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In a developing country like India, one of the most important health hazards is neonatal sepsis. The ever full SNCUs of the hospitals are living proof of this. The neonates both early and late are extremely vulnerable to all organisms, both in the community and much more so in the hospital. Neonatal sepsis contributes to infant mortality rate in a very significant way. Nosocomial neonatal sepsis is much more dangerous and contributes to morbidity and mortality in a very big way.METHODSIn this study, neonatal sepsis was assessed by culture of blood, pus from infected umbilical stump, and CSF sample received from SNCU. The isolated organisms were identified phenotypically following our laboratory protocol. Antibiotic sensitivity testing was done by Kirby-Bauer method, following CLSI guidelines.RESULTSIt was found that 48% of the total samples received from SNCU were growth positive. Klebsiella pneumoniae was isolated in maximum number of cases, 42.85% followed by Staphylococcus aureus 18.53%. Antibiotic sensitivity test by Kirby- Bauer method showed that all Gram-positive cocci were sensitive to vancomycin. There was only one linezolid resistant Staphylococcus aureus. Among the Gram-negative bacilli 100% isolates were sensitive to carbapenems. Acinetobacter baumannii and Pseudomonas aeruginosa isolates were multidrug resistant.CONCLUSIONSSNCU admitted babies are extremely vulnerable to septicaemia. The ever-changing drug resistant patterns of the infecting organisms is a perineal problem. Thus, infection control measures are to be strictly enforced in this setting.
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Background: Neonatal mortality rate (NMR) is one of the major contributors to infant mortality rate. The neonatal mortality depends on many factors birth weight, gestational age, post-natal care; it also depends on maternal social and environmental conditions which contribute to the social determinants of maternal health. This study was taken up to identify maternal social determinants contributing to outcome among outborn neonates in order to reduce neonatal deaths. The present was conducted to assess the outcome among the outborn neonates and assess the maternal social determinants of health affecting the outcome.Methods: A cross sectional study conducted in sick newborn care units (SNCU), Hassan Institute of Medical Sciences, Hassan among all out born neonates. After taking prior written consent, all mothers/bystanders of outborn neonates were interviewed using predesigned, pretested semi-structured proforma. Social factors, environmental conditions and antenatal care affecting the maternal health were collected. Neonatal outcome data was collected from SNCU register. The mothers/bystanders of outborn neonates not willing to give consent and re-admitted neonates were excluded from the study. Data analysis was done using SPSS V20.0.Results: Of 353 outborn neonates admitted, 16.1% was mortality rate. Number of antenatal care visits, consumption of iron tablets, gestational age, high risk mother, staff attending delivery, birth weight, referral time (at p≤0.5) and distance from hospital, passive smoking exposure, maternal services utilization (at p-value <0.1) were significantly associated with poor outcome among outborn neonates.Conclusions: There is need for establishment of SNCUs at sub-divisional levels.
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Background: Around 66% of infant and over 50% of under-five mortality occurs in newborn period. 99% of neonatal deaths occur in low and middle income countries. Most of these deaths can be prevented by suitable interventions at various levels. The premise of the study is that the neonates who require long transportation (>1 hour) have higher chances of mortality or prolonged stay in the hospital.Methods: A retrospective retrieval of data and prospective interview was conducted in G.B Pant children’s hospital Srinagar, an associated hospital of Govt. Medical College Srinagar in North India.Results: During the period of study 1431 neonates from twelve districts of the state were referred to the hospital for treatment, out of whom, 102 (7.13%) could not be saved. Neonatal death rate was found highest (11.11%) in neonates referred from districts of category-III (>100 kms from the referral hospital), followed by category-II (50-100 kms from the referral hospital) and category-I (>50 kms from the referral hospital). Average length of stay was observed longest for the neonates referred from districts of category-III followed by category-II and category-I.Conclusions: Several other studies found that transfer of sick neonates from another health facility were associated with relatively higher probability of morbidity and mortality after controlling for other predictors. Distance no doubt is a risk factor for neonatal outcome of referred neonates as we have observed in our study. To minimize neonatal deaths it is necessary to strengthen the perinatal services sick newborn care unit {(SNCUs) in district Hospitals)}.
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Background: India accounts for 24% of global neonatal mortality. It is important to study the mortality and morbidity pattern as it helps to implement new treatment protocols, interventions, planning and policy making which helps in better survival and improvement in the quality of life among survivors. The aim of the project study was to determine the causes of morbidity and mortality in neonates admitted in our hospital.Methods: This study was conducted at Special Newborn Care Unit (SNCU) of Veer Chandra Singh Garhwali Government Institute of Medical Science and Research providing level II neonatal care. This is a retrospective hospital based observational study. Data from admission and discharge registers were extracted, compiled and analyzed from March 2016 to February 2018. Neonates taken against medical advice and those referred to tertiary care centers were excluded in calculation of survival outcome. Statistical analysis was done in form of percentage, proportions and chi square test was used to find statistical significance.Results: 1582 neonates were admitted during the study period. 60.80% were inborn and 39.20% were outborn. 59.54% were male and 40.46% were female. Major causes of admission were jaundice (24.72%), sepsis (20.48%), birth asphyxia (18.52%), meconium aspiration syndrome (10.11%). Birth asphyxia was the major cause of mortality, followed by sepsis and prematurity. Mortality was more in outborn babies 14.67% compared to inborn babies 9.80%.Conclusions: Neonatal jaundice, birth asphyxia and sepsis were the commonest causes of morbidity. Common causes of mortality were birth asphyxia and sepsis and prematurity. More deliveries at institutions with SNCU facility, early identification of danger signs and timely referral to tertiary care centers can prevent neonatal deaths.
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Background: Patients who leave against medical advice (LAMA) is a universal problem. Neonates being unable to decide for their own, are dependent on parents for all decisions for their treatment. LAMA is a sensitive issue in neonatology practice with ethical and medico legal ramifications. This study was done to evaluate the factors associated with the decision of LAMA by care givers in our special newborn care unit (SNCU).Methods: This is a retrospective hospital based observational study and was conducted in SNCU of HNB Base Teaching Hospital, Srinagar, Garhwal. Data pertaining to LAMA between 1st August 2017 and 31st July 2018 was retrieved. Information obtained included place of birth, gestational age, weight, diagnoses, duration of hospital stay and reasons for LAMA. Data were entered into a Microsoft Excel Spread Sheet and analyzed using software. Graph Pad Prism v 7.04. Chi-Square test was used to test for significant difference among various groups.Results: Out of 689 neonates admitted in SNCU during the study period, 167 (24.24%) took LAMA. Male to female ratio of 1:1.1. 102 (61%) were inborn and 65 (39%) were out born. Term babies constituted 62.87%. 78.44% neonates were discharged within 7 days of admission. 58 (34.73%) neonates had sepsis and 30 (17.96%) had birth asphyxia. The commonest reason in 25.15% for taking LAMA was to take the neonate to better equipped facility followed by false perception that the baby is well enough to be discharged.Conclusions: Multiple factors contribute for getting a neonate discharged against medical advice. Improvement of infrastructure, training of health care staff for proper counselling, sensitivity and empathy towards neonate and the care givers can decrease the rate of LAMA.
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Placenta plays a vital role in normal fetal development and failure of placenta to gain weight and insufficiency of its function can result in fetal disorders. We performed this study to determine placental weight with birth weight, maternal diabetes, pre–eclampsia/eclampsia, Anemia, Apgar score, SNCU admission, in a longitudinal cross–sectional study, women with single pregnancy, and gestational age between 29–42 weeks were studied. The placental weight, birth weight, maternal age, gestational age, hypertensive disorders in pregnancy, maternal diabetes, Apgar score in 5th minutes after delivery were examined. Two fifty pregnant women were included in the study. The mean and standard deviation for maternal ages and gestational ages at deliveries were 25.6 ± 4.4 and 38.3 ± 4.4 days, respectively. The mean and standard deviation of neonates’ weights at birth and placental weights were 2709 ± 614.0g and 466.6 ± 112.2 g, respectively. The prevalences of low and high placental weights were 2% and 2.8%, respectively. There were statistically significant relationships between placental weight, placental weight ratio(PWR) and birth weight, maternal diabetes, hypertensive disorders in pregnancy, anemia, Apgar score, SNCU admission . Our findings indicate that placental weight Ratio(PWR) can be associated with important variables influencing some maternal and neonatal outcomes .Careful attention to placenta growth during pregnancy, for example by ultrasonography, can guide physicians to assess neonatal health.