6541 A pilot neonatal network for government hospitals in province 2 Madhesh Pradesh, Nepal

Objectives Madhesh Pradesh in Nepal has the second highest neonatal mortality rate and highest delivery rate nationally.1 Neonatal networks have been shown to support collaboration, local hospitals and overall standardisation of care.2 3 The programme aimed improve newborn care across the province by increased collaboration, standardisation, and a common governance framework. Methods A neonatal network was formed to address the challenges shown by a recent survey of 12 government hospitals in Madhesh Pradesh, Nepal where no similar network existed previously.4 The network comprises of a senior nurse and doctor representative from each hospital and aims to meet every 4 months. The following goals were outlined: education and training, standardisation of paperwork, clinical protocols and governance frameworks. Results Baseline service mapping was conducted across all 12 hospitals; data included births, admissions, preterm deliveries, deaths, transfers, staffing and facilities table 1 to shape current scope, provision and gaps. Data were shared with stakeholders in all hospitals and the local government. Data helped identify the need for creating the following workstreams: Education and training A local nursing training scheme has been piloted and established to upskill newborn nursing competencies.5 Outreach support for district hospitals without paediatricians has been piloted at one of the 12 hospitals in Aug 2023.6 Standardisation of paperwork across network hospitals The steering group has ratified 3 routinely used documents including postnatal check proformas, medication charts and newborn early warning score vitals chart to be introduced across the network. Common governance frameworks Standard operating procedures were created and ratified by the steering group to streamline pathways to seek transfer of sick newborns or clinical advice from tertiary centres e.g. table 2. Future tasks are outlined including the need for stakeholder collaboration with the government department of health, UNICEF, patient and public involvement and standardisation of newborn unit admission and transfer criteria. Conclusion This is the first neonatal network established for government hospitals working in low-resource settings in Madhesh Pradesh, Nepal. Early signs are encouraging – network workstreams are supporting pilot programmes for education, helping to open district newborn units and standardisation of paperwork. Ongoing support is needed, with input from stakeholders including clinical staff at hospitals and the government to sustain progress. References Nepal Demographic and Health Survey 2016 https://www.dhsprogram.com/pubs/pdf/fr336/fr336.pdf Profit J, Soll RF. Neonatal networks: clinical research and quality improvement. Semin Fetal Neonatal Med. 2015;20:410–415. Marlow N, Bryan Gill A. Establishing neonatal networks: the reality. Archives of Disease in Childhood – Fetal and Neonatal Edition 2007;92:F137-F142. A McLoughlin, et al. RCPCH conference 2024 submission. H Watson, et al. RCPCH conference 2024 submission. B Prakash, et al. RCPCH conference 2024 submission.