Impact of managerial and clinical interventions on trend of neonatal care and mortality in a regional hospital in Iran: a retrospective study

Background Neonatal mortality is one of the most important indicators of health system performance. This study presents the impact of managerial and clinical interventions on newborn care and mortality in a regional hospital in Iran. Methods This continuous time series study is conducted retrospectively on a four-years course at Ali Ibn Abi Talib Hospital of Zahedan, Iran. Variables of interest included number of deliveries, number of admitted newborns, rate of non-invasive ventilation, rate of surfactant administration in ventilated newborns, mortality rate of ventilated newborns, neonatal mortality rate of hospital, average length of stay of newborns in hospital, and the discharge against medical advice (DAMA) in admitted newborns. Statistical analysis performed by R programming language v. 4.3.2 and using interrupted time series model. P-value of 0.05 considered as significant. Results The interventions included training and capacity building of staff, expansion of Neonatal Intensive Care Unit (NICU) infrastructure, and improving the quality of care. As result of the interventions, number of newborns cared at hospital increased from 101 per month to 166, and at the same time, the rate of non-invasive ventilation increased from 50 to 64%, rate of surfactant use became more rational (decreased from 23.1% to 21.9), mortality rate of ventilated newborns decreased from 43.6% to 24%, average length of stay (from 4.7 to 3.6 days) and the DAMA (from 64 to 10%) decreased too. Conclusion Implemented interventions were successful in improving studied variables. Yet, some impacts of them may appear in time period after this study. Comprehensive, evidence-based intervention packages with consideration of local context may lead to improved care outcomes in NICUs.