Scalability of the Basic Care Model for Very Low Birth Weight Infants and Implementation Research Considerations

Objectives: To study the scalability of the rural hospital (RH) model of basic newborn care in a general hospital (GH) by including very low birth weight (VLBW) infants, and to assess the implementation aspects. Study design: Observational Settings: RH (1988-1992) and General Hospital, (GH) (2010-2013). Subjects: VLBW infants with birth weight ranging from 1000 g to 1500 g. Interventions: (1) RH: Basic care including warmth, feeding, antibiotics, and oxygen (2) GH: Basic plus circulatory care (2010-12), and continuous positive airway pressure (CPAP) support (2013). Mechanical ventilation and surfactant therapy were not available. Main outcome measure: Mortality Results: The cumulative mortality (38.5%) with basic neonatal care in the RH model declined to 26.6% at the GH with the addition of circulatory support and a “home-made” CPAP system. Conclusions: The RH package may be scaled up by adding CPAP and circulatory support to reduce the mortality among VLBW infants. The RH model is scalable horizontally and vertically. What is already known about this subject? Implementation research constitutes a relatively new and underdeveloped field, One of the facets of health system research is the implementation research. Implementation research aims at bridging the gaps between knowledge and action. What does this study add? Tertiary care center can help in developing basic newborn care at a rural hospital. The rural hospital model can be upscaled vertically as well as horizontally. Addition of circulatory support and CPAP to basic newborn care can significantly lower neonatal mortality. How might it impact on clinical practice in the foreseeable future? The study may encourage tertiary care centers to facilitate the development of basic newborn care centers at the rural hospitals. These centers, in turn, can spread horizontally.