Mortality Pattern of In-Born vs Out-Born Neonates - Comparative Study of Neonates Admitted to Special New Born Care Units of a Tertiary Care Hospital of Hilly Region of North India

Abstract

BACKGROUND The high incidence of global neonatal mortality has triggered several efforts to improve facility-based neonatal care but despite these many advances in perinatal and neonatal care, the outcomes achievable at different levels are comparable. This study was undertaken to compare the mortality pattern among both the inborn and outborn neonates admitted to the special new born care units (SNCU)s of tertiary care hospital of Shimla city, in the hilly state of Himachal Pradesh. METHODS A cross-sectional study involving a record review of all neonates admitted to the specialized neonatal care units of the paediatric ward of IGMC, Shimla & Kamla Nehru Hospital (KNH) over five years from January 2016 to December 2020 was conducted. The most important causes of mortality and its associated factors were analysed, and a statistical inference was made. RESULTS Among the 4018 outborn neonates admitted to the SNCU of the pediatric ward of IGMC, Shimla, 2440 (60.73 %) were males and 1578 (39.27 %) were females while 6607 inborn neonates were admitted to the SNCU of KNH Shimla and among them 3655 (55.32 %) were males and 2952 (44.68 %) were females. In the outborn SNCU of IGMC Shimla, 307 (7.64 %) died while in the inborn SNCU of KNH Shimla, 366 (5.54 %) neonates died over a span of 5 years. In outborn SNCU of IGMC Shimla, a maximum of 110 (35.83 %) neonates died due to sepsis/pneumonia/meningitis, followed by 60 (19.54 %) due to respiratory distress syndrome and 50 (16.29 %) due to HIE/moderate-severe birth asphyxia while in case of inborn SNCU of KNH, maximum deaths of 115 (31.42 %) were due to respiratory distress syndrome, followed by 93 (25.41 %) due to sepsis/pneumonia/meningitis and 69 (18.85 %) due to HIE/moderate-severe birth asphyxia. At outborn SNCU of IGMC, Shimla, most of the neonates who died 118 (38.44 %) weighed about 1500-2499 gm, while in inborn SNCU of KNH, Shimla, most of the neonates 147 (40.16 %) had weight between 1000-1499 gm. At outborn SNCU of IGMC Shimla, 131 (42.67 %) were preterm while at inborn SNCU of KNH, 305 (83.3 %) were preterm. CONCLUSIONS Sepsis, birth asphyxia and RDS are the important causes of mortality, which must be urgently addressed. Improving antenatal care, improved access to health facilities, early identification of danger signs, timely referral, capacity building, can reduce neonatal mortality. KEY WORDS Comparison, Neonatal Mortality, SNCUs, Tertiary Care Hospital, Inborn Neonate, Outborn Neonate.