TRACKING NEW BORN DISCHARGED FROM SCNU
Dr. Gagan Gupta
Health Specialist , UNICEF
Background……..
Highest IMR in the Country at 67 per 1000 (SRS 2009)
2002- 2006 : IMR reduced by 11 points with out a single
point drop in Neonatal Mortality
Government Sector: Special Care was Non Existent
Key Strategy : Guna Model
Continuum of Care from Community to Facility
Community:
24 x 7 Referral Transport
Facility:
-IMNCI
-SCNU
-Immunization.
-NRC
-ORS & Zinc in Diarrhea.
-Model Labour Rooms
-ASHA for Social Mobilization
-24 x 7 Safe Delivery
Centers at Sub - Block level
-Maternal Death Audit
-Staff trained in Skilled Birth
attendance and Essential
Newborn Care
Piloted in Guna in 2007,Replicated in Shivpuri being Scaled up State Wide
Strengthening Facility Based New Born Care
To ensure Continuum of Care
with IMNCI in community and
SCNU at the Facility.

First 2 Units established by
UNICEF at Guna and Shivpuri.

Establishment cost of each unit
Rs. 45 Lakhs.( Civil work 25 lakh,
Equipments 20 lakh)

Running cost of pilot units and
scale up entirely through NRHM.

SCNU Shivpuri
Scale Up Under NRHM : SCNU Vidisha District Hospital
New-Born being treated at SCNU
Backed Up By….
Model Maternity wing at District Hospital …..
Maternity Ward : Shivpuri District Hospital
Model Labor Room : Shivpuri
Free 24 x 7 Referral transport with Call Centre
Saving Life on Wheels : 24 x 7
Status of Special Care New Born Units : M.P
31 Functional
MRN
BHD
09 to start by 31st January
10 under construction
GLR
DTA
SOP
SVP
TKM
NMC
GUN
AKN
RWA
CTP
PAN
STN
SDH
MDS
SJP
RTM
DHR
IDR
DMH
BPL
UJN
DWS
NSP
BRW
KND
MDL
SNI
BHP
CDW
BTL
UMR
DDR
HSB
HRD
KRG
KTN
SDL
JBP
RSN
SHE
JBA
SA
VDS
RJG
BLG
ANP
What Happens After Discharge ??
Objective….

Determine survival at One year in babies discharged from SCNU

To follow this cohort for Neurological Development

Learn and put in place system for prospective follow up of
discharged new born with Community – Facility linkages.

Generate evidence for justifying continued investments of
large funds on SCNU amongst other competing priorities
Methodology….

Study Area : SCNU Guna and Shivpuri
- First 2 units in the State were established in these districts.
- Presence of Call Centre, Block Coordinators for support

Study Sample : All New Born discharged from SCNU since
inception till 31st December 2008.
Guna :
1617 (14th Dec. 2007 – 31st Dec.2008 )
Shivpuri : 557 (1st July 2008- 31st December 2008)
Methodology….
Type of Study : Retrospective in 3 phases.
- Phase 1 : Desk review, Data entry, Telephonic Tracking.
- Phase 2 : Visit to community for verification
- Phase 3 : Clinical evaluation for developmental assessment.
Follow up Stages..…..
Phase 1 : Screening of Records
Phase 2 : Verification by Home visit
Phase 3 : Developmental Assessment
ADMISSIONS – FOR WHAT ??
INDICATIONS OF ADMISSION
Birth Asphyxia
258
104
67
748
20
30
67 6
20
4
Respiratory
Distress
Septicemia
603
23
681
N= 2681
Respiratory Distress (HMD,TTNB,MSL,PNEUMONIA)
Septicemia
Birth Asphyxia
Hyperbilirubinemia
Low Birth Wt.
Congenital Anomaly
Hypothermia
Feeding difficulties
Pre term
Tetanus
Convulsion
Polycythemia
IUGR
FOLLOW UP FINDINGS
DISTRICT SHIVPURI
ISO : 9001 Certified Unit
TRACKING OUTCOME
466
433(92.9%)
58
55 (94.8%)
33
SUCESSFULLY DISCHARGED
LAMA/DOR
TOTAL
TRACKED
29(87.9%)
TERTIARY REFERRAL
SURVIVAL OUTCOME
433
392(90.5%)
55
SUCESSFULLY DISCHARGED
39 (70.9%)
LAMA/DOR
TRACKED
SURVIVED
29
16 (55.2%)
TERTIARY REFERRAL
TIME DISTRIBUTION
Total deaths = 70
URBAN RURAL DISTRIBUTION
Total deaths = 70
CASTE WISE DISTRIBUTION
Total deaths = 70
WEIGHT ON ADMISSION
250
DISCHARGE PLUS LAMA PLUS TERTIARY REFERRAL
212
DEATHS
200
175
Total deaths = 70
150
100
50
84
46
17(37%)
19(23%)
18(10%)
16(7.5%)
0
< 1500 GM
1500-2000 GM
2000 -2500 GM
> 2500 GM
FOLLOW UP OUTCOME
DISTRICT : GUNA
ISO : 9001 Certified Unit
SURVIVAL OUTCOME
1169
1048 (89.6 %)
194
148(76..3%)
31
SUCESSFULLY DISCHARGED
LAMA/DOR
TRACKED
SURVIVED
15(48.4%)
TERTIARY REFERRAL
TIME DISTRIBUTION
120
114
Total deaths = 183
100
80
60
40
23
20
12
5
0
2
5
4
5
10
2
0
0
1
1
2
3
4
5
6
7
8
9
10
11
12
>12
Month Month Month Month Month Month Month Month Month Month Month Month Month
WEIGHT ON ADMISSION
DISCHARGE PLUS LAMA PLUS TERTIARY REFERRAL
700
DEATHS
634
Total deaths = 183
600
500
358
400
287
300
200
115
100
45 (39.1%)
54 (18.8%)
36 (10.1%)
48 (7.6%)
0
< 1500 GM
1500-2000 GM 2000 -2500 GM
> 2500 GM
Phase 3 :Developmental Screening
District Shivpuri (M.P.)
Developmental Screening : Protocols
Neurodevelopmental , Visual and Hearing screening done

Neurodevelopmental : Pathaks modification of Baroda Scale.

Hearing : American Academy of Pediatrics criteria

Visual : American Academy of Pediatrics guidelines
Developmental Screening…
Head Circumference
Screening for Visual Deficits
Total Children with Deficit Including Other Causes
60
53
50
42
40
30
20
11
10
0
Children found with
deficits
As a Sequale to the
treatment of SCNU
Congenital or Accquired in
Community
SUMMARY : FOLLOW UP OUTCOME

Survival in New Born discharged after successful completion
of treatment was 90% at 1 year of age

Deaths were higher in new born who were discharged
against medical advise and tertiary referrals.

More than 60 % Deaths occurred in 1st month after
discharge.

Deaths were higher in excluded and rural population .
SUMMARY : FOLLOW UP OUTCOME

Survival in < 1500 gram birth wt. was 61 % against 93% in
> 2500gm.

Deficits were seen in 11 % of Children who survived with
Neurological deficit being commonest.

SAM prevalence was unusually low on follow up.
LESSONS LEARNED….

Strong tracking system should be in place.

Vital information on admission should be recorded
(Postal Address ,Mobile numbers)

Need to develop follow up protocols with community and
facility linkages. (Extending continuum of care)

Local resources are best suited for follow up and tracking.
(AWW, ASHA)

First month after discharge is most critical with need to
focus on very low birth wt babies < 2000 grams
Action Initiated :Tracking System….

SCNU Software developed and all vital information on
admission / discharge recorded in it by data operator.

On discharge Parents are counseled & provided contact of
IMNCI worker along with a community follow up card.

Data operator sends SMS to IMNCI trained worker to enroll
the discharged child.

SMS reminders are sent to Parents as well as worker on
day of Follow up.
Community Follow up card
Actions Initiated : Tracking System

IMNCI trained AWW to make Six home visits as
per IMNCI schedule in first month.

At least one home visit to be done by ANM

SCNU follow up at 15 days, 1,3,6 & 12 months
or in case of complications

Status upgraded at the end of the day of visit.
Admission Entry Form
Entry after Treatment Outcome
Daily Follow - up List
SCNU Software Generated Graphs : 2010
DISTRICT SHIVPURI
District Hospital Delivery Vs Inborn Admission
SNCU Shivpuri (M.P.)
DH Delivery
Inborn Admission
13000
8292
Admissions in Numbers
8276
6734
607 ( 9%)
891 (10.8%)
725 ( 8.7%)
0
2008-09
2009-10
2010-11
SNCU functioning since June 2008
SCNU Case Record Sheets
&
Monitoring Formats
Case Record File
Neonatal Admission Sheet
Discharge Card
SCNU Follow-up Statistics 2011
District Shivpuri (M.P.)
Facility Follow-up Statistics: 2010- 2011, SCNU Shivpuri
Total Facility Follow-up done since start : 2184
Community Follow-up Statistics , Shivpuri : 2011( Till Oct.)
Mainstreaming and Scaling Up….

Mainstreamed under NRHM for State wide use.

Data operators sanctioned and on board in all units

SCNU Software installed in all SCNUs across the State.

Case Record sheets and SCNU stationary compatible with
software developed and put in use Statewide

Both Software and Case record sheets in line with GOI
guidelines on FBNC

Support to Other States : Orissa / Haryana / Uttaranchal /
Andhra Pradesh / Maharashtra
Work Under Progress……

Mentoring visits to New Born corners & Stabilization units
by SCNU / Maternity team
Work Under Progress……

Linkage of Software and Neonatal case sheets with
Maternity records

Setting up online monitoring system for centralized
monitoring

Neonatal transport system

Early intervention clinic for limiting disability
Sharing Across States…..
States being Supported :
•
•
•
•
•
•
Haryana
Andhra Pradesh
Uttaranchal
Tamilnadu
Orissa
Maharashtra
Justified Investment For Tomorrow…
BABY 2
New Born Discharged
from SCNU….
N = 42
TREATMENT OUTCOME
STATUS UNCLEAR =2
N = 53
New Born Corners till Sub Block level ….
24 x 7 Sub Centre at Shivpuri