Burden of disease and survival rate amongst hospitalized newborns in Himalayan region in North India

OBJECTIVE: To describe the patient population, priority diseases, and outcomes in neonates admitted to neonatal unit in the Himalayan region of North India. STUDY DESIGN: The retrospective study was conducted at a University teaching hospital in Himachal Pradesh, and captured anonymized data on all admissions in newborn unit over 6-year period. RESULTS: Total 12449 newborns were admitted, 4669 were outborn, M:F of 1.35:1 and 81% of them were discharged successfully. Overall admissions surged by 76 percent in six years, preterm admissions increased by 41%. During the same period delivery load grew by 24.7%. Majority 64.9% were full-term; 50.4% (6279/12449) of neonates were low birthweight (LBW; <2.5 kg) and 3.8% were Extreme LBW (ELBW; <1.0 kg). Among intramural, out of 20.2% preterm, 1.8% were <28 week; compared to 1.5% <28 week and 14.1% preterm in extramural. The intrauterine growth restriction rate was 17.6% for intramural and 19.3% for extramural, respectively. The most common morbidities were prematurity (40.2% & 27%), jaundice (32.6% & 27.5%), RDS and respiratory problems (19.2% & 9.8%), sepsis (11.3% & 23.5%), and perinatal asphyxia (6.2% and 7.5%) among inborn and outborn respectively. Total 798 (6.4%) newborns died, 10.5% of all deaths happened within 24 hours; mortality was very high amongst ELBW (110/205, 53.7%) and very preterm infants <28 weeks (81/135,60%). Only 993 inborn and 18 outborn received antenatal corticosteroids, with only 383 inborn and 4 outborn receiving four doses of Dexamethasone. Low gestational age, LBW, less of antenatal corticosteroids, outborns, male sex, and congenital deformity were all found to have a significant association with death (P < 0.001). CONCLUSION: Preterm accounts for a considerable majority of our total admissions. Greater efforts and investment in better prenatal care, infrastructure, therapeutic facilities, manpower, and periodic training and review of staff nurses are all urgently needed to address the extremely high burden of illnesses and mortality among hospitalized newborns; otherwise, lowering the NMR will remain an unattainable goal.