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

OBJECTIVE: To estimate the direct causes of mortality among preterm neonates <33 weeks’ gestation by examining three large multicentric, hospital-based datasets in India. METHOD: Three prospective hospital-based datasets: National Neonatal Perinatal Database (NNPD) of India, Delhi Neonatal Infection Study (DeNIS) cohort, and Goat Lung Surfactant Extract (GLSE)-Plus cohort were analyzed to study the causes of death among preterm neonates of less than 33 weeks’ gestation admitted to the participating tertiary care hospitals in India. RESULTS: A total of 8024 preterm neonates were admitted in the three cohorts with 2691 deaths. Prematurity-related complications and sepsis contributed to 53.5% and 19.8% of deaths in the NNPD cohort, 51.0% and 25.0% in the DeNIS cohort, and 39.7% and 40.9% in GLSE-Plus cohort, respectively. CONCLUSIONS: Nearly a quarter (20-40%) of preterm neonates less than 33 weeks’ gestation admitted to Indian NICUs died of sepsis. The study results have implications for health policies targeted to reduce the neonatal mortality rate in India.