Determinants of Adverse Outcome of Hospitalized Extramural Newborns
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《交互式心脏血管和胸部手术》
Department of Pediatrics, S.S. Medical College, Rewa (M.P.), India.
In our country more than 75% of deliveries are non-institutional out of which nearly half are conducted by untrained personnel. We carried out a prospective observational study including 300 extramural newborns (home delivery, delivery at centers without resuscitation or newborn care facilities) from in and around Rewa district Madhya Pradesh to evaluate the determinants of their adverse outcome.
Out of the 300 extramural newborns studied, 59% were low birth weight and 24.3% were preterm. The common morbidities were neonatal hyperbilirubinemia 21.3%, anemia 17%, sepsis - late onset 15,7%, severe birth asphyxia 12.3%, sepsis - early onset 7.3%, diarrhea 5%, malarial fever 3.3% and meconium aspiration syndrome 3%.
Causes of death were shock 24.6%, extrinsic perinatal hypoxia 22.8%, sepsis 21.1%, hyaline membrane disease 7%, congenital anomalies 5.3%, kernicterus 3.5%, anemia 3.5% and intestinal perforation 1.8%. Out of the 57 deaths 59.6% were LBW, Mortality rate among preterm newborns was 30.1%.
Survival was directly proportional to socio economic class - 100%, 80% and 69% in upper, middle and lower class respectively. Urban newborns had better survival as compared to rural ones (83.5% and 69.2% respectively). Poor outcome was seen with increasing distance from the hospital and emergency hours admission. Survival was more among newborns with mothers educated upto high school or higher as compared to newborns with mothers with lower education - 82.5% (94/114) and 64.3% (126/196) respectively. Extremes of maternal age was also associated with poor outcome with survival rates of 68.4%, 75.1% and 64.3% in age groups <18, 19-30 and >31 years respectively.
Adequate antenatal care had significant association with survival. Poor outcome was seen with delivery by untrained birth attendants - mortality rates of 24.6% (30/122) and 26.7% (12/45) with untrained dai and relative respectively.
Exclusive breast feeding was associated with lower mortality rates - 10.3% (11/107) as compared to 20.1% (32/159) in artificially fed group and 27.3% (3/11) in partially breast fed group. Artificial feeding was associated with higher rates of diarrhea and sepsis. Similar observations were made by other authors(1,2). The high rate of LBW in this study could be due to the fact that the study population was sick newborns. The various factors associated with LBW are shown in Table I. Similar associations were also reported by previous studies(3-5).
Substantial reduction in neonatal morbidity and mortality can be achieved by prevention of LBW. It was also seen that maternal literacy also influenced factors like age at first pregnancy, utilization of antenatal services, hospital delivery and exclusive breast feeding.
References
1. Narayan I, Prakash K, Gujral VV. The value of human milk in the prevention of infection in the high risk low birth weight infant. J Pediatr 1981; 99: 496-498.
2. Haider R. Neonatal diarrhea in a diarrhea treatment center in Bangladesh: Clinical presentation, breastfeeding management and outcome. Indian Pediatr 2000; 1: 37-43.
3. Deshmukh JS, Motghare DD, Zodpey SP, Wadhva SK. Low birth weight and associated maternal factors in an urban area. Indian Pediatr 1998; 35: 33-36.
4. Nurual A, Abel R, Sampathakumar V. Maternal risk factor associated with low birth weight. Indian J Pediatr 1993; 60: 269-274.
5. Mondal B. Risk factors for low birth weight in Nepali infants. Indian J Pediatr 2000; 67: 477-482.(A.K. Rawat, M.V. Razia,)
In our country more than 75% of deliveries are non-institutional out of which nearly half are conducted by untrained personnel. We carried out a prospective observational study including 300 extramural newborns (home delivery, delivery at centers without resuscitation or newborn care facilities) from in and around Rewa district Madhya Pradesh to evaluate the determinants of their adverse outcome.
Out of the 300 extramural newborns studied, 59% were low birth weight and 24.3% were preterm. The common morbidities were neonatal hyperbilirubinemia 21.3%, anemia 17%, sepsis - late onset 15,7%, severe birth asphyxia 12.3%, sepsis - early onset 7.3%, diarrhea 5%, malarial fever 3.3% and meconium aspiration syndrome 3%.
Causes of death were shock 24.6%, extrinsic perinatal hypoxia 22.8%, sepsis 21.1%, hyaline membrane disease 7%, congenital anomalies 5.3%, kernicterus 3.5%, anemia 3.5% and intestinal perforation 1.8%. Out of the 57 deaths 59.6% were LBW, Mortality rate among preterm newborns was 30.1%.
Survival was directly proportional to socio economic class - 100%, 80% and 69% in upper, middle and lower class respectively. Urban newborns had better survival as compared to rural ones (83.5% and 69.2% respectively). Poor outcome was seen with increasing distance from the hospital and emergency hours admission. Survival was more among newborns with mothers educated upto high school or higher as compared to newborns with mothers with lower education - 82.5% (94/114) and 64.3% (126/196) respectively. Extremes of maternal age was also associated with poor outcome with survival rates of 68.4%, 75.1% and 64.3% in age groups <18, 19-30 and >31 years respectively.
Adequate antenatal care had significant association with survival. Poor outcome was seen with delivery by untrained birth attendants - mortality rates of 24.6% (30/122) and 26.7% (12/45) with untrained dai and relative respectively.
Exclusive breast feeding was associated with lower mortality rates - 10.3% (11/107) as compared to 20.1% (32/159) in artificially fed group and 27.3% (3/11) in partially breast fed group. Artificial feeding was associated with higher rates of diarrhea and sepsis. Similar observations were made by other authors(1,2). The high rate of LBW in this study could be due to the fact that the study population was sick newborns. The various factors associated with LBW are shown in Table I. Similar associations were also reported by previous studies(3-5).
Substantial reduction in neonatal morbidity and mortality can be achieved by prevention of LBW. It was also seen that maternal literacy also influenced factors like age at first pregnancy, utilization of antenatal services, hospital delivery and exclusive breast feeding.
References
1. Narayan I, Prakash K, Gujral VV. The value of human milk in the prevention of infection in the high risk low birth weight infant. J Pediatr 1981; 99: 496-498.
2. Haider R. Neonatal diarrhea in a diarrhea treatment center in Bangladesh: Clinical presentation, breastfeeding management and outcome. Indian Pediatr 2000; 1: 37-43.
3. Deshmukh JS, Motghare DD, Zodpey SP, Wadhva SK. Low birth weight and associated maternal factors in an urban area. Indian Pediatr 1998; 35: 33-36.
4. Nurual A, Abel R, Sampathakumar V. Maternal risk factor associated with low birth weight. Indian J Pediatr 1993; 60: 269-274.
5. Mondal B. Risk factors for low birth weight in Nepali infants. Indian J Pediatr 2000; 67: 477-482.(A.K. Rawat, M.V. Razia,)