{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T02:30:39Z","timestamp":1785897039623,"version":"3.56.0"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.18871.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T00:00:00Z","timestamp":1700784000000}},{"DOI":"10.12688\/wellcomeopenres.18871.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T00:00:00Z","timestamp":1700784000000}}],"reference-count":43,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T00:00:00Z","timestamp":1700784000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["092654"],"award-info":[{"award-number":["092654"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"crossref","award":["207522"],"award-info":[{"award-number":["207522"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns3:p>Background One in five newborns in Nairobi County, Kenya, may require inpatient neonatal care. We sought to examine referrals to and from three busy first-level referral public hospitals in Nairobi and what infrastructure and systems are available to support neonatal transport from these first-referral level hospitals to the main tertiary care center. Methods Patient-level data of newborns over 12 months were retrospectively extracted from routinely collected patient data and examined to characterize those referred into and out of three newborn units in the study hospitals. Structural assessments using a checklist completed during hospital visits were used to describe hospitals\u2019 readiness to support newborn referral and transport. Results Five percent (398\/7720) of the cohort studied were either referrals into study hospitals (68%, 272\/398) or referrals out (32%, 126\/398). Among 397 (99%) and 268 (67%) with sex and gestation documented respectively, 63% (251) were male and 44% (118) were preterm infants (&lt;37 weeks). Among those referred in, 26% (69\/272) died and 2.6% (7\/272) were further referred to a tertiary-care newborn unit. Prematurity (39%) and birth asphyxia (29%) were the main in-referral reasons from 38 different health facilities, with specialist reviews (34%) predominant for out-referrals to a tertiary center. Diverse transport methods were used for referrals to study hospitals including private and public ambulances, vehicles, and guardian\u2019s arms while onward referrals to the tertiary center were done by hospital ambulances. Drugs and medical supplies required for stabilization were well available at the study sites, however, only oxygen nasal cannula, nasal prongs, and face masks were available in ambulance of hospital 3. Conclusion There is a need to develop, equip and maintain a high-quality referral and newborn transport system that can support the continuum of newborn care across referral care pathways into and from first-referral level hospitals.<\/ns3:p>","DOI":"10.12688\/wellcomeopenres.18871.3","type":"journal-article","created":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T09:50:20Z","timestamp":1700819420000},"page":"126","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Assessment of neonatal referral infrastructure and clinical characteristics of referred neonates in three first referral hospitals in Nairobi County, Kenya"],"prefix":"10.12688","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5593-1211","authenticated-orcid":false,"given":"John","family":"Wainaina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Irimu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7427-0826","authenticated-orcid":false,"given":"Mike","family":"English","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Mbaire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Waiyego","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Manyasi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kimutai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caren","family":"Emadau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia","family":"Muturi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0851-3711","authenticated-orcid":false,"given":"Jalemba","family":"Aluvaala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2023,11,24]]},"reference":[{"key":"ref-1","article-title":"Neonatal 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status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.20925.r56055, Susan Niermeyer, Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, 21 Apr 2023, version 1, 2 approved with reservations","URL":"https:\/\/wellcomeopenresearch.org\/articles\/8-126\/v1#referee-response-56055","order":0,"name":"referee-response-56055","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.22432.r70510, Helen Nabwera, Department of Paediatrics and Child Health, The Aga Khan University, Nairobi, 28 Dec 2023, version 3, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/8-126\/v3#referee-response-70510","order":1,"name":"referee-response-70510","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.22432.r106512, Peter Saula, School of Medicine, Moi University, Eldoret, 05 Nov 2024, version 3, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/8-126\/v3#referee-response-106512","order":2,"name":"referee-response-106512","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by funds from the Wellcome Trust (#207522) awarded to Mike English as a senior fellowship together and funds from a Wellcome Trust core grant awarded to the KEMRI-Wellcome Trust Research Programme (#092654). Additional financial support came from a grant to the NEST program from the John D. and Catherine T. MacArthur Foundation, the Bill & Melinda Gates Foundation, ELMA Philanthropies, and The Children\u2019s Investment Fund Foundation UK under agreements to William Marsh Rice University with a sub-agreement to ME through the University of Oxford Centre for Tropical Medicine and Global Health\u201d. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}