DOI: 10.14260/jemds/2014/1954
ORIGINAL ARTICLE
A STUDY OF DISEASE PATTERN AND OUTCOME OF NEWBORNS ADMITTED
TO NICU IN A TERTIARY CARE HOSPITAL
Siva Saranappa S.B1, Madhu G.N2, Ritesh Singh3
HOW TO CITE THIS ARTICLE:
Siva Saranappa S.B, Madhu G.N, Ritesh Singh. “A Study of Disease Pattern and outcome of Newborns Admitted
to NICU in a Tertiary Care Hospital”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 05,
February 03; Page: 1113-1118, DOI: 10.14260/jemds/2014/1954
ABSTRACT: BACKGROUND: Advances in perinatal and neonatal care have significantly reduced
neonatal mortality rates and have benefited preterm infants admitted to neonatal intensive care
units. Analysis of care practices can provide insights into how care practices might be changed to
improve outcomes. OBJECTIVE: 1. To study the disease pattern, outcome and factors contributing to
mortality of the newborns admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary care
hospital. 2. To compare the mortality rate between inborn and outborn babies. PATIENTS &
METHODS: A retrospective case record review and analysis of all the newborn babies including both
inborn and outborn (Referred from elsewhere) admitted to the NICU during the period of 2011 to
2013 were included in the study and the data was recorded on the data forms. For comparison
between two groups Chi square test was used. RESULTS: Total number of babies admitted to NICU
during the study period was 3152, of which inborns were 73.3% (2311) and 26.7% (841) were
outborn. 54% were males and 46% were females. 75% were term newborns and 25% were preterm
newborns. Majority of babies weighed between 2500-3000 grams. The mortality among the inborn
babies was only 1.9% (45/2311) as compared to the outborn which was 5.7% (48/841) which was
statistically significant p=0.0003. Although statistically insignificant, the mortality in males was
higher at 3.2% (54/1698) than the females which was 2.7% (39/1454) (p=0.4). The major cause of
mortality was Preterm with Hyaline Membrane Disease (HMD) (36.5%) followed by neonatal
sepsis(34.30%) and other causes like Hypoxic Ischemic Encephalopathy, Congenital Heart Disease,
Meconium aspiration syndrome and major congenital malformations. CONCLUSION: Significant
mortality in outborn babies as compared to the inborns highlights the need for better transport
facilities and early referral of the newborns requiring NICU care. Also, there is a need to establish
NICU facilities in the remote areas to reduce the mortality.
KEYWORDS: Neonate, Neonatal transport, morbidity, Mortality.
INRODUCTION: Advances in perinatal and neonatal care have significantly reduced neonatal
mortality rates and have benefited preterm infants admitted to neonatal intensive care units (NICU) 13. There was a large reduction in mortality rate in the recent years, despite the clinically small but
statistically significant reductions in birth weight and gestational age which, by themselves, would be
associated with a higher mortality rate. The rapid decline in neonatal mortality during the past 4
decades has been attributed to improvements in neonatal intensive care. This decline was
attributable to improved condition of the infants on NICU admission (improved birth weight, higher
Apgar scores, and better physiologic ability) that reflected improving obstetric and delivery room
care. It was also due to more effective newborn intensive care and aggressive respiratory and
cardiovascular treatment 4. Recent publications have highlighted these trends but have also reported
significant variations in mortality rates among NICUs.5-7 Variations in mortality rates are important
Journal of Evolution of Medical and Dental Sciences/ Volume 3/ Issue 05/February 03, 2014
Page 1113
DOI: 10.14260/jemds/2014/1954
ORIGINAL ARTICLE
because they permit inferences about quality of care. Examination of care practices associated with
variations in mortality rates can provide insights into how care practices might be changed to
improve outcome7, 8. This study was undertaken to study the disease pattern and outcome, and to
know the factors contributing to the mortality.
OBJECTIVES: 1. To study the disease pattern, outcome and factors contributing to mortality of the
newborns admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary care hospital. 2. To
compare the mortality rate between inborn and outborn babies.
METHODS: A retrospective case record review and analysis of all the newborn babies including both
inborn and outborn (Referred from elsewhere) admitted to the NICU during the period of 2011 to
2013 were included in the study and the data was recorded on the data forms. the data was analyzed.
For comparison between two groups Chi square test was used.
RESULTS: Total number of babies admitted to NICU during the study period was 3152 (tab-01). Out
of which inborns were 73.3% (2311) and 26.7% (841) were outborn (Born elsewhere and referred).
54% were males and 46% were females. 75% were term newborns and 25% were preterm
newborns. Majority of babies weighed between 2500-3000 grams. The major indication for
admission was neonatal jaundice (36%), followed by preterm management (14%), neonatal sepsis
(11%), transient tachypnea of newborn (8%) and others (tab 1). The overall mortality was 2.95%
(93/3152). The mortality among the inborn babies was only 1.9% (45/2311) as compared to the
outborn which was 5.7% (48/841). The death in males was higher at 3.2% (54/1698) than the
females which was 2.7% (39/1454). 70% (65/93) babies which died required mechanical ventilation.
The major cause of mortality was Preterm with RDS (36.5%) followed by neonatal sepsis (34.30%)
and others (tab 2).
No. of babies Percentage
(n=3152)
(%)
2311
73.31
841
26.68
1698
53.87
1454
46.12
2372
75.25
780
24.74
Inborn babies
Out born babies
Male babies
Female babies
Term babies
Pre term babies
Babies who received
307
mechanical ventilation
Tab 01: Descriptive Data
9.73
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DOI: 10.14260/jemds/2014/1954
ORIGINAL ARTICLE
Clinical condition
Total no. of babies Percentage (%)
Neonatal Jaundice
1121
35.56
Preterm Management
444
14.08
Transient Tachypnea of newborn
254
8.05
Late onset sepsis
221
7.01
Meconium Stained Amniotic Fluid
178
5.64
Hyaline Membrane Disease
140
4.44
Early onset sepsis
130
4.12
Infant of Diabetic Mother
125
3.96
Perinatal depression
118
3.74
Hypoglycemia
67
2.12
Intrauterine Growth Retardation
62
1.96
Feeding problems
59
1.87
Neonatal seizures
49
1.55
Perinatal asphyxia
46
1.45
Surgical Conditions
43
1.36
Congenital anomalies
29
0.92
Congenital Heart Disease
27
0.85
Meconium Aspiration Syndrome
26
0.82
Tab 02: Distribution of babies based on the clinical condition
Cause of Death
Total no. of deaths (n) Percentage (%)
Hyaline membrane disease
34
36.5
Neonatal Sepsis
32
34.3
Congenital heart disease
09
9.6
Meconium aspiration syndrome
08
8.6
Hypoxic Ischemic Encephalopathy stage III
07
7.5
Major congenital anomaly
03
3.2
Tab 03: Specific cause and mortality
Total deaths
percentage
P value
Inborn babies
45
1.9
p=0.0003
Outborn babies
48
5.7
Male babies
54
3.2
p=0.4
Female Babies
39
2.7
Tab 4: Comparison of deaths between inborn/outborn and male/female
DISCUSSION: This study was conducted with the objective to study the disease pattern, outcome and
factors contributing to mortality of the newborns admitted to the Neonatal Intensive Care Unit
(NICU) of a tertiary care hospital. A total of 3152 newborns were admitted to the NICU during the
study period. Majority were inborns (73.3%). Most of them were males (53.9%) and most of them
Journal of Evolution of Medical and Dental Sciences/ Volume 3/ Issue 05/February 03, 2014
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DOI: 10.14260/jemds/2014/1954
ORIGINAL ARTICLE
were term newborns (75.3%). According to birth weight, 33.1% of them were between 2500-3000
grams, 20.2% were between 2000-2500 grams, 17.8% were between 1500-1999 grams, 16.1% were
between 3000-3500 grams, 6.9% were between 1000-1499 grams, 3.6% were between 3500-3999
grams. Babies with birth weight of less than 1000 grams and more than 4000 grams constituted 1%
each.
Neonatal jaundice was the most common indication for admission to NICU (35.6%) which is
similar to that reported by Mcgil ugwu 8. other indications for admission to NICU are shown in table 2.
The specific causes of death in this study have been shown in table 3. The major cause of
death was Hyaline membrane disease (HMD) accounting to 36.5% of deaths. Variable rates of death
due to HMD have been reported in literature: - 19.2%9, 24%10, 41%11, and 40-60% 12. This variation
in the death rates is probably due to the facilities available for management of high risk newborns.
Neonatal sepsis was the second most frequent cause of death accounting to 34.3%. Kuruvilla KA13 et
al reported that deaths due to neonatal sepsis was 14.4% accounting to 19.1% of total deaths. other
authors have also reported variable results accounted to neonatal sepsis.
In our study, it was found that outborn babies (table 4) had a significantly higher mortality of
5.7% when compared to the inborn babies with 1.9% (p=0.0003). This comparison highlights that the
babies which have been referred for the requirement of NICU care have higher mortality. This can be
due the problems associated with the neonatal transport. Various complications of neonatal transport
such as hypothermia, hypoglycemia and others have been reported14. Even intra hospital transports
are associated with increased risk of clinical complications 15. Buch Pankaj 16 reported a mortality of
32.2% in transported neonates. Gustavo Goldsmit et al reported that 28 of 160 transported neonates
died 17.
CONCLUSION: In spite of many advances in neonatal care, prematurity and neonatal jaundice still
continue to be the most common problems in the newborns. Also, HMD and neonatal sepsis are still
the most common causes of death. Outborn babies are at higher risk of death due the problems they
encounter due to and during the transport. Significant mortality in outborn babies as compared to the
inborns highlights the need for better transport facilities and early referral of the newborns requiring
NICU care.
Hence, there is a need to establish neonatal care facilities especially in rural and
remote areas so that the problems of neonatal transport can be minimized. Also, providing
meticulous antenatal care and prevention of premature delivery can reduce the morbidity and
mortality in newborn.
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Journal of Evolution of Medical and Dental Sciences/ Volume 3/ Issue 05/February 03, 2014
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DOI: 10.14260/jemds/2014/1954
ORIGINAL ARTICLE
AUTHORS:
1. Siva Saranappa S.B.
2. Madhu G.N.
3. Ritesh Singh
PARTICULARS OF CONTRIBUTORS:
1. Assistant Professor, Department of Pediatrics,
Kempegowda Institute of Medical Sciences &
Research Centre.
2. Assistant Professor, Department of Pediatrics,
Kempegowda Institute of Medical Sciences &
Research Centre.
3. Junior Resident, Department of Neonatology,
Kempegowda Institute of Medical Sciences &
Research Centre.
NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. Siva Saranappa S.B.,
Assistant Professor,
Department of Pediatrics,
Kempegowda Institute of Medical Sciences &
Research Centre,
Bangalore – 560004.
E-mail: drsharan727@gmail.com
Date of Submission: 13/01/2014.
Date of Peer Review: 14/01/2014.
Date of Acceptance: 18/01/2014.
Date of Publishing: 28/01/2014.
Journal of Evolution of Medical and Dental Sciences/ Volume 3/ Issue 05/February 03, 2014
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