Nicu Outcome in a Low Resource Teaching Hospital Setting

Abstract

To study the mortality pattern in a level III neonatal intensive care unit (NICU)in a low resource teaching hospital.METHODS: A retrospective study was conducted over a period of three years from January 2011 to December 2013. The medical records of all babies who died after being admitted to the NICU were reviewed. Survival was defined as the discharge of a live infant from the hospital. Data regarding birth weight, gestational age, final cause of death and diagnosis was analyzed. Exclusion criteria were to exclude (A) babies who came in the NICU for a few hours observation and were shifted to mother. (B) Any baby who could not be successfully resuscitated in labor room and (C) babies who left the hospital against medical advice and calculation of survival was done after subtracting them from total admission.RESULTS: A total of 1031 babies were admitted in this 3 year period in our NICU. Out of these, 95.5% babies survived and 46 babies expired (4.4%). The total number of deliveries in these three years was 5400 and the neonatal mortality rate (NMR) in this study was 8.5% per 1000 live births. In the very low birth weight (VLBW) group the survival was 92% (n=101) and in extremely low birth weight (ELBW) group it was 60% (n=10). In low birth weight (LBW) group 95.1% babies survived (n=502). Total Survival of VLBW & ELBW together was 89%. Out of 46 expired babies 86.9% (n=40) were premature and 45.6% babies (n=21) were below 30 weeks of gestational age. Sepsis was the predominant cause of death (34.7%) followed by hyaline membrane disease (HMD) (19.2%) and Hypoxic Ischemic Encephalopathy (HIE) (15.2%) in these 46 babies.CONCLUSIONS: This study identified neonatal sepsis, Hyaline membrane disease or Respiratory distress syndrome (RDS) and HIE as the major contributors to the neonatal mortality. Adequate antenatal care to at risk mothers and advances in the neonatal intensive care with the use of sophisticated technology will improve the neonatal outcome.