Nicu outcome in a low resource teaching hospital setting

ORIGINAL ARTICLE

NICU Outcome in a Low Resource Teaching Hospital Setting

Shruti Sarkar, Dipankar Sarkar, Sheela Longia, Sibi Dinesh.

Department of Paediatrics, People's College of Medical Science and Research Center, Bhopal, MP.

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Abstract
Objective: To study the mortality pattern in a level 3 neonatal intensive care unit (NICU) with special reference to the problems faced in a low resource teaching hospital.

Methods: A retrospective study was conducted over a period of three years from January 2007 to December 2009. 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, stay in NICU, final cause of death and diagnosis or co-morbidities leading to death 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 labour 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 687 babies were admitted in this 3 year period in our NICU. Out of these, 573 babies survived (92.4%) and 47 babies expired (7.5%). The total number of deliveries in these three years was 2912 and the neonatal mortality rate (NMR) in this study was 16.1 per 1000 live births. In the very low birth weight (VLBW) group the survival was 75.4% (n=85) and in extremely low birth weight (ELBW) group it was 22.2% (n=25). In low birth weight (LBW) group 95.8% babies survived (n=367). Overall NICU mortality was 9.7%. Total Survival of VLBW & ELBW together was 63%. Out of 47 expired babies 91.4% (n=43) were premature and 43% babies (n=21) were below 30 weeks of gestational age. Sepsis was the predominant cause of death (31.9%) followed by hyaline membrane disease (HMD) (25.5%) and necrotising enterocolitis (NEC) (9%) in these 47 babies. But when the data was analysed to check the diagnosis or co-morbidities in these babies leading to the cause of death it was found that prematurity was the commonest problem (82%) followed by HMD (63%) and sepsis 48%.

Conclusion: We conclude that the overall survival of newborns in our unit is comparable to many previously published reports.

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