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NEONATAL PROFILE AND OUTCOME OF THE NEONATES ADMITTED IN NICU:

A HOSPTAL BASED PROSPECTIVE STUDY

Research · May 2018

DOI: 10.13140/RG.2.2.22772.45449

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 ORIGINAL RESEARCH PAPER Volume-7 | Issue-5 | May-2018 | ISSN No 2277 - 8179 | IF : 4.758 | IC Value : 93.98

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH

“NEONATAL PROFILE AND OUTCOME OF THE NEONATES ADMITTED IN NICU:

A HOSPITAL BASED PROSPECTVE STUDY”

Neonatal
Yudhvir Singh Block Medical Officer *Corresponding Author
Kotwal*
Farooq Ahmed Jan Additional Professor & Medical Superintendent
Ghulam Hassan Assistant Professor & Head of Department
Yatoo
Sangita Kotwal Consultant Pediatrician
ABSTRACT
BACKGROUND: India contributes to about 1.2 million deaths every year out of the four million newborn babies who die in the first month of life
out of which. India thus faces the biggest newborn health challenge of any country in the world. A study of NICU was undertaken at SKIMS
Srinagar to determine the profile and outcome of the neonates admitted to a NICU of a Tertiary Care Teaching Hospital in Jammu & Kashmir.
MATERIAL AND METHODS: A descriptive case series hospital based prospective study was conducted over a period of one year from with
effect from 1st January 2013 to 31st December 2013 in NICU of SKIMS Srinagar by following neonates from admission to discharge, LAMA or
death collecting the data by using a proforma.
RESULTS: The three most common cause of admission was Neonatal Jaundice (26.7%), Septicemia (19.1%), and Prematurity (12.5%). The
neonatal mortality in the NICU was 9.8%. The neonatal mortality in late neonatal period was slightly more than in the early neonatal period (12.0%
versus 9.2%; p-value =0.014). The gender wise outcome of the neonates admitted to NICU revealed that neonatal mortality in male was slightly
more than female (11.1% versus 8%; p-value=0.1012). It was found that death in pre-term (<37 weeks) was more than those born at term (37-42
weeks) (16.8% versus 5.4%; p-value <0.0001). About 3/4th of the extremely low weight (<1000g) neonates expired and the p- value was
calculated at <0.0001 meaning thereby that weight on admission is very strongly associated (p<0.0001) with outcome of the neonates. For the
outcome according to place of delivery it was found that the mortality in the neonates born in the health institution was less than neonates born at
home (8% versus 25.5%; p-value < 0.0001). The neonatal mortality in the neonates born to illiterate mothers was more than literate mothers
(17.7% versus 6.3%; p-value <0.00001).
CONCLUSIONS: The study showed that the age at admission, gestational age, weight on admission, place of delivery and literacy of mothers is
associated with outcome. However, the gender , place of residence and type of family is not associated with outcome of the neonates in NICU.
KEYWORDS
Profile, Neonate, Outcome, NICU

INTRODUCTION advances, the judicious implementation of neonatal intensive care

Childbirth is an occasion for joy and celebration. However, there is a measures can result in reduction of morbidity and mortality. The study
threat of serious illness or death of a newborn and it places serious was under taken with the objective to determine the bio-social profile
responsibilities on health care providers to respond appropriately and and outcome of the neonates admitted to a Level-III NICU of Sher-i-
with effective therapy. World over, four million newborn babies die in Kashmir Institute of Medical Sciences (SKIMS) Srinagar (Jammu and
the first month of life—99% in low and middle-income countries every Kashmir) which is the only Tertiary Care Teaching Hospital in Jammu
year. [1] In India, 26 million babies are born every year, and 1.2 & Kashmir.
million die in the first four weeks of life, which accounts for a quarter
of global neonatal deaths. India thus faces the biggest newborn health MATERIAL AND METHODS
challenge of any country in the world. [2] Neonatal deaths constitute This descriptive case series, hospital based prospective study was
about two-thirds of infant deaths in India with 45% of the deaths conducted over a period of one year from with effect from 1st January
occurng within the first two days of life. 2013 to 31st December 2013 in Level-III NICU of Sher-i-Kashmir
Institute of Medical Sciences(SKIMS) Srinagar (Jammu and
[3] The common cause of neonatal mortality in India are asphyxia, Kashmir). This NICU of SKIMS Srinagar receives the out born
prematurity and low birth weight, infections like pneumonia and neonates who are referred by the other health institutions of Kashmir
gastroenteritis and a variety of surgical problems. It has been observed Province of Jammu and Kashmir State of India as high-risk babies.
that improved level of newborn care can bring down the mortality
rates. [4] While high infant mortality rates were recognized by the The NICU provides the Intensive Care, Incubation, Resuscitation,
British medical community at least as early as the 1860s, modern Ventilation, Exchange Transfusion, Phototherapy, Ultrasonography,
neonatal intensive care is a relatively recent advance. [5] High ECG, Echo, and Diagnostic Laboratory services. The NICU has 18
neonatal mortality rate in a country reflects the poor availability of Open care system, 5 Syringe pumps, 5 Infusion pumps, 10 Incubators,
quality and quantity of infrastructure and utilization of neonatal care of 2 Resuscitators, 5 Phototherapy units, 5 Ventilators, 18 Incubator
that country. Improved neonatal care can lead to increased infant Cots/ Beds, 1 Ultra Sound Machine and other equipments. The NICU
survival. has a Nurse: Patient ratio varies from 1:7 in the morning shift to 1: 15
during the afternoon and night shifts. In addition, there are usually, 2
The Neonatal Intensive Care Units (NICU) have a role in developing Consultants, 1 or 2 Senior Residents, and 2 Junior Residents including
countries like India; although neonatal intensive care is among the Post Graduate Residents, covering the neonatal unit depending on the
more expensive services that any health care systems can provide. [6] rotations.
The cost of establishing a neonatal intensive care unit runs into crores
of rupees in India in which equipment cost formed two-thirds of the The data was collected in a predesigned standardized proforma. The
establishment cost and ancillary personnel salary comprised the largest progress of the patient and eventual outcome following the
proportion of the running costs. [7] Neonatal intensive care is cost management of the child were also recorded. On arrival in neonatal
intensive and rational use of neonatal unit services by targeting its unit, baby was examined by Senior Resident/ PG Resident and then by
utilization for the very low birth weight neonates and maintenance of Neonatologist/ Pediatrician. The neonates were followed from the
community based home-based newborn care is required. [8] In time of admission up to the time of discharge or LAMA or death.
developing countries where budgetary constraints limit technological Neonatal data was collected at time of admission and finalized after
International Journal of Scientific Research 199
Volume-7 | Issue-5 | May-2018 ISSN No 2277 - 8179 | IF : 4.758 | IC Value : 93.98

discharge or LAMA or death. Diagnosis of Pre-maturity was Clinical

or based on WHO definition for pre-maturity (live born neonates Term (>37-42 weeks) 614 60.51
delivered before 37 weeks from 1st day of last menstrual period). Post-term (>42 weeks) 9 0.9
Weight of neonates was measured using electronic weighing machines Weight on Admission High (>4000 g) 17 1.7
having gram as smallest division. WHO definition for Low Birth Normal (2500-4000g) 591 58.2
Weight (LBW), Very Low Birth Weight (VLBW), and Extreme Low Low (1500-2499g) 335 33.0
Birth Weight (ELBW) were used for classfication as Low Weight
(LW), Very Low Weight (VLW), and Extreme Low Weight (ELW) Very Low (1000-1499g) 68 6.7
neonates. All the sick neonates brought alive to neonatal unit with Extremely Low
definitive symptomatology and diagnosis were included and the study (<1000g) 4 0.4
and the neonates brought dead and those who left the neonatal unit Residence Rural 694 68.4
against the medical advice (LAMA) were excluded from the study.
Urban 321 31.6
Approval for the study was obtained from the SKIMS Hospital's
Ethical Committee. No Financial assistance was taken from any Place of Delivery Hospital 913 90.0
individual, association, Organization or institution. The data collected Home 102 10.0
was analyzed by using SPSS version 20 software and the frequency Type of Family Joint Family 728 71.7
and percentages were calculated. Nuclear Family 287 28.3
Literacy status of Mother Illiterate 305 30.1
RESULTS AND OBSERVATION
The data analysis showed that there were 1017 neonates admitted to Literate 710 69.9
NICU during the one-year period of study i.e. 1st January-31st Ration Card Above Poverty Line 438 43.2
December 2013 out of which the two (2) neonates that left against Below Poverty Line 577 56.8
medical advice (LAMA). Being insignificant in numbers these two Total 1015 100
neonates were excluded from analysis and data was analyzed for only
1015 neonates..

The Average Length of Stay (ALS) of the neonates admitted to NICU The distribution of admitted neonates revealed that the three most
was 5.65 days ( Standard Error = 0.167, 95% Confidence Interval for common cause of admission was Neonatal Jaundice, Septicemia, and
Mean between 5.97 upper & 5.32 lower, Median =4.00, Variance = Prematurity (Table-2).
28.274 and Standard Deviation= 5.317). The minimum and maximum Table-2: Showing common cause admission of the neonates to
Average Length of Stay (ALS) of the neonates was 1 and 28 days NICU
respectively with a Range of 27. The average age on admission of the Disease Total
neonates was 4.84 days ( Standard Error = 0.168, 95% Confidence
Interval for Mean between 5.17 upper & 4.51 lower, Median =3.00, N %
Variance = 28.639 and Standard Deviation= 5.352). The minimum and NNJ 271 26.7
maximum age was 1 and 28 days respectively with a range of 27. Septicemia 194 19.1
Prematurity 127 12.5
The distribution of admitted neonates revealed that four-fifth (4/5th) of Birth Asphyxia 71 6.9
the neonates were in the age group of 0-7 days i.e. in early neonatal
period whereas about one-fifth (1/5th) were in the late neonatal period. RDS 58 5.7
The ratio of males and female neonates was 1:0.7. The average Hypernatremic Dehydration 42 4.1
gestational age at birth of the neonates admitted to NICU was 36.15 Hypoglycemia 40 3.9
weeks (Standard Error = 0.081, 95% Confidence Interval for Mean Seizure Disorder 35 3.4
between 36.31 upper & 35.99 lower, Median =37.00, Variance = 6.638 TTN 33 3.3
and Standard Deviation= 2.576). MAS 30 3
Congenital Anomalies 26 2.6
The minimum and maximum gestational age of the neonates was 25
and 43 weeks respectively. The distribution of neonates according to Pneumonia 24 2.4
gestational age at birth revealed that about two-fifth (38.5) were born Polycythemia 19 1.9
prematurely and a negligible number (0.9%) were born at post-term of Meningitis 14 1.4
gestation. The study showed that the average weight on admission of Diarrhea 8 0.8
the neonates was 2525.65 grams (Standard Error = 19.817, 95% Others 23 2.3
Confidence Interval for Mean between 2564.54 upper & 2486.77 Total 1015 100
lower, Median =2590.00, Variance = 399408.455 and Standard
Deviation= 631.988). It was observed that out of 1015 neonates admitted most were
discharged (90.2%) whereas as some expired (9.8%) (Table-3).
The minimum and maximum weight of the admitted neonate was 920
and 4350 grams respectively. More than half of the admitted neonates Table-3: Showing outcome of the neonates who were admitted to
were of normal weight (2500-3500 grams). Most of the neonates NICU
were born in health institutions and small number were born at home. Outcome N %
More than 2/3rd of the neonates were resident of rural area and almost Discharged 916 90.2
similar number born in joint families. The literacy rate and
Expired 99 9.8
employment rate among mothers of the neonates were less than
among the fathers. More than half of the neonates belonged to families Grand Total 1015 100
having Below Poverty Line (BPL) ration cards. The distribution of
neonates is shown in Table-1 The data was also analyzed for association of age at admission, gender,
Table-1: Showing profile of the neonates admitted to NICU gestational age at birth and weight on admission with outcome. As
shown in Table-4, the neonatal mortality in late neonatal period was
Characteristics N % slightly more than in the early neonatal period (12.0% versus 9.2%; p-
Neonatal Age on Admission 0-7 days 806 79.4 value =0.014) and the age wise outcome of admitted neonates showed
8-14 days 124 12.2 strong association (p<0.05) . The gender wise outcome of the neonates
15-21 days 64 6.3 admitted to NICU revealed that neonatal mortality in male was slightly
more than female (11.1% versus 8%; p-value=0.1012) neonates
22-28 days 21 2.1
however the gender is not associated (p>0.05) with outcome. It was
Gender Female 427 42.1 found that death in pre-term (<37 weeks) was more than those born
Male 588 57.9 at term (37-42 weeks) (16.8% versus 5.4%; p-value <0.0001)
Pre-term (<37 38.6 neonates and gestational age wise outcome of admitted neonates is
Gestational Age weeks) 392 1 very strongly associated (p<0.001) with outcome. About 3/4th of the

200 International Journal of Scientific Research

extremely low weight (<1000g) neonates expired and the p- value for prevention and treatment and to implement and evaluate health care
was calculated at <0.0001 meaning thereby that weight on admission is programs. Reporting of neonatal bio-social profile and outcome from
very strongly associated (p<0.0001) with outcome of the neonates. time to time contributes to identify deficiencies and assists health
The mortality in the neonates belonging to rural was more than planners and workers to pay their due attention. Perhaps this is the first
belonging to urban neonates (10.8% versus 7.5%; p-value =0.0963) published data concerning Neonatal Intensive Care Unit issue in
indicating that the residence is not associated (p>0.05) with outcome. Jammu & Kashmir. This is a hospital-based study and may not present
For the outcome according to place of delivery it was found that the what is going on in the community. So, the results of this study should
mortality in the neonates born in the health institution was less than be compared cautiously with other similar studies, because NICU of
neonates born at home (8%) versus 25.5%; p-value < 0.0001) and the SKIMS Srinagar doesn't have a birthing site and only out-born
place of delivery is very strongly associated (p<0.0001) with neonates are admitted here.
outcome.
This one-year prospective study was done in order to document the
The study also found that the neonatal mortality in the neonates bio-social profile and outcome of the neonates admitted to a Level-III
belonging to joint family was slightly more than neonates belonging NICU of SKIMS Srinagar. It was found that a total of 1017 neonates
to the nuclear family (10.9% versus 7%; p-value =0.0604) however the were admitted in the NICU during the period of study i.e. 1St Jan-31st
type of family is not associated (p>0.05) with outcome. It was also Dec 2013. Only outborn neonates are admitted in SKIMS Srinagar.
observed that the neonatal mortality in the neonates born to illiterate The bio-social profile provides us an indication for the area of neglect
mothers was more than literate mothers (17.7% versus 6.3% ; p-value and the need to take corrective measures in this regard. There were
<0.00001) indicating that the literacy of mothers is very very strongly 1017 neonates admitted out of which the two (2) neonates that left
associated (p>0.05) with outcome of the neonates in NICU (Table-4) against medical advice (LAMA). The age wise distribution of admitted
neonates in our study revealed that most the neonates were in the age
DISCUSSION group of 0-7 days (79.4%) group followed by 12.2% in 8-14 days age
Accurate data on the bio-social profile and outcome of the neonates group. Thus the findings of our study were similar to the study by
admitted to a Level-III NICU are useful for many reasons. It is Anjum ZM and Shamoon M (2009) [9]. Our study also showed that
important for the providers of care, investigators, local and national males (58%) outnumber their female (42%) counterparts. It is
health administrators, and for decision makers to design interventions consistent with local literature reported by Kumar MK, et al. (2012)

Characteristics Outcome Total χ2 test p-value

Discharge Death
N % N % N %
Fisher's exact test .014
Neonatal Age on Admission 0-7 days 732 90.8 74 9.2 806 100 10.187
8-14 days 108 87.1 16 12.9 124 100
15-21 days 61 95.3 3 4.7 64 100
22-28 days 15 71.4 6 28.6 21 100
Pearson Chi- 0.101
Square static
Gender Female 393 92.0 34 8.0 427 100 value= 2.687
Male 523 88.9 65 11.1 588 100
Fisher's Exact Test <0.00
Pre-term (<37 static 01
Gestational Age weeks) 326 83.2 66 16.8 392 100 value=36.658
Term (>37-42
weeks) 581 94.6 33 5.4 614 100
Post-term (>42
weeks) 9 100 0 0 9 100
Fisher's Exact <0.00
Weight on Admission High (>4000 g) 17 100 0 0 17 100 Test value=40.988 01
Normal (2500-
4000g) 558 94.4 33 5.6 591 100
Low (1500- 286 85.4 49 14.6 335 100
2499g)
Very Low (1000- 54 79.4 14 20.6 68 100
1499g)
Extremely Low
(<1000g) 1 25.0 3 75.0 4 100
Pearson Chi- 0.096
Square 3
Residence Rural 619 89.2 75 10.8 694 100 value=2.765
Urban 297 92.5 24 7.5 321 100
Pearson Chi- <0.00
Square 01
Place of Delivery Hospital 840 92.0 73 8.0 913 100 value=31.902
Home 76 74.5 26 25.5 102 100
Pearson Chi- 0.060
Square 4
Type of Family Joint Family 649 89.1 79 10.9 728 100 value=3.526
Nuclear Family 267 93.0 20 7.0 287 100
665 93.7 45 6.3 710 100 Pearson Chi- <0.00
Literacy status of Mother Literate Square =31.3168 001
251 82.3 54 17.7 305 100
Illiterate
International Journal of Scientific Research 201
[10] (60 % male versus 40 % female). The ratio of males (590) and The study of neonates who were admitted in Level-III NICU of a
female (427) neonates was 1:0.7 almost similar to a study conducted by Tertiary Care Teaching Hospital in Jammu & Kashmir-India showed
Nahar J, et al. (2007) [11]. The average age of gestation of neonates that the age at admission, gestational age , weight on admission, place
was 36.15 week which was similar to a study conducted by Nahar J, et of delivery and literacy of mothers is associated with outcome.
al. (2007) [11]. However, the gender , place of residence and type of family is not
associated with outcome of the neonates in NICU.
in which it was 35.6 ± 3.4 weeks. In this study about two-third of the
neonates were of full term (60.6%) gestation and one-third were RECOMMENDATIONS
preterm (38.5%) which was similar to another study conducted by i. Institutional Deliveries must be enhanced and home births
Gauchan E, et al. (2011) [12] in which there were 67.5 % term babies prevented
and 31.3% preterm babies. In contrast to our findings a study ii. There is a need for early & timely referral to a tertiary care hospital
conducted by Seyal T, et al. (2011) [13] found that 42.8% neonates from peripheral and non-tertiary setups to prevent neonatal
were preterm. Our findings are understandable because probably mortality.
Janani Suraksha Yojana (JSY) & Janani Shishu Sawasthaya iii. Further studies to evaluate the risk factors and causes of neonatal
Karyakram (JSSK) Scheme of National Rural Health Mission infections in our environment will assist in appropriate
(NRHM) has enhanced the Ante-Natal Check Up, hospital deliveries interventions to bring about a reduction in mortality.
and neonatal care among the general population.
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neonatal organs. The mortality in Normal Weight, Low Weight, Very
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was 5.6%, 14.6%, 20.6%, and 75% respectively which was probably
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organs. It was found that most of the neonates born in Health
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home births due to lack of access to treatment facilities as well as mis
handling.

LIMITATIONS OF STUDY
i. This is a hospital based study and may not represent what is going
on in community
ii. We were unable to diagnose inborn errors of metabolism due to
lack of diagnostic facilities

CONCLUSION

202 International Journal of Scientific Research

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