European Journal of Cardiovascular Medicine

According to the World Health Organization (WHO), 4 million newborn deaths occur worldwide every year [1]. Among these, approximately 98% of deaths occur in developing countries, primarily due to infections, asphyxia, complications of prematurity, and low birth weight [2].

Neonatal mortality accounts for nearly two-thirds of infant mortality and one-third of under-five mortality worldwide [3–5]. The neonatal period is the most vulnerable stage in a child’s life. The infant mortality rate of any country reflects its socioeconomic status as well as the efficiency and effectiveness of its healthcare system and its outcomes [6].

Due to immature immunity, neonates are more prone to infections. Admissions in a Neonatal Intensive Care Unit (NICU) depend on various factors such as socioeconomic status, cultural behavior, literacy, traditional beliefs, and gender bias [7].

Globally, especially in developing countries, neonatal care is improving with increasing availability of trained personnel and medical resources. However, prematurity, infections, and birth asphyxia continue to be the most common causes of neonatal mortality. Many of these causes are preventable. Besides the vulnerability of the newborn, morbidity and mortality also depend upon the level of care available [8].

Understanding the pattern of NICU admissions and their outcomes is essential for future planning, effective management, and optimized use of resources and skilled healthcare workers. The aim of this study was to assess the major causes of NICU admissions, causes of neonatal death, and to identify gaps in care, enabling targeted interventions for better outcomes.

This was a retrospective observational study conducted at the NICU of Saraswathi Institute of Medical Sciences, Hapur, India. All babies admitted between March 2016 and December 2016 were analyzed with respect to:

• Age (in days)
• Sex
• Birth weight
• Cause of admission
• Duration of hospital stay
• Outcome (survived or expired)

Exclusion criteria:

• Babies with incomplete data
• Babies admitted only for observation less than 24 hours

The catchment area for the NICU included local villages, especially from Hapur district, Uttar Pradesh, India.

NICU facilities included:

• 12 beds
• 10 multipara monitors
• 2 neonatal ventilators
• 12 radiant warmers
• 8 phototherapy (LED type) units
• 6 syringe pumps

All diagnoses were made using standard definitions. Statistical analysis was done using Chi-square tests to determine differences between categorical variables. A p-value < 0.05 was considered statistically significant.

During the study period, a total of 175 neonates were admitted to the NICU.

Table 1: Gender-Based Admission Pattern

Table-2: Birth Weight Based Admission Pattern.

Table 2 shows the distribution of babies admitted according to their birth weights. ELWL were 9 (5.14%), VLWL were 32 (18.28%) and LBW were 81 (46.28%) and remaining were normal birth weight neonates. The difference was found statistically significant.

Table 3 shows distribution of conditions causing NICU admissions. Maximum number of babies were preterm 96(54%), more than half of all the babies, followed by sepsis 22 (12.57%), birth asphyxia 16 (9.4%), neonatal jaundice 12 (6.85%), Meconium aspiration syndrome. 10 (5.71%) and the difference was statistically significant.

Table-3: Cause based admission pattern.

Table- 4: Pattern of admission and death based upon the birth weight.

Table 4 shows the distribution of mortality in relation with their birth weight. Out of 29 deaths maximum

belonged to VLBW group accounting 34.48%, followed by LBW7 (24.13%) and babies having normal birth

weight (24.13%) and ELBW (17.24%) and the difference was found non-significant.

Table- 5: distribution of diseases causing death.

Table 5 shows distribution of causes of death. Out of 175 admitted babies 29 were died with a mortality rate of17.14%. Maximum number of death were observed with preterm, 18 out of 29 with 62%, their various complications followed by birth asphyxia (20.69%). Third commonest cause of mortality was sepsis (10.34%) which is followed by MAS (6.89%) and was found statistically non- significant.

The benefits of neonatal intensive care are clear and there has been a significant all in neonatal mortality

Rate in developed countries with the advent of mechanical ventilation and the concept of neonatal intensive care [7,9]. In our study, a total of 175 babies were analyzed retrospectively. Male neonates predominate over female neonates with a male to female ratio of 1.21:1. The male predominance in our study is consistent with other studies [6,10]. This predominance of male babies indicates that male neonates are more vulnerable during the neonatal period, a finding in agreement with the well described biological survival of girls [11]. With regard to birth weights of neonates admitted, maximum number of neonates belonged to LBW  (46.28%) followed by normal birth weight and VLBW (18.28%). Similar findings were observed in studies done by Bhagat et aland Prasad V et al [12,7]. More than half (62%) of neonates were preterm and were found as most common indications of admission in NICU. Similar observations were found in studies done by Bhagat et al, Elizabeth U et al, and Prakash J et al [9, 12, 13]. Many studies reported lesser number of preterm admission in comparison to our study [14,6,7]. Second most common indications of NICU admission in our study were neonatal sepsis. Similar observation was found by Syed R. Ali [15]. Many researchers reported birth asphyxia as second most common cause of NICU admission [12]. Other important causes of indication of admission in NICU were birth asphyxia (20.69%), meconium aspiration syndrome (9.71%) and neonatal jaundice (6.85%). Narayan R reported neonatal jaundice as most common cause of admission as most of the babies in their NICU came from high altitude [6].

Out of 175 neonates 29 (17.14%) died in our study. Similar observations were found in studies of Bose O Toma etal, Ike Elizabeth U et aland Walanaet al. [16,9,17 ]. Narayan R found 8% mortality in their study. Mortality rate of any neonatal intensive care unit depends upon many factors other than the clinical condition of the baby such as the infrastructure, man power, skilled hands etc. Hence the mortality rate reports vary widely in different studies from different regions. Mortality rate in relation to birth weight were observed as in Normal weight (24.13%), VLBW (34.48%), LBW (24.13%)and ELBW (17.24%). Most common condition causing highest mortality were preterm associated with their different complications. Second most common cause of mortality was birth asphyxia and third commonest was neonatal sepsis followed by meconium aspiration syndrome. Similar obser-vations were found by Bhagat et al[9]. Low birth weight is one of the leading cause of admission and mortality in most of the developing countries [18]. Immaturity tends to increase the severity and complications of most of the neonatal diseases. Immature organs, therapeutic complications and specific conditions and complications in premature babies contribute to high rate of morbidity and mortality. Morbidity and mortality inversely related to their gestational age.

Therefore, prevention of morbidity and mortality related to prematurity will significantly reduce overall morbidity and mortality. Appropriate antenatal care, good obstetric practices, proper referral, improvement of facilities for caring for preterm babies as well as proper newborn care practices have been found to reduce morbidity and mortality from prematurity[ 19]. Neonatal sepsis is a significant cause of neonatal morbidity and mortality particularly in preterm, LBW babies [20,21]. In our study it was the third most common cause of morality.

The incidence of neonatal sepsis in the developed countries is 1-10/1000 where as it is roughly three times in developing countries [22]. It is estimated that around 23% of all newborn deaths are caused by birth asphyxia [23]. Following improvement in antenatal and obstetrical care in most of the developed countries the incidence of birth asphyxia has reduced significantly and less than 1 per 1000 live births die from this. Syed R Ali et al and Saleem M etal found birth asphyxia as most common cause of mortality in their studies [15,10].

Prematurity, low birth weight, birth asphyxia, neonatal sepsis, meconium aspiration syndrome, neonatal jaundice were the leading causes of admission in NICU. Prematurity, birth asphyxia neonatal sepsis were the most common causes of mortality. These mortalities can be reduced with better management of antenatal care, improved perinatal care, promoting institutional delivery, early recognition and timely intervention with early referral to tertiary care centre.

Limitations of Study: Surgical cases after initial stabilization transferred to paediatric surgery ward

were not followed.

Contributions:  Sheetal Aggarwal contributed in making concept, design and acquisition of data and

analyzed the data, drafted the article and revised critically.

1. World Health Organization. Perinatal Mortality: A Listing of Available Information. Geneva, WHO, 1996, pp. 32–36. WHO/FRH/MSM/96.7.
2. Black, Robert E., Saul S. Morris, and Jennifer Bryce. "Where and Why Are 10 Million Children Dying Every Year?" The Lancet, vol. 361, no. 9376, 28 June 2003, pp. 2226–2234.
3. World Health Organization. Mother–Baby Package: Implementing Safe Motherhood in Countries. Maternal Health and Safe Motherhood Programme, Geneva, WHO, 1994. WHO/FHE/MSM/94.11.
4. Saving Newborn Lives: State of the World’s Newborns. Save the Children Federation, 2001, pp. 1–49.
5. World Health Organization. Management of Sick Newborn: Report of a Technical Working Group. Ankara, WHO.
6. Narayan, R. "A Study of the Pattern of Admissions and Outcome in a Neonatal Intensive Care Unit at High Altitude." Sri Lanka Journal of Child Health, vol. 41, no. 2, 2012, pp. 79–81.
7. Prasad, Veena, and Nutan Singh. "Causes of Morbidity and Mortality Admitted in Government Medical College Haldwani in Kumoun Region Uttarakhand India." Journal of Pharmaceuticals and Biomedical Sciences (JPBMS), vol. 9, no. 23, 2011, pp. 1–4.
8. Bang, Abhay T., and Rani A. Bang. "Diagnosis of Causes of Childhood Deaths in Developing Countries by Verbal Autopsy: Suggested Criteria." Bulletin of the World Health Organization, vol. 70, no. 4, 1992, pp. 499–507.
9. Ike, Elizabeth U., Modupe O., and Oyetunde. "Pattern of Diseases and Care Outcomes of Neonates Admitted in Special Care Baby Unit of University College Hospital, Ibadan, Nigeria from 2007 to 2011." IOSR Journal of Nursing and Health Science, vol. 4, no. 3, 2015, pp. 62–71.
10. Saleem, M., et al. "Pattern of Neonatal Admissions and Its Outcome in a Tertiary Care Hospital of Southern Punjab (A 5 Years Study)." Pakistan Journal of Medical and Health Sciences, vol. 8, no. 4, 2014, pp. 916–921.
11. Roy, R. N., et al. "Mortality Pattern of Hospitalized Children in a Tertiary Care Hospital of Kolkata." Indian Journal of Community Medicine, vol. 33, no. 3, 2008, pp. 187–189.
12. Baghel, B., A. Sahu, and K. Vishwanadham. "Pattern and Admission and Outcome of Neonates in NICU of Tribal Region Bastar, India." International Journal of Medical Research Professionals, vol. 2, no. 6, 2016, pp. 147–150.
13. Parkash, J., and N. Das. "Pattern of Admissions to Neonatal Unit." Journal of the College of Physicians and Surgeons Pakistan, vol. 15, no. 6, June 2005, pp. 341–344.
14. Hoque, M. S., S. Alam, et al. "Pattern of Neonatal Admissions and Outcome in an Intensive Care Unit of a Tertiary Care Paediatric Hospital in Bangladesh–A One–Year Analysis." Journal of Bangladesh College of Physicians and Surgeons, vol. 31, no. 3, 2013, pp. 134–139.
15. Ali, Syed R., Shakeel Ahmed, et al. "Disease Patterns and Outcomes of Neonatal Admissions at a Secondary Care Hospital in Pakistan." Sultan Qaboos University Medical Journal, vol. 13, no. 3, 2013, pp. 424–428.
16. Toma, Bose O., et al. "Pattern of Neonatal Admissions and Outcome in a Tertiary Institution in North Central Nigeria." Journal of Medicine in the Tropics, vol. 15, no. 2, 2013, pp. 121–125.
17. Walana, W., et al. "Pattern, Causes and Treatment Outcomes of Neonatal Admission in the Tamale Teaching Hospital." Clinics in Mother and Child Health, vol. 13, no. 4, 2016, doi:10.4172/2090-7214.1000252.
18. Ahmed, A. S. M. N. U., et al. "Preterm Very Low Birth Weight Babies: Outcome of Admitted Newborns at a Community-Level Medical College Hospital in Bangladesh." Journal of Bangladesh College of Physicians and Surgeons, vol. 26, no. 3, 2008, pp. 128–134.
19. Olowonyo, T., S. Oshin, and I. Obansanjo-Bello. "Some Factors Associated with Low Birth Weight in Ogun State, Nigeria." Nigerian Medical Practitioner, vol. 49, no. 6, 2006, pp. 154–157.