Comparitive Study Of Short-Term Outcomes Of Preterm Babies ≤30 Weeks In A Tertiary Care Hospital Between India And The U.K

Abstract

Large numbers of preterm babies are born in middle income countries and neonatal care is improving in these countries. However, comparative clinical outcomes of preterm babies between a tertiary neonatal unit from middle income country and higher income country is limited. Objective: To compare the clinical profile and short-term outcomes of preterm babies ≤ 30 weeks gestation admitted to a tertiary care hospital in India and the U.K. Design: Retrospective cohort observational study using anonymised data from Electronic Patient Records. Setting: Regional tertiary neonatal intensive care unit (NICU) of Manipal Hospitals, Bangalore, India and Homerton University Hospital, London, UK. Participants: Preterm babies born at ≤ 30 weeks gestation admitted to NICUs over five year period (January 2011 to December 2015). Infants with major congenital abnormalities were excluded. Intervention: This is an observational study and routine care was provided as per departmental standard protocols. Main outcome measures: Comparison of neonatal unit mortality between two centres, infant morbidities till discharge from neonatal unit. Results: A total of 740 babies from the U.K centre and 294 babies from Indian centre were enrolled into the study. The mean gestational age in the U.K cohort was 26.6 ± 2.16 weeks, whereas in Indian cohort was 28.4 ± 1.66 weeks (p,<0.001). A significantly lower number of mothers received antenatal steroid (37% v 73%), and higher number of babies were inborn (78.6%) in Indian centre compared to the UK centre (67.3%; p < 0.001). Incidence of BPD and IVH ≥ grade 2 was significantly lower, and ROP needing treatment was significantly higher in Indian centre. Higher number of babies were treated for ductus arteriosus and incidence of culture positive sepsis was significantly high in Indian cohort babies. Survival of babies born at gestational age > 28 weeks was comparable between the U.K and Indian centres. Survival of babies born at ≤ 28 weeks gestation was lower in Indian centre. Conclusions and relevance: The survival of babies above 28 weeks prematurity was comparable between a tertiary care centre in India and the U.K. However, survival of babies ≤ 28 weeks gestation was lower in Indian centre. Incidence of ROP and sepsis was higher in Indian centre.