Neonatal References: Epidemiology and Prognosis in a Malian Context

Neonatal mortality remains a public health problem in Mali. The neonatal referral is a systemic factor determining the neonatal prognosis. This work was initiated to determine the frequency of neonatal referrals and to determine their prognosis. Patients and Methods: A cross-sectional study was carried out from November 1, 2019 to January 31, 2020 in the neonatology service of the pediatrics department of the Gabriel Toure University Hospital in Bamako. All newborns referred by another health structure in the country were included in this stud. All newborns referred by another health structure in the country were included in this study. To determine the risk factors related to the neonatal referral, we performed univariate and multivariate analyzes to determine the odds ratios and fitted with a significant p probability if p < 0.05 and the 95% confidence interval. Results: The frequency of referrals was 54.3%. Newborns came from basic structures in 19.3% of cases, from tertiary structures in 6.7%. The main reason for transfer was prematurity (40.2%) followed by perinatal anoxia (15.3%), malformations (15.3%), respiratory distress (15.2%) and infection neonatal (9.1%). The ambulance was the primary means of transfer in 71.3%. In 80% of cases the transfer had been made within the first 24 hours of life. On admission, a third of the newborns (31.1%) were less than 1500 g, hypothermic in 43.8% and febrile in 15.1%. The evolution was marked by 40.2% of deaths. The analysis of prognostic factors, allowed us to observe that the more the newborn is premature or of low weight the more risk of death was very high with respectively 18.5 times in the less than 28 weeks of amenorrhea (WA) (ORa = 18.5;CI = 1.9 - 180;p = 0.012) and 6.6 times in those less than 1000g (ORa = 6.6;CI = 1.4 - 29.7;p = 0.015). Likewise, any change in body temperature increased risk of death by 1.9 times compared to normothermia. Conclusion: The establishment of a neonatal referral system is necessary to reduce neonatal mortality in our context.