Morbidities and Outcome of a Neonatal Intensive Care in Western Nepal

Abstract

Background: Neonatal mortality rate of developing countries is declining over decades. In the recent years increasing number of preterm and high risk neonates have facilities for tertiary care treatment. The aim of the study was to assess the morbidities and outcome of neonatal intensive care admissions.Methods: It was a retrospective observational study carried out in neonatal intensive care unit of the Manipal Teaching Hospital, Pokhara, Nepal from January 2014 to December 2015. Neonatal details including place of delivery, birth weight, gestation, diagnosis at admission, hospital course and final outcome were recorded in predesigned proforma. Risk of mortality was calculated using odds ratio and 95% confidence interval. Results: There were total 1708 admission during study period and inborn as well as out born neonates were equally admitted. Neonatal hyperbilirubinemia (37.1%), neonatal sepsis 532 (31.2%), prematurity, 314 (18.4%) perinatal asphyxia 112 (6.6%), meconium aspiration syndrome 79 (4.6%) and intrauterine growth restriction 49 (2.8%) were main indications for hospitalization. A total of 1410 (82.6%) the patients were discharged after treatment, 167 (9.7) left against medical advice, 115 (6.7%) died in hospital and 16 (1%) cases were referred. Preterm neonates had twice the risk of mortality than term neonates (OR =2.1664). Birth weight < 2500 grams had three times more risk of neonatal mortality than normal birth weight (OR =3.0783).Conclusions: Neonatal hyperbilirubinemia, prematurity and neonatal sepsis were common morbidities inneonatal intensive care unit.

<p>Discharge Against Medical Advice from NICU in a Tertiary Hospital of Central Nepal: A Descriptive Cross-Sectional Study</p>

“…The reasons stated were their domicile in another region, had other children at home, and dissatisfaction towards the treating physician. 12 The other reasons for DAMA in this study were a lack of improvement (21%) and the belief of significant improvement (12%). This is also worrisome as there is clearly a lapse in perceiving the severity of illness of newborns among family members.…”

“…However, other authors from various tertiary centers of Nepal have reported the incidence of DAMA to be 2-12%. [9][10][11][12] This discrepancy should be taken in the context of variations in local socio-cultural beliefs, services offered by the institutions, and different time scale of studies. In other developing countries like ours, the prevalence of DAMA varies from 11.1-25.4% of total admissions in the NICU.…”

Morbidity Pattern and Hospital Outcome of Neonates Admitted in Tertiary Care Hospital, Nepal

“…Studies from various parts of country showed high variability of neonatal mortality ranging from 3.32% -24.74%. 6,11 Likewise similar type of variation in neonatal mortality were observed in different countries which ranged from 7.16% -36.6%.¹ [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] These variabilities in mortality within the country and also outside might be due to various reasons including severity of illness during admission, time lapse between illness and hospital arrival, percentage of extramural cases, availability of medical equipment and skill of the medical experts.…”

“…Male babies being predominant in both hospital admissions (77.35%) as well as in poor outcomes, (22.65%) raise the issues of biological vulnerability of male neonates, similar finding were observed in other studies. [6][7][8][9][10][11][12] Neonates born to young mothers who were less than 20 years have highest mortality rate which is statistically significant (p-value 0.002). This might be due to poor nutritional status, low maternal education, lack of family support, abs ence of antenatal checkup and poor socioeconomic condition.…”

Gamma Glutamyl Transferase and Uric Acid Levels Can Be Associated with the Prognosis of Patients in the Pediatric Intensive Care Unit

“…Increased GGT levels are associated with poor outcomes in sepsis and cardiovascular diseases in adults [ 1 , 2 , 3 , 4 , 5 , 6 ]. Sepsis is also universally accepted as a risk factor in ICUs [ 15 ]. GGT is considered as a predictor for diseases involving oxidative stress and inflammatory reactions.…”