final data MPDSR Week 3 march 2024.pptx

Weekly mpdsr report

1. Kawempe National Referral Hospital MPDSR 17/03/2024 – 23/03/2024 DR. TUMUKUNDE VICTOR (PAEDIATRICIAN) DR. NDAWULA INNOCENT (JHO)

2. Weekly statistics 17 th -23 th MARCH DAY 17TH 18TH 19TH 20TH 21nd 22rd 23th Total Prev wk Admissions 16 25 16 26 19 17 23 142 161 Hospital born 10 15 10 18 12 11 15 91 103 BBA 00 01 00 00 01 01 00 03 02 Referrals in 06 9 06 08 06 05 08 48 56 Preterms 07 12 08 14 11 11 13 76 75 Terms 09 13 08 12 08 6 10 66 87

3. Weekly statistics DAY 17th 18th 19th 20TH 21ST 22nd 23rd Total Prev .wk Referrals out 00 01 00 00 2 00 01 04 01 Discharges 12 10 03 09 07 20 05 66 127 Deaths 00 03 04 05 02 03 04 21 24 Preterms on ward 42 48 53 56 47 40 43 AVG 47 AVG 45 Terms on ward 37 26 31 37 50 32 35 AVG 35 AVG 39 Total on ward 79 74 84 93 97 72 78 AVG 82 AVG 84

4. Death summary Mortality by time of the day day duty –6(29%) evening duty – 8(38%) night duty-7(33%) DAY 17th 18th 19th 20th 21st 22nd 23rd Total Prev .wk Deaths 00 01 05 06 02 03 04 21 24 ENND 00 01 04 06 02 03 03 19 24 LNND 00 00 01 00 00 00 01 02 00 Term babies 00 00 02 03 02 00 01 08(38% 6(25% Preterm babies 00 01 03 03 00 03 03 13(62% 18(75% Born from KNRH 00 00 01 03 01 01 03 09(43% 10(42% Referrals / BBA/ Unknown 00 01 04 03 01 02 01 12(57% 14(58%

5. 11/03/2024 – 16/03/2024 17/03/2024- 23/03/2024 admissions 161 142 Discharges 127 66 Mortality 24 21

6. Possible causes of Death Possible cause of Death Total Number From KNRH Referral/BBA Respiratory Distress Syndrome 06 3 3 Hemorrhagic Disease of the Newborn/bleeding disorder 03 2 1 Birth Asphyxia / Hypoxic Ischemic Encephalopathy 06 2 4 Congenital Anomalies 01 1 Neonatal Sepsis 04 1 3 NEC with prematurity 01 1

7. REFERRAL UNIT NUMBER OF DEATHS CAUSE OF DEATH TMR HOSPITAL 01 HIE KISENYI HC IV 02 N . SEPSIS, HIE DOCTORS’ HOSPITAL SSEGUKU 02 RDS ,N.SEPSIS MADDU HC IV 01 RDS KISAKYE MEDICAL SERVICES 01 N.SEPSIS MIREMBE HC III 01 CONGENITAL ANOMALIES MUKONO GENERAL HOSPITAL 02 RDS ,HDN KAMWOKYA HC 01 HIE KISUBI H/C 01 HIE

8. Project analysis slide 8 CHALLENGES AMONG REFERRALS Challenges Recommendations. Babies brought in very sick with severe asphyxia, low APGAR scores , window for intervention is usually small. ( TMR HOSPITAL , KISENYI HCIV) Some facilities are still low on pre referral communication. Feedback being given to referral units Communication prior to referral– baby should have documentation on whether communication done

9. Project analysis slide 8 Kawempe born challenges (OBGY and SCU) Challenges Recommendations. S ome staff are using students to transfer babies to special care unit and yet these students don’t fill in the admission forms correctly. We still don’t have iv ampicillin and burretes Staffs should escort babies to SCU and complete the documentation in the admission files and book.

10. POSITIVES The unit acquired a new printer so we shall be able to print out our discharges Timely response by the biomedical engineers Most of the drugs and supplies are available especially Surfactant and oxygen cylinders Fewer power outages

11. CASE SUMMARIES

12. CASE 1 Maternal history Name: N.H IP NO. : UG-CCM-336 AGE: 32 GRAVIDITY-PARITY:- G6P5+0 DOA: 15/03/24 Presented with a history of labor like pains, no pv bleeding, no DOL

13. Case 1 15/03/24 at 21 48hrs Received a G6p5+0 not sure of dates with LLP No other history reported VE v+v normal, os 9cm dilated, membranes ruptured and clear liquor No other exam findings reported 16/03/24 at 03 30 hrs ( 6 hrs later ) G6P5+0 at term admitted in active labor reportedly to have been in second stage > 1 hour O/E:- FGC afebrile, no pallor, exhausted, no dehydration PA:- FH 38/40, Ceph , LL, Presenting Part 3/5 palpable, 3 Contractions noted in 10 mins , FHHR 152 bpm VE v+v normal,cx os fully dilated, membranes ruptured, clear liquor ,caput +++, moulding ++ station +1

14. 1 At 03 35hrs later , delivered the baby by SVD , Baby boy 3.5kg a/s 4-6 at 03 45hrs 10minutes after the arrival of the dr. Baby was admitted to SCU at 4 59hrs on the 16/03/24 1hr and 14 mins later due to birth asphyxia Case 1 An impression of obstructed labour made Booked for emergency c-section Blood work up done 1L of Ringer’s lactate given

15. CASE 1 Baby was sick looking ,convulsing in severe respiratory distress with a SAS 7/10 Sp02 72%on room air We made a diagnosis HIE II ??? EONS Baby was managed with iv phenobarbital, ampicillin ,genta,vit k,TXA and put the baby on CPAP Baby continued to desaturate on mechanical vent, attempts to resuscitate using bag and mask ventilation, adrenaline and chest compressions were futile, baby confirmed dead on 20/03/24 at 11 15hrs on his DOL 5 CAUSE OF DEATH .HIE II

16. GAPS Delivering a mother who had features of obstruction by SVD Delay to make timely intervention following prolonged stage of labor RECOMMENDATIONS TIMELY MONITORING OF MOTHERS IN LABOUR THIS MOTHER WOULD HAVE BENEFITED FROM C/S

17. CASE 2 Name:- B/O N.S Age:- 33 years Gravidity-Parity:- G5P3+1 IPNo :- UG-ANH-542 DOA:- 13/03/24 at 1136hours Baby’s DOB:- 13/03/24 at 1420hours Place of birth:- KNRH APGAR:- 9-10 Birth weight:- 2.8kg Mode of delivery:- SVD Baby’s DOD:- 21/03/24 at 1050 hours Time spent :-7 DAYS

18. Maternal history 13/03/24 at 1136hrs 33/F G5P3+1 at 40WOA by dates, 1P/S 6years ago, VBAC 1 year ago to an ENND due to birth asphyxia Came in with 5 hrs hx of LLP not associated with headache, blurring of vision, or epigastric pain and no pv bleeding O /E afebrile , not pale BP- 198/106mmhg,pr100bpm PA FH 38/40,FHHR145-155bpm, Ceph , LL ,ROA VE v+v normal ,cx 4cm dilated 50%effaced,station -2, membranes intact

19. Mother delivered a live baby girl by SVD with a birth weight of 2.8kg , APGAR Score 9-10 on 13/03/24 at around 14 20 hours (3hrs 30 mins later). Baby brought to SCU at 12 48hours on 15/03/24 a day after delivery due to “excessive crying and dehydration” O/E:- Baby was sick looking , moderate palor, deeply jaundiced , afebrile , some dehydration . baby had been given warm water by the mother because she had no expressed breast milk outflow and yet the baby was crying . Had a distended abdomen with green aspirates. In severe respiratory distress with a SAS score of 7/10, saturating at 75% on room air Heart rate of 145 b/min Diagnosis:- Neonatal sepsis Some dehydration Neonatal jaundice Anemia r/o HDN

20. CBC done showed marked leukocytosis predominantly neutrophils: Baby was initiated on cefotaxime , IV fluids (D10) and phototherapy for 3 days with no improvement IV M eropenem was also initiated Baby kept desaturating on bubble CPAP but we had no free mechanical Ventilation and electric CPAP Baby deteriorated and passed on 10 00hrs on 21/03/24 on the 8 th DOL

21. POSSIBLE CAUSE OF DEATH :- NEONATAL SEPSIS GAPS Baby was given water because she had no breast milk Baby was born to a high risk mother and the baby not transferred to SCU immediately RECOMMENDATIONS Guidance on how to manage babies of mothers who don’t have EBM ALL BABIES born to high risk mothers should be transferred immediately to SCU for monitoring

22. RAMADHAN MUBARAK BLESSED HOLY WEEK