Intensive Care for High-Risk Infants in Calcutta

Subramanian, Chitra; Clark-Prakash, Cherie; Dadina, Zarine K.; Ferrara, Bruce; Johnson, Dana E.

doi:10.1001/archpedi.1986.02140230055031

Cited by 7 publications

(3 citation statements)

References 15 publications

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“…Data from Mayurbhanj indicated that the NMR among infants with birthweight of >1,500 g showed a decline while those having very LBW did not benefit much. Similar findings were discussed in India in a level II unit where weights of babies in the range of 1,500-2,499 g had the maximum decline in mortality (14). The impact of level II units on very LBW babies yielded mixed results (12,15).…”

Section: Discussionsupporting

confidence: 74%

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Assessment of Special Care Newborn Units in India

Neogi

Malhotra

Zodpey

et al. 2011

J Health Popul Nutr

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The neonatal mortality rate in India is high and stagnant. Special Care Newborn Units (SCNUs) have been set up to provide quality level II newborn-care services in several district hospitals to meet this challenge. The units are located in some remotest districts where the burden of neonatal deaths is high, and access to special newborn care is poor. The study was conducted to assess the functioning of SCNUs in eight rural districts of India. The evaluation was based on an analysis of secondary data from the eight units that had been functioning for at least one year. A cross-sectional survey was also conducted to assess the availability of human resources, equipment, and quality care. Descriptive statistics were used for analyzing the inputs (resources) and outcomes (morbidity and mortality). The rate of mortality among admitted neonates was taken as the key outcome variable to assess the performance of the units. Chi-square test was used for analyzing the trend of case-fatality rate over a period of 3-5 years considering the first year of operationalization as the base. Correlation coefficients were estimated to understand the possible association of case-fatality rate with factors, such as bed:doctor ratio, bed:nurse ratio, average duration of stay, and bed occupancy rate, and the asepsis score was determined. The rates of admission increased from a median of 16.7 per 100 deliveries in 2008 to 19.5 per 100 deliveries in 2009. The case-fatality rate reduced from 4% to 40% within one year of their functioning. Proportional mortality due to sepsis and low birthweight (LBW) declined significantly over two years (LBW <2.5 kg). The major reasons for admission and the major causes of deaths were birth asphyxia, sepsis, and LBW/prematurity. The units had a varying nurse:bed ratio (1:0.5-1:1.3). The bed occupancy rate ranged from 28% to 155% (median 103%), and the average duration of stay ranged from two days to 15 days (median 4.75 days). Repair and maintenance of equipment were a major concern. It is possible to set up and manage quality SCNUs and improve the survival of newborns with LBW and sepsis in developing countries, although several challenges relating to human resources, maintenance of equipment, and maintenance of asepsis remain.

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Section: Discussionsupporting

confidence: 74%

“…Experiences worldwide have shown that level II units can contribute maximally towards bringing down the mortality rate among LBW babies (11,12,14,15). With improved performance in the functioning, the NMR among infants of >1,500 g can match that of a level III unit.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Special Care Newborn Units in India

Neogi

Malhotra

Zodpey

et al. 2011

J Health Popul Nutr

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“…Regionalized neonatal/perinatal care with a good network of facilities at various levels has emerged as an effective strategy to tackle neonatal disease burden [2,3]. Evidence supports that in places where regionalization is not present, secondary level units can also lower NMR significantly [4][5][6][7][8][9]. Establishing such neonatal units is currently one of the thrust areas in South-east Asian countries.…”

mentioning

confidence: 92%

Challenges in scaling up of special care newborn units-lessons from India

et al. 2011

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Neonatal mortality rate in India is high and stagnant. Special Care Newborn Units (SCNUs) are being set up to provide quality level II newborn care services in district hospitals of several districts to meet this challenge. The units are located in some of the remotest districts where the burden of neonatal deaths and accessibility to special care is a concern. A recently concluded evaluation of these units indicates that it is possible to provide quality level II newborn care in district hospitals. However, there are critical constraints such as availability and skills of human resources, maintenance of equipment and bed occupancy. It is not the SCNU alone but an active network of SCNU (level II care), neonatal stabilization units (level I care) and newborn care corners can impact neonatal mortality rate reduction higher. Number of beds is also not sufficient to cater to the increasing demand of such services. Available number of nurses is a problem in many such units. An effective and sustainable system to maintain and repair the equipment is essential. Scaling up these units would require squarely addressing these issues.

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