Table 2.
Division of newborn care by the LINC project into six categories of care combined into newborn units across the five South African facility levels41–43 (online supplementary appendix table A3)
| Category of care | Facility level and package of care |
| Routine care |
Primary healthcare (clinic) and hospitals:
All newborns Neonatal resuscitation and routine care at birth Identification and referral of at-risk or sick newborns Care provided by enrolled and professional nurses |
| Inpatient care | |
| Kangaroo mother care |
Level 1 (district hospital), 2 (regional hospital) and 3 (tertiary hospital):
Management of uncomplicated neonates <2000 g Provision of warmth, nutrition and infection prevention |
| Standard inpatient care |
Level 1, 2 and 3 hospitals:
Management of small neonates (1500–2000 g/32–36 weeks’ gestation) Management of large neonates (>4000 g) Management of jaundice (phototherapy), possible infection, wasting, low Apgar scores, meconium staining, uncomplicated congenital abnormalities and neonates requiring oxygen or gavage feeding Care provided by a minimum of professional nurses (1 nurse:6 neonates), enrolled nurses and medical officers (MOs) (24-hour care if >18 beds) |
| High care |
Level 2 and 3 hospitals (may be provided at level 1 depending on available referral centres):
Management of small neonates (<1500 g/<32 weeks’ gestation) Management of jaundice (exchange transfusion), sepsis, convulsions, meconium aspiration, recurrent apnoea, moderate to severe respiratory distress requiring >40% oxygen with a head box, nasal prong CPAP or short-term intermittent positive pressure ventilation Management of chest drains and simple surgical conditions Care provided by a minimum of professional nurses (1 nurse:2 neonates), enrolled nurses and MOs (24-hour care if >18 beds) |
| Intensive care |
Level 2 and 3 hospitals
Management of complex or multisystem medical conditions, persistent hypoglycaemia, cardiovascular disease and neonates requiring invasive ventilation, total parenteral nutrition, therapeutic cooling or advanced neurological or cardiovascular monitoring Management of surgical conditions Care provided by a minimum of professional nurses (ideally 1 nurse:1 neonate; however, it is acceptable to have a ratio of 1:2 at level 3 and 1:3 at level 2), MOs, paediatricians and neonatologists (at level 3) |
| Specialised care and surgery |
Level 4 (quaternary hospital):
Specialised medical and surgical services spanning provincial boundaries Care provided by a minimum of professional nurses (ideally 1 nurse:1 neonate, but acceptable to have a ratio of 1:2), MOs, paediatricians (full time) and neonatologists |
CPAP, continuous positive airway pressure; LINC, Limpopo Initiative for Newborn Care.