Clinical Profile and Outcome of Newborns Discharged Against Medical Advice From a Tertiary Care Centre

Discharge against medical advice in Special Care Newborn Unit in Chattogram, Bangladesh: Prevalence, causes and predictors

“…Prematurity (25.8%) exceeds PNA (23.9%) and sepsis (22.6%) in Nigeria [ 3 ]. Another two studies found additional causes of low birth weight (10.2%) and neonatal jaundice (10.2%) [ 13 ]: major congenital malformations (58%) and perinatal asphyxia (14%) [ 21 ]. Common congenital anomalies which lead to DAMA were congenital anorectal malformations, esophageal atresia/tracheoesophageal fistula, and congenital intestinal atresia [ 2 ].…”

Discharge against medical advice in the neonatal unit of Rivers State University Teaching Hospital, Nigeria: a two-year prospective study

“…10,[18][19][20][21] Much higher prevalences of 6.7%, 7.5%, 7.7%, 9.3%, 11.1% and 25.4% were documented in Abuja northern Nigeria, Edo state southern Nigeria, India, Jigawa, Gombe northern Nigeria and India respectively. 1,4,5,7,14,22 These differences could be attributed to different geographic locations, variation over time even in the same locality, socioeconomic status, ignorance, cultural factors as well as the availability of health insurance.…”

“…While the occurrence of DAMA is frequently unanticipated, challenging and upsetting for the treating paediatrician to discharge a sick newborn against medical advice, the consequences are double-edged because it puts a tremendous burden on the healthcare system and the family by raising the rate of both hospital readmissions and out-of-hospital deaths. 4,5 Oftentimes, the choice to stop treatment of the hospitalized unwell neonate is frequently made by their parents or a significant family member. 4,[6][7][8] This is especially disconcerting because it violates children's rights and presents legal concerns.…”

“…[6][7][8]12,14 However, some studies in India found the presence of congenital anomalies and a study in China found younger maternal age, neonates that are small for gestational age and have low Apgar scores to be significantly associated with neonatal DAMA. 2,5,16 Yet, another study from Saudi Arabia differed, as the author suggested that the risk factors for neonatal DAMA were difficult to predict because they were numerous. 10 Co-existing disease conditions can influence the parental choice to allow their infants complete treatment while on admission.…”

“…While most studies in Nigeria document neonatal sepsis, birth asphyxia and prematurity as the common neonatal co-morbidities, a study conducted in India where families were contacted via telephone following DAMA, reported the presence of congenital malformations and cardiac malformations to have accounted for over half (58.6%) and about two-fifths (43.7%) of DAMA cases respectively. [5][6][7][8]12,15 The authors highlighted that four out of five (80%) neonates with DAMA died within a median of 11 days post-DAMA. On the contrary, more often than not, in the Nigerian setting, neonates DAMA are lost to follow-up and are at an increased risk of death which go largely unrecorded.…”