Study of the Morbidity and the Mortality Patterns in the Neonatal Intensive Care Unit at a Tertiary Care teaching Hospital in Rohtas District, Bihar, India

Abstract

Objective: To study the morbidity and the mortality patterns in the neonatal intensive care unit at a tertiary care teaching hospital in the Rohtas district of Bihar. Design: Retrospective study. The medical records of all the neonates who were admitted to the NICU were reviewed. Settings: Neonatal Intensive Care Unit of a tertiary care teaching hospital which is located in the Rohtas district of Bihar. The study was carried out over a period of 1 year during January 2010 to December 2010. Participants: 236 neonates with some illness who were admitted to the NICU, who belonged to the Rohtas district of Bihar. Outcome: The patterns of the morbidity and the mortality among the neonates who were admitted to the NICU in the Rohtas district. ‘Survival’ was defined as the discharge of a live neonate/ infant from the hospital. Results: A total of 285 babies were admitted to our NICU, of which 258 babies belonged to the Rohtas district. Of the 258 babies, 22 babies had left the hospital against medical advice (LAMA). A total of 236 neonates were included for the data analysis. The ratio of the male (59.6%) and female (40.4%) Neonates was 1.48:1. The major causes of the morbidity were low birth weight (LBW) (39.8%), prematurity (38.6%), neonatal sepsis (23.3%), neonatal hyperbilirubinaemia (20.4%), birth asphyxia with hypoxic ischaemic encephalopathy (HIE) (18.2 %), intrauterine growth retardation (IUGR) (14 %) and hyaline membrane disease (9.7 %). The most common causes of the referral from other hospitals were severe birth asphyxia with HIE (32.5%), neonatal sepsis (22.9%), prematurity with low birth weight (13.4 %), and prematurity with respiratory distress syndrome (12%). In this study, the overall NICU mortality rate was 13.6% ( 32/236). The babies who were born outside our hospital had a 2.5 times higher mortality rate as compared to the babies who were born in our hospital. Most of the deaths were associated with low birth weight (including LBW, VLBW and ELBW) (59.2%), prematurity (46.9%), sepsis (34.4 %), hypoxic ischaemic encephalopathy (HIE) (31%), Hyaline membrane disease or Respiratory distress syndrome (RDS) (25%) and intra uterine growth retardation (IUGR) (12.5%). Conclusion: This study identified LBW, prematurity, neonatal sepsis, neonatal hyperbilirubinaemia, and HIE as the major causes of the morbidity and low birth weight, prematurity, neonatal sepsis, HIE, and Hyaline membrane diseaseor Respiratory distress syndrome (RDS) as the major contributors to the neonatal mortality. Adequate antenatal care to the at risk mothers and advances in the neonatal intensive care with the use of sophisticated technology will improve the neonatal outcome.