Causes of death in preterm neonates (&lt;33 weeks) born in tertiary care hospitals in India: analysis of three large prospective multicentric cohorts

Jain, Kajal; Sankar, Mari Jeeva; Nangia, Sushma; Ballambattu, Vishnu Bhat; Sundaram, Venkataseshan; Ramji, Siddharth; Plakkal, Nishad; Prabhash, Kumar; Jain, Ashish; Sivanandan, Sindhu; Vishnubhatla, Sreenivas; Chellani, Harish; Deorari, Ashok K.; Paul, Vinod K.; Agarwal, Ramesh

doi:10.1038/s41372-019-0471-1

Cited by 31 publications

(28 citation statements)

References 25 publications

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“…The higher incidence of sepsis causing neonatal deaths were consistent with two recent studies from India reporting up to 41% of deaths due to sepsis in VLBW infants. 20,21 Antenatal care practices may differ, including frequency of prenatal care visits, gestational age at maternal referral, and antibiotics administered to mothers with preterm rupture of membranes or preterm labor. Postnatal care practices differ as well, including empirical antibiotics chosen for early or late onset sepsis for preterm infants with risk factors, central line maintenance, and infection control prac-tices.…”

Section: Discussionmentioning

confidence: 99%

Mortality and Morbidity in Premature Infants: An East and West Comparative Study

et al. 2021

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Objective Survival of preterm infants differs dramatically depending on birthplace. No previous studies have compared outcomes of preterm infants between low middle-income and high-income countries such as India and the United States. The purpose of this study is to evaluate differences in care practices, resources, mortality, and morbidities in preterm infants with birth weight 700 to 1,500 g between two major neonatal centers in these countries. Study Design This is a retrospective cohort study with de-identified data from Fernandez Hospital (FH) in Hyderabad, India, and Texas Children's Hospital (TCH) in Houston, TX, for infants born January 2016 to December 2018, and weighing 700 to 1,500 g at birth. The primary outcome was death before hospital discharge. Results Of 1,195 infants, 736 were admitted to FH and 459 were admitted to TCH. After controlling for differences in gestational age, small for gestational age, and antenatal corticosteroid use, TCH patients had lower mortality before hospital discharge (adjusted odds ratio [aOR] = 0.28, 95% confidence interval [CI]: 0.16–0.48, p < 0.001) and more bronchopulmonary dysplasia (BPD; aOR = 2.2, 95% CI: 1.51–3.21, p < 0.001). The composite outcome of death or BPD and death or any major morbidity (BPD or intraventricular hemorrhage grade II or more or periventricular leukomalacia grade II or more or retinopathy of prematurity requiring treatment) were not different. Conclusion In this study, TCH infants had decreased odds of death before hospital discharge compared with FH but higher odds of BPD, which may be related to increased survival and differences in care practices. Key Points

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Section: Discussionmentioning

confidence: 99%

Mortality and Morbidity in Premature Infants: An East and West Comparative Study

et al. 2021

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“…A recently published study from Ethiopia shows RDS to be the most prevalent cause of preterm death followed by sepsis (11) . In a large prospective Indian study using three hospital-based data sets from National Neonatal Perinatal Database (NNPD), Delhi Neonatal Infection Study (DeNIS), and Goat Lung Surfactant Extract (GLSE)-plus cohorts, K Jain et al in 2019 (12) analyzed that among preterm neonates of less than 33 weeks, sepsis is an important direct cause of death attributing to 20-40% of mortality, prematurity related complications were the causes of death in 40-50% cases and perinatal events accounted for only 9-12% deaths in this gestational group.…”

Section: Discussionmentioning

confidence: 99%

Mortality Profile of Preterm Infants <32 Weeks in a Tertiary Care Nicu at a Charitable Hospital in Eastern India

Mitra¹,

Chattopadhyay²

2021

GJMR

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Introduction: India has ⅕of the world's premature babies, and prematurity accounts for 40% of Neonatal Mortality in India. Determination of the cause of death is essential in formulating strategies to improve preterm care and reduce mortality. Method: We conducted a retrospective study at the NICU of Ramakrishna Mission Seva Pratishthan, a charitable hospital with a teaching institute, the Vivekananda Institute of Medical Sciences. We included all intramural babies between 24 and 32 weeks, born between 1st of January 2018 and 31stof December 2020, in the study to find out mortality rates and the etiology of the deaths that occurred. Results: Overall mortality in babies <32 weeks was 12.39%, 33.33% in babies <28 weeks and 4.76% in babies between 28 and 32 weeks. The predominant cause of death was perinatal asphyxia (46.67%), followed by prematurity-related causes (40%), while sepsis accounted for 13.33% of deaths.

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“…22 cohort and Goat Lung Surfactant Extract (GLSE)-Plus cohort) and concluded that 20-40% of preterm neonates less than 33 weeks gestation admitted to Indian NICUs were died of sepsis. 23 Their conclusion was that in verbal autopsy based analysis would have classified all deaths in preterm infants <33 weeks gestation to be directly related to prematurity related complications. Whereas analysis of hospital-based medical certification attributed prematurity related complications as a cause of mortality in only 40-50% of babies.…”

Section: Discussionmentioning

confidence: 99%

Mortality profile of extreme to very preterm infants in an extramural tertiary care neonatal unit of a teaching hospital in Southern India: a retrospective study

Shanmugam

Karthik

Muthukumaran

et al. 2020

Int J Contemp Pediatr

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Background: Neonatal deaths account for 47% of all deaths in children younger than 5 years globally. More than a third of deaths are due to preterm related complications. Understanding the factors contributing to preterm deaths and pattern of mortality is needed to implement interventions that are essential in improving neonatal survival.Methods: This was a retrospective study done in neonatal intensive care unit, Institute of Child Health (ICH) and Hospital for Children, Chennai, a tertiary care regional center. All preterm (<32 weeks) deaths registered in the neonatal medical records from 1st of January 2018 to 31st of December 2018 were analysed. Primary causes of deaths were analysed by two consultants. When there were more than one cause contributing to responsible for death the most significant problem was taken as the cause of death.Results: Overall neonatal mortality was 312 (14.2%) of 2189 neonates. Out of 148 admissions in the study population mortality was 74.2% (26 of 35) for extreme preterm (<28 weeks) infants and 42.7% (48 of 113) for very preterm (28 to 32 weeks) infants. Predominant causes of death were sepsis 44.5% (33), prematurity-related complications 37.8% (28) followed by congenital anomalies 12.1% (9) and miscellaneous causes 2.7% (2). Respiratory Distress Syndrome (RDS) and Intra Ventricular Haemorrhage (IVH) attributed to 75% (21/ 28) of deaths among prematurity-related complications.Conclusions: This study identified sepsis; prematurity related complications were the predominant causes of mortality in the extreme to very preterm population. Understanding the specific causes of preterm mortality would help to implement interventions to promote their survival.

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Causes of death in preterm neonates (<33 weeks) born in tertiary care hospitals in India: analysis of three large prospective multicentric cohorts

Cited by 31 publications

References 25 publications

Mortality and Morbidity in Premature Infants: An East and West Comparative Study

Mortality and Morbidity in Premature Infants: An East and West Comparative Study

Mortality Profile of Preterm Infants <32 Weeks in a Tertiary Care Nicu at a Charitable Hospital in Eastern India

Mortality profile of extreme to very preterm infants in an extramural tertiary care neonatal unit of a teaching hospital in Southern India: a retrospective study

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