A Study on Clinical Profile and Outcome of Sick Neonates in a District Level SNCU

Author(s): Subinay Mandal

BACKGROUND Though several primary care-based strategies and programmes were introduced at national level since nineties, the neonatal mortality was almost stagnant since recent past. Special Care Newborn Units (SNCUs) have now been established in several district and sub divisional hospitals to meet the challenges of reduction of neonatal mortality. Identifying the factors influencing neonatal mortality will help in planning measures for further reduction of neonatal mortality & morbidity. With this background, we conducted this study to evaluate the clinical profile and outcome of sick newborns in a district level SNCU. METHODS We retrospectively analysed the computerised data of our twenty bedded level II SNCU, for the period of ten months (from 01/01/2017 to 01/11/2017). Admission, treatment, and outcome profile was analysed thoroughly. Necessary ethical permission was taken from the institution. RESULTS Total number of newborns admitted in SNCU was 843 of which 55.8% was inborn 44.2% was out born. Out of the total newborns admitted, 75.8% were term, 0.6% were post term and rest 199 (23.6%) were preterm. Major indications for admission were perinatal asphyxia 22.4% & neonatal jaundice 22.5%. Average duration of stay of the sick newborns was 4.54 days. Most common diagnoses were birth asphyxia 21.5%, neonatal jaundice 21% & neonatal sepsis 19.9%. 41.6% patients needed oxygen for treatment. 33.8% neonates were treated with phototherapy. Sepsis was diagnosed in 16.6% patients. Antibiotics were used in 38.8% patients. Common antibiotic used were ampicillin, gentamicin, cefotaxime & amikacin. 82.9% patients were discharged, 7.7% were referred to higher centre and 8.3% neonates expired. Common causes of death were birth asphyxia (45.7%), prematurity (14.5%), respiratory distress syndrome (12.9%), sepsis (8.6%) etc. In very low birth neonates, common causes of death were prematurity (41.7%), respiratory distress syndrome (20.8%), birth asphyxia (16.7%) and sepsis (4.2%). Case fatality in sepsis was 3.6%, birth asphyxia 17.1% and in RDS 27.3%. In preterm babies (28 to <37 weeks), death rate was 16.7%. CONCLUSIONS In our SNCU, like rest of our country, common causes of neonatal deaths are birth asphyxia, prematurity & sepsis. In our SNCU survival of full-term neonates is better and survival of preterm neonates is also high. Prematurity is one of the important reasons for neonatal death in our SNCU. To improve survival of neonates, a better intrapartum care for the prevention of birth asphyxia & timely inutero referral of preterm babies to higher centre is required.