Challenges and opportunities for neonatal respiratory support in Nigeria: a case for regionalisation of care

Background: Neonatal health appears not to have received the deserved attention in the context of the Child Survival Strategies and this must have contributed to the non-attainment of the MDG-4 in Nigeria. Neonatal mortality contributes 40% or more to the current rate of child deaths globally, with birth asphyxia, prematurity and its complications and severe infections as the leading causes. This emphasises the need to re-focus on neonatal health. Given the state of the economy in the lowand middle-income countries, Nigeria, like most of the other countries lack the resources required for efficient neonatal health care with minimal attention on the strategies needed to address the major causes of newborn death. Objectives: To assess the contemporary situation of neonatal care in Benin City, Nigeria and examine diverse approaches to be adopted to provide high level neonatal care services aimed at improving neonatal survival rates. Methods: The trends of neonatal morbidities and mortality over the period between 1974 and 2014 were studied by reviewing the hospital records covering admissions and weekly mortality records. The pattern of categories of babies and the causes of death were recorded. The information gathered identified the gaps in the management strategies for newborns over the years. Electronic databases such as the Medline and Pubmed were searched for relevant literatures published between 1960 and 2015 which might provide ideas required to fill the gaps. Results: In the 1974-1976 era, the major cause of neonatal mortality at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria, was birth asphyxia with an attendant perinatal mortality of 80.9/1000 births. The decline in the perinatal mortality to 33.4/1000 births between 1976 and 1980 was linked to the introduction of delivery room resuscitation with a reciprocal decline in the incidence of birth asphyxia. Thereafter, neonatal mortality rate has continued to increase. This increase could be attributed to a three-fold rise in the proportion of very preterm admissions from 6.5% in 1985 to 19.3% in 2013. This population of babies is predisposed to Respiratory Distress Syndrome and respiratory failure. Neonatal intensive care did not include respiratory supports until very recently (2013) when the facilities were provided but at high cost to the patient and the health system. Conclusion: The strategies required to address reduction in neonatal mortality rates should necessarily include neonatal resuscitation and mechanical ventilation, all within the context of Neonatal Intensive Care. In order to provide the full range of neonatal intensive care services in a resourceconstrained setting such as Benin City, Nigeria, regionalisation of care in a stepwise manner is recommended, both for improved medical outcomes and economic realities.