An Audit of Specialized Newborn Care Unit’s (SNCU) Performance at a Taluk Hospital in India

Abstract

Objective: To report the performance of specialized newborn care unit (SNCU) at a Taluk hospital and its impact on the trends in neonatal mortality rate (NMR) over one calendar year. Existing publications on NMR are from tertiary centers that may not reflect ground realities at semirural and district hospitals. Design:Retrospective comparative clinical study with a closed audit loop (i.e. level of evidence [LoE] III) comparing the NMR before inception of SNCU (Group I) vs. since establishing SNCU (Group II) was undertaken.Setting: Review of all live births and neonatal deaths at SNCU of a Taluk hospital of Uttara Kannada district in Karnataka state, India. Patients:The parturition and death registers of all deliveries over two calendar years immediately preceding the establishment of SNCU (Group I) and since its inception and regular functioning (Group II) were reviewed and details pertaining to the sex of the neonate, mode of delivery, birth weight, pre-term vs. full-term, reason for admission to SNCU, cause of death (where applicable) were collected against a standardized proforma which formed the study cohort. Interventions:The clinical services provided to neonates by SNCU and its impact on neonatal mortality rate (NMR) was studied.Outcomes: NMR was the key outcome studied in reporting SNCU's performance.Results: There was a two-fold reduction in NMR in Group II and SNCU was instrumental in reducing the NMR from 6.4/1000 live births (Group I) to 3.03 (Group II). There was also a significant reduction in NMR of babies born out of caesarean sections (p=0.04). Conclusion:The SNCU was pivotal in providing round the clock clinical care that was associated with reduction in NMR and timely referrals to tertiary centers in realizing the national rural health mission's(NRHM) millennium developmental goals (MDG) towards improving maternal and child health.