Evaluation the causes of mortalities among low-birth-weight new-borns in NICU, MGM medical college and LSK hospital in Kishanganj

 

Kunal Anand¹, Shreemant Gautam^2*

 

Abstract              Background: Babies below 1.8 kg are the group who are most susceptible to morbidity and mortality in the neonatal period . Since mortality and morbidity will be highest in this group in developing countries like India, this group is the subject of the present research work. Methods: This Study was conducted in the Neonatal Intensive Care Unit at the department of pediatric medicine, M.G.M. Medical College and L.S.K. Hospital. An annual delivery rate of approximately 6000 babies per year and approximately 100 – 120 babies < 1.8 kgs being delivered every year. The final sample size was 85 for the purpose of the study, study period was November 2018 to September 2019. Results: 1>Babies <1.8Kgs accounted for 12.6% of the total admissions for newborns 2>The overall mortality of babies < 1.8 kgs was 34.1% and the mortality was higher for lower birth weight group as compared to higher birth weight groups. The mortality rate of 751-1000 grams was 57.1% and mortality rate of 1001 - 1800 grams was 22.9%. Conclusion: The in-utero transfer of the premature babies with anticipated low birth weight will decrease the complication relating to transfer of such babies to special care nursery and thereby, improving the outcome.

 

INTRODUCTION

A newborn infant weighing less than 2500g at birth is termed as low birth weight (LBW) neonate. Low birth weight in a newborn infant result due to intrauterine growth restriction (IUGR) or prematurity. Nearly one third of neonates born in India are low birth weight.¹ Compared with term infants, preterm infants are at high risk for respiratory morbidity, need of ventilation (noninvasive or invasive), jaundice, hypoglycemia and sepsis. The incidence of morbidities increased from 23% at 40 weeks to 30%, 39.7%, 67.5%,89.5%,and 89.75% at 38, 37, 36, 35 and 34 weeks respectively.² Hypoglycemia, is defined as a blood glucose value of less than 40 mg / dL ( plasma glucose level of <45 mg / dl.). It is commonly associated with a variety of neonatal conditions like prematurity, intrauterine growth restriction and maternal diabetes. Screening for hypoglycemia in high-risk situations is recommended. Supervised breast feeding may be an initial treatment option in asymptomatic hypoglycemia. However, symptomatic hypoglycemia should always be treated with infusion of parenteral dextrose. Neonates needing dextrose infusion rates above 12 mg/ kg / min should be investigated for a definite cause of hypoglycemia. Hypoglycemia has been linked to poor neuro developmental outcome and hence aggressive screening and treatment is recommended.³ Hyperbilirubinaemia is the commonest morbidity in the neonatal period and 5 to 10 % of all newborns require intervention for pathological jaundice. Jaundice is an important problem in the first week of life. High bilirubin levels may be toxic to the developing central nervous system and may cause neurological impairment even in term newborns though in most cases it is benign and no intervention is required, some have clinically significant hyperbilirubinemia mandating the use of phototherapy⁴ and exchange transfusion. Respiratory Distress Syndrome or HMD is the commonest cause of neonatal mortality and morbidity in preterm babies. CPAP, Mechanical Ventilation and Surfactant are the prime modalities of intervention. RDS is common in preterm babies less than 34 weeks of gestation. The incidence is higher in neonates less than 28 weeks of gestation. In addition to prematurity, maternal diabetes, acidosis and caesarian section are risk factors.⁵ Intraventricular - periventricular hemorrhage is common in preterm babies because of inadequately supported germinal matrix . Cranial USG is able to detect intraventricular – periventricular haemorrhage and periventricular leucomalacia.⁶

 

METHODOLOGY

It was prospective observational stud, Study was conducted in the Neonatal Intensive Care Unit at the department of pediatric medicine, M.G.M. Medical College and L.S.K. Hospital. An annual delivery rate of approximately 6000 babies per year and approximately 100 – 120 babies < 1.8 kgs being delivered every year . The final sample size was 85 for the purpose of the study, study period was November 2018 to September 2019.Neonates having birth weight below 1.8 kg was included and Neonates with Congenital anomalies and Birth Asphyxia were excluded in this study. 85 babies with birth weight below 1.8 kg. were followed up closely at our NICU for hypothermia, appearance of respiratory distress, sepsis, jaundice, hypoglycemia, hypocalcaemia, Seizures, Necrotizing enterocolitis, IVH etc.

Hypothermia in a newborn baby was defined as core temperature of < 36 degrees celcius .

Respiratory Distress was evaluated using Downes score or Silverman Anderson retraction score

Respiratory support was given by free flow oxygen, head box, Indegenous CPAP, nasal CPAP machine ( Meditrin ) or Ventilator ( Maquet servo i )

SEPSIS has been defined as Confirmed Sepsis ie. Blood culture positive ( Bact Alert 3 D ) or Presumed sepsis ie. Screen positive if two (or more) parameters mentioned below are positive .             

Sepsis Screen parameters

Total leukocyte count < 5000 / mm3

Absolute neutrophil count < 1000 / mm3

Immature/total neutrophil > 0.2

C reactive protein (CRP) ≥ 6 mg / L

Neonatal Jaundice was treated by Phototherapy or by exchange transfusion depending upon the serum level of bilirubin, the birth weight, the gestational age at birth and the presence of Rh incompatibility, ABO incompatibility, risk factors like birth asphyxia, sepsis, birth trauma, G 6 P D deficiency and hypothyroidism.The decision for treating with phototherapy or with exchange transfusion was made as per guidelines laid down by Bhutani VK and others in American Academy of Pediatrics subcommittee on hyperbilirubinaemia .