SAVING MORE NEONATES IN-HOSPITAL - AN INTERVENTION TOWARDS A SUSTAINABLE REDUCTION IN NEONATAL-MORTALITY IN A NICARAGUAN HOSPITAL

A process of change was initiated in a Nicaragruan regional hospital i n order to achieve a sustainable reduction of early neonatal mortality . A series of organizational, educational and hygienic measures was in troduced, involving all staff in antenatal care, delivery care and neo natal care. Neonatal mortality decreased from 56/1000 live births in 1 985 to 11/1000 in 1993. A commission of maternal and child health, a w eekly perinatal audit, the active involvement of all staff and dedicat ed work of key individuals, as well as national policy decisions, are considered important determinants of the process. Keeping neonatal mor tality in focus through continuous analysis of care routines, and thro ugh external exchange of ideas is important in order to sustain improv ements anti to decrease further the mortality.