Study of the neonatal mortality and morbidity patterns in the NICU over a five-year period at a rural tertiary care teaching hospital in South-West Bihar

Abstract

Introduction: Neonatal mortality, defined as death within the first 28 days of life, is a core indicator for neonatal health and wellbeing and is becoming a prominent component of overall under-five mortality. It is therefore receiving particular attention from health authorities. Zw3Aims and objectives: 1. To determine the patterns of morbidity and mortality in the NICU in the last 5 years. 2. To know the outcomes of neonatal admissions in the NICU in the last 5 years. Methodology: This was a retrospective record-based study conducted in the NICU of a tertiary care teaching hospital situated in rural South Bihar, India. Medical records of a total of 1222 neonates belonging to the Rohtas district and admitted in the NICU of Narayan Medical College & Hospital, Sasaram between December 2015 and December 2019 were reviewed. The data on admission, sex, gestational age, birthweight, indications for admission, primary diagnosis and associated medical conditions, duration of hospitalization, complications encountered, investigations during hospitalization, and outcome were extracted and analysed. Result:  64.2% were term babies and 58.3% had normal birth weight. The data analysis for the morbidity showed that neonatal hyperbilirubinemia (NNH) (26.68%) was the most common cause of admission to NICU, followed by early-onset sepsis (EOS) (18.49%), perinatal hypoxia-ischemia (birth asphyxia) (16.61%), prematurity (admitted for preterm care, no complications on admission) (11.29%), respiratory distress syndrome (RDS) (8.30%), meconium aspiration syndrome (MAS) (6.98%) and late-onset sepsis (LOS) (5.85%), in that order. The overall mortality rate was 11.29% (138 out of 1222 total admissions). The major causes of mortality were perinatal hypoxia-ischemia (24.63%), prematurity (22.46%), EOS (15.22%), RDS (13.77%), LOS (10.87%) and MAS (10.14%). Prematurity (22.46%), LOS (21.13%), RDS (18.81%), birth asphyxia (16.74%), MAS (16.47%) and necrotizing enterocolitis (NEC) (11.11%) were the most lethal in terms of case fatality rates. Conclusion: This study identified neonatal hyperbilirubinemia (NNH), early-onset sepsis (EOS), perinatal hypoxia-ischemia (birth asphyxia), prematurity, respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS) and late-onset sepsis (LOS) as the major causes of neonatal morbidity in the NICU of our institute in rural South Bihar. With a mortality rate of about 11%, the major causes of neonatal deaths were perinatal hypoxia-ischemia, prematurity, EOS, RDS, LOS and MAS. Prematurity, LOS, RDS, birth asphyxia, MAS and NEC were the most lethal diseases in terms of case fatality rates.

Key Words: NICU, MAS and NEC.