ABSTRACT
Background: Objectives of present study was to assess receiving system of newborns, bed occupancies of referring facilities and receiving facility and assessment of rationality of referrals made by referring facilities to receiving facility leading to congestion at receiving facility. The study was conducted in Department of Pediatrics, Special Newborn Care Unit, Kamla Raja Hospital, Gajra Raja Medical College, Gwalior, Madhya Pradesh.Methods: This study was a prospective observational study which was conducted for a period of one year. Referred newborns fulfilling inclusion criteria were enrolled in study, and their receiving characteristics, bed occupancies of referring facilities and receiving facility, number of rationale and irrational referrals at receiving facility were statistically analysed.Results: Total referred newborns enrolled in the study was 2000. As receiving SNCU, of institute caters not only its nearby places, but also to distant districts of Madhya Pradesh, Rajasthan and Uttar Pradesh. SNCU wise receiving was in order of SNCU Morar (20.60%), Morena (19.40%), Bhind (5.70%), Dholpur (5.35%), Shivpuri (4.40%), Chattarpur (3.10%), Datia (1.20%), Sheopur (0.40%) and Jhansi (0.30%). Referring SNCU wise bed occupancy was in order of SNCU Guna (189.16%), Shivpuri (154%), Morena (72.33%), Bhind (71.63%), Sheopur (69.32%), Morar (64.15%) and Datia (62.11%). Referring SNCU wise case fatality was in order of SNCU Jhansi (100%), Sheopur (100%), Chattarpur (56.45%), Bhind (38.59%), Shivpuri (35.22%), Morena (33.76%), Dholpur (27.10%), Datia (25%), Morar (22.08%).Conclusions: Discordant bed occupancy at referring SNCU and receiving SNCU and low rationality of referrals are reason for congestion at receiving SNCU. Optimum utilization of beds and cordant bed occupancy between referring and receiving SNCU may improve the working conditions in SNCU and newborn outcome. Referral system should be close loop systemwith the provision of Down Referral.
ABSTRACT
Background: This study was aimed to assess newborn referral and factors contributing to outcome of referred newborns.Methods: This prospective observational study was conducted in a tertiary newborn referral facility for a period of one year. Referred newborns fulfilling inclusion criteria were enrolled in study, and assessed in terms of demographic profile, transport characteristics, physiological variables. Investigations, management of neonatal illness was done as per standard management protocols, they were followed up to their outcome.Results: Out of 2000 enrolled referred newborns, 30.10% were expired. Mean gestational age for survived newborns was 36.54'2.92 (SD) weeks, for expired newborns 35.24'3.99 (SD) weeks. Mean weight for survived newborns 2312.27 gms '555.71 (SD), for expired newborns 1936.71 gms '665.67 (SD). Out of total 60.05% newborns transported from periphery, had higher mortality i.e. 35% as compared to newborns transported from urban place i.e. 25%. Mean transport duration for survived newborns 61.94 minutes '55.18 (SD), for expired newborns 89.51 minutes '88.94 (SD). Prolonged CRT was observed' in 57.45% newborns, grunting'' 19.70%, Cyanosis 11%, gasping 7.6%, apnea 5%, respiratory distress 39.80%, hypothermia 74.95%, and 25.50% required resuscitation on admission. Unattended delivery, self-arranged mode of transport, prolonged CRT, respiratory distress, apnea , hypothermia on admission, weight on admission(<1500gms), hypoglycaemia and duration of transport more than 1 hour' found statistically significant independent variables associated with mortality of referred newborns.Conclusions: A significant number of neonatal deaths can be prevented, if referral system is structured and organized. Improper referral leads to poor physiological profile of referred newborns, which leads to their poor outcome. There are many independent variables which are affecting the outcome of referred newborns. These independent variables can be taken care in holistic way once the referral system is cultured and nurtured in existing health system.