4 99 096 neonates from 1998 to 2000 | IV | Gestational age breakdown45 46 47 |
| Severe infection | Possible severe bacterial infection (pSBI) as defined from WHO Young Infants Clinical Signs Study (YICCS) criteria)31 | Seale et al 31 | SSA modelled estimate for 2012 from global systematic review | IIIb | NA |
| Jaundice requiring treatment | Neonatal jaundice requiring medical intervention (ie, phototherapy or exchange blood transfusion) | Olusanya et al 49 | 5266 neonates presenting to four primary healthcare clinics for routine vaccination in Lagos, Nigeria. Overall vaccine uptake estimated to be 75%–98%. These clinics known to account for >75% of all vaccination in the city | V | Systematic review for the UK National Institute of Clinical Excellence50 |
| Major congenital malformations | Congenital malformations likely to result in mortality or severe morbidity without neonatal inpatient care: congenital heart defects, major central nervous system defects, orofacial clefts, major gastrointestinal malformations | Different sources were used to estimate different malformation groups. Data were used from the Modell Global Database of Congenital Disorders51 52 the International Clearinghouse for Birth Defects Surveillance and Research, (ICBDSR)53 the European Concerted Action on Congenital Anomalies and Twins, (EUROCAT)54and individual studies from SSA55–62 and high-income settings.63 64 For details, see online (supplementary appendix table 2) | IIIa/IV/V | Prevalence ratios64 (large collection of USA birth registries: n=7, 209, 768 births) used to distribute cases by gestational age | |
| Intrapartum stillbirths | Foetal death occurring during the period of labour, in neonates≥1000 g BW or ≥28 weeks of gestation | Lawn et al 65 and Cousens et al 66 | Kenyan national stillbirths (total) estimate from global systematic review for 2009 and SSA estimate of proportion of stillbirths that are intrapartum for 200965 66 | IIIa/IIIb | NA |
*Evidence levels correspond to the hierarchy of evidence outlined in appendix 2 table s1
†Balchin et al estimate incidence of meconium stained amniotic fluid (MSAF), Fanaroff reports only 5% of neonates born with MSAF develop MAS—results calculated accordingly (see online supplementary appendix 1 for details).
‡Although Seale et al focused on pSBI, the broad nature of the YICCS criteria they applied to identify pSBI also results in the inclusion of severe non-bacterial infections (i.e. viral or fungal), which may require inpatient neonatal care.