First-Year Experience of a Newly Established Level II Neonatal Unit in Kaduna, Northwest Nigeria: High Patient Load and High Survival Despite Resource Constraints

Abstract

Background:
Neonatal mortality remains a major contributor to under-five mortality in Nigeria, accounting for approximately 30–40% of all under-five deaths. Although Kaduna State has recorded a decline in neonatal mortality from 63 to 47 deaths per 1,000 live births between 2018 and 2023–24, the rate remains above the national average of 41 per 1,000 live births. Strengthening facility-based neonatal care is essential to reducing preventable neonatal deaths. This study evaluated the first year performance of a newly established Level II
neonatal unit in Kaduna State, Northwestern Nigeria.

Subjects and Methods:
A retrospective descriptive study was conducted using routinely collected data from all neonates admitted to the Yusuf Dantsoho Memorial Hospital (YDMH) neonatal unit between June 2024 and May 2025. Data were extracted from admission and discharge registers, case notes, unit logbooks, and performance reports. Variables collected included demographic characteristics, birth
weight, gestational age, diagnoses, interventions received, and outcomes. Data was analyzed using descriptive statistics.

Results:
A total of 832 neonates were admitted during the study period, of whom 662 (79.6%) were referred from outside the facility (outborn). Monthly admissions ranged from 41 to 110, with an average of 76 admissions per month. The outborn ward consistently operated at full occupancy. Overall survival to discharge was 94.1%, while mortality was 5.9%. The leading causes of admission were neonatal sepsis (31.8%) and birth asphyxia (29.9%). Kangaroo Mother Care was provided to 184 low-birth-weight infants, including 160 weighing less than 2.0 kg. Twenty three neonates received continuous positive airway pressure (CPAP), while 152 received phototherapy and nine underwent exchange blood transfusion. Oxygen therapy was administered to 38% of admitted neonates. Successful resuscitation resulting in spontaneous breathing was achieved in 91.7% of neonates requiring support at birth. Birth asphyxia accounted for the largest proportion of deaths (36.7%)

Conclusions:
The newly established Level II neonatal unit managed a high volume of admissions and achieved high survival outcomes despite significant resource constraints. The findings demonstrate that strategic investments in neonatal infrastructure, equipment, development, and evidence-based workforce clinical practices can substantially improve neonatal outcomes in resource-limited settings. Expansion of similar Level II neonatal services could contribute significantly to reducing neonatal mortality in Nigeria and comparable low- and middle-income countries.