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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 26  |  Issue : 1  |  Page : 42-45

Causes of mortality and morbidity among neonates admitted to the neonatal intensive care unit in Ladakh, India


1 Centre of Research for Development, Cytogenetic and Molecular Biology Research Laboratory, University of Kashmir, Srinagar, Jammu and Kashmir, India
2 Advanced Centre for Human Genetic, SKIMS Soura, Srinagar, Jammu and Kashmir, India

Date of Submission07-Feb-2020
Date of Acceptance18-Jun-2021
Date of Web Publication29-Jun-2021

Correspondence Address:
Dr. Md. Niamat Ali
Centre of Research for Development, Cytogenetic and Molecular Biology Research Laboratory, University of Kashmir, Srinagar - 190 006, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmgims.jmgims_14_20

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  Abstract 

Background: The first month of life is the most important and hazardous as neonates are prone to a number of infections and obstacles. This hospital-based prospective study was conducted for two years from June 1, 2017, to May 31, 2019, in the neonatal intensive care unit (NICU) of District Hospital, Kargil-Ladakh. Aims and Objective: The aim of this study is to analyze the causes of morbidity and mortality among neonates in the tribal population of Ladakh region. The final diagnosis of the patients was made mainly on clinical grounds by pediatricians with the help of available necessary laboratory investigations. Results: During the period of 2 years, a total of 686 neonates were admitted to the NICU of district hospital Kargil. Out of the 686 neonates, 57.1% were male and 42.8% female with a ratio of 1.34:1. Of the admitted neonates, 68.8% were inborn and 31.1% were outborn babies. Of them, 628 (91.5%) neonates were discharged, two left against medical advice, four were referred to a specialty hospital in Kashmir valley, and 52 (7.5%) died. Of the 52 expired neonates, 27 (51.9%) were male and 25 (48%) were female. Thirty-seven were inborn and delivered at a district hospital, while 15 were born outside the district hospital. The major causes of morbidity among neonates in NICU were preterm with low birth weight (36.5%), neonatal sepsis (19.2%), meconium aspiration syndrome (19.2%), birth asphyxia (13.4%), and intrauterine growth restriction (5.7%). Conclusion: We found prematurity, neonatal sepsis, meconium aspiration syndrome, and asphyxia to be the common causes of mortality in neonates. Most of these problems can be prevented by improving the quality of the concerned health units, improved maternal care, timely intervention, and timely referral to tertiary care hospitals in high-risk situations.

Keywords: Ladakh, morbidity, mortality, neonates, tribal population


How to cite this article:
Murtaza M, Ali MN, Khan IS, Zargar MH. Causes of mortality and morbidity among neonates admitted to the neonatal intensive care unit in Ladakh, India. J Mahatma Gandhi Inst Med Sci 2021;26:42-5

How to cite this URL:
Murtaza M, Ali MN, Khan IS, Zargar MH. Causes of mortality and morbidity among neonates admitted to the neonatal intensive care unit in Ladakh, India. J Mahatma Gandhi Inst Med Sci [serial online] 2021 [cited 2021 Nov 28];26:42-5. Available from: https://www.jmgims.co.in/text.asp?2021/26/1/42/319838


  Introduction Top


The first month of life is the most important and hazardous. Lack of proper care of ill neonates also remains one of the important challenges in the field of pediatrics. In India, neonatal death accounts for two-third of infant deaths; among them, 40%–45% of the deaths occur within the first 2 days of neonatal life.[1] According to the NITI Aayog report of 2016, the neonatal mortality rate in India is 34/1000 live births and ranges from 23 in urban areas to 38 in rural areas. The neonatal mortality rate in Jammu and Kashmir as per NITI Aayog was 24/1000 live births and ranged from 23/1000 in urban areas to 25/1000 live births in rural areas.[2]

Prematurity, infections, jaundice, birth asphyxia, and pneumonia have been found to be the major causes of admission to neonatal intensive care units (NICU) in developing countries.[3] In developed countries, the major causes of admissions to NICUs are mostly congenital anomalies which are nonpreventable.[3]

Globally, the cause of neonatal deaths varies, based upon the facilities available and quality of health care provided by the local health centers. Regular audit of neonatal admissions is necessary to identify deficiencies in management of neonates, to assist health workers to better understand neonatal problems, to improve health care facilities for neonates, and thereby to, reduce mortality and morbidity among neonates. Neonatal mortality also reflects the socioeconomic status and health care of the region. Kargil Ladakh is a thinly populated area of Himalaya lying at an altitude of 2676 m and mainly comprising an arid desert. The people have continued permanent exposure to high altitude that may affect accordingly on the neonates. The aim of this study was to assess the major cause of mortality among neonates who are admitted to the NICU of the District Hospital in Kargil, Ladakh, in India.


  Materials and Methods Top


This hospital-based prospective study was conducted for a period of 2 years from June 1, 2017, to May 31, 2019, in the NICU of the District Hospital in Kargil-Ladakh. The data of all the admitted neonates obtained from the consulting admission register of the NICU were analyzed. The diagnoses of the patients were made mainly on clinical grounds by pediatricians, with the help of available necessary laboratory investigations. The primary problem was considered as the final diagnosis, even if the baby developed any other problems or complications.

This study was approved by the Ethics Committee of the Sher-i-Kashmir Institute of Medical Sciences, Srinagar (Deemed University).


  Results Top


During the period of 2 years, 686 neonates were admitted to the NICU. Of them, 392 (57.1%) were male and 294 (42.8%) were female with a male: female ratio of 1.34:1. Of the 392 males, 271 were inborn and 121 were outborn. The inborn are those neonates who are born under medical supervision at a district hospital, while outborn neonates are those who are born at home under the supervision of an ASHA or health worker posted at the village level and due to complications after birth is admitted to the NICU of the district hospital. Among the female babies, 201 were inborn and 93 were outborn. Overall, 472 (68.8%) babies were born in the main hospital and 214 (31.1%) were born in peripheral hospitals and were referred as well as home delivery cases [Figure 1].
Figure 1: Gender distribution of the admitted neonates at neonatal intensive care unit

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Of the total 686 neonates admitted, 628 (91.5%) neonates were discharged, two left against medical advice, four were referred to a specialty hospital in Kashmir valley, and 52 (7.5%) expired [Table 1].
Table 1: Various outcomes of neonatal intensive care unit

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Among the 52 expired neonates, 27 (51.9%) were male and 25 (48%) were females [Table 2]. Of these cases, 37 neonates were delivered at the district hospital, while 15 were born outside the district hospital [Table 3].
Table 2: Gender-wise admission of neonates to neonatal intensive care unit along with mortality rate

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Table 3: Admission ratio of inside and outside delivered babies along with mortality rate

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It was found that the major causes of mortality among neonates in NICU were preterm with low birth weight (36.5%), neonatal sepsis (19.2%), meconium aspiration syndrome (19.2%), birth asphyxia (13.4%), and intrauterine growth restriction (5.7%) [Table 4].
Table 4: Cause-wise admission in the neonatal intensive care unit

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The majority of babies admitted to NICU had neonatal sepsis (30.75%) followed by transient tachypnea (12.68%), meconium aspiration syndrome (11.66%), birth asphyxia (9.91%), and neonatal jaundice (9.03%). The other indications that led to admission in the NICU were preterm, pyoderma, chromosomal abnormalities, congenital anomalies, pneumonia, respiratory distress, hypothermia, light for date, anuria, and refusal to feed.


  Discussion Top


Accurate data on neonatal problems are useful for health administrators to make decisions on designing treatment and preventive measures. This study was a hospital-based one from a NICU that catered to the tribal population of Ladakh region. This 2-year study was conducted to document the common problems which led to admission of neonates in the NICU. It was found that a total of 686 neonates were admitted in the NICU during the period of study June 1, 2017–May 3, 2019. The neonates that are born at District Hospital as well as cases of home delivery under the supervision of ASHA workers were included in the study. Our study revealed a mortality rate of 7.5% in the NICU of Kargil District Hospital which is less than that reported by the study done by Kotwai et al. (9.73%) at the NICU of a tertiary care teaching hospital of Jammu and Kashmir.[4]

This study is important to collect data regarding neonatal mortality and morbidity of the region. This district in Ladakh, India, is among the highest world plateaus and the environment is hypoxic. In harsh winters, the physiological adaptation leads to genetic differences. The data on neonates about the health, disease pattern, and volume of diseases are important for the local administrators that provide care and investigation for neonates. There are very limited data from NICUs and very few published reports from the hospitals of Ladakh. Perhaps, this is probably the first data from a NICU from Ladakh and this hospital-based study may not be similar to community results. A number of studies have been conducted on high altitude problems and it was found that the farming population of Ladakh are prone to a number of respiratory illnesses due to the environmental dust from domestic fire soot.[5]

However, the pattern of mortality and morbidity seen in our study findings was not similar to other studies which show differences due to altitude, ethnicity, and cultural differences which are reflective of the daily routine of life. This study found that the major reasons for neonatal admission to the NICU of the region were neonatal sepsis (30.75%), transient tachypnea (12.68%), meconium aspiration syndrome (11.66%), birth asphyxia (9.91%), neonatal jaundice (9.03%), and low birth weight with preterm (6.26%). Sepsis was the major cause of admission in the NICU with an account of 19.23% of mortality rate. It is also the major cause of mortality and morbidity in developing countries.[6] Maternal infections and traditional home deliveries under unhygienic conditions are the major reasons for neonatal infection. Transient tachypnea is the second major cause of admission in the NICU as it is a temporary respiratory problem that lasts for 2–3 days after the onset of a problem. The transient tachypnea is caused by the slow absorption of fluid in the neonate's lungs and that makes taking oxygen harder. Meconium aspiration syndrome was found to be the third major cause of admission of neonates. Meconium is the dark sterile fecal material produced by the intestine of a baby before birth which passes out after birth when the baby starts feeding. When the meconium passes out before birth, it mixes with amniotic fluid and is inhaled into the neonate's lungs, causing stress during the initial gasping breaths after birth.

This study found that the main cause of morbidity among neonates was preterm with low birth weight (36.5%) followed by neonatal sepsis (19.2%), meconium aspiration syndrome (19.2%), birth asphyxia (13.4%), and intrauterine growth restriction (5.7%). The most common cause of neonatal mortality was low birth weight with prematurity, which is similar to findings reported in the studies conducted by Prasad and Singh, Seyar et al., Nahar et al., and Narayan et al.[7],[8],[9],[10] Low birth weight with prematurity is one of the leading causes of morbidity in neonates in almost all developing countries. The severity of clinical manifestations of the most neonatal diseases tends to increase with immaturity. It was found that prematurity was associated with a number of problems such as respiratory distresses, low birth weight, and hypoglycemia.

In our study, we found that 91.5% of the neonates were discharged with satisfactory improvement after treatment, 7.58% ended up with neonatal mortality, 0.29% left against medical advice, and four severe cases were referred to Kashmir for advanced treatment.

We found prematurity, neonatal sepsis, meconium aspiration syndrome, and asphyxia to be the common causes of mortality in neonates. Most of these problems can be prevented by improving the quality of the concerned health units, improved maternal care, timely intervention, and timely referral to tertiary care hospitals in high-risk situations.

Acknowledgment

The authors of this article are thankful to the in-charge of NICU and CMO of District Hospital Kargil-Ladakh for allowing this study to be conducted. Mohd Murtaza acknowledges a fellowship from CSIR New Delhi, India, to conduct this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Toolkit for Setting up of Special Care New-Born Units, Stabilization Units and New-Born Corners. New Delhi: United Nations Children's Fund; 2008. p. 9. Available from: http://www.unicef.org/india/SCNU_book1_April_6.pdf. [Last accessed on 2019 Jun 28].  Back to cited text no. 1
    
2.
NITI Aayog Report 2016. Available from: http://niti.gov.in/content/infant-mortality-rate-imr-1000-live-birth. [Last accessed on 2019 Jun 28].  Back to cited text no. 2
    
3.
Khinchi YR, Kumar A, Yadav S. Profile of neonatal sepsis. J Coll Med Sci Nepal 2010;6:1-6.  Back to cited text no. 3
    
4.
Kotwai YS, Yatoo GH, Ahmad Jan FA. Morbidity and morbidity among neonates admitted to a neonatal intensive care unit of a tertiary care teaching hospital of Jammu and Kashmir (India). Neonat Pediatr Med 2017;3:136.  Back to cited text no. 4
    
5.
Norboo T, Saiyed HN, Angchuk PT, Tsering P, Angchuk ST, Phuntsog ST, et al. Mini review of high altitude health problems in Ladakh. Biomed Pharmacother 2004;58:220-5.  Back to cited text no. 5
    
6.
Chaudry IJ, Chaudry NA, Hussain R, Munir M, Tayyub M. Neonatal septicemia. Pak Postgrad Med J 2003;14:18-22.  Back to cited text no. 6
    
7.
Prasad V, Singh N. Causes of morbidity and mortality in neonates admitted in Government Medical College Haldwaniin Kumaon Region (Uttarakhand) India. J Pharm Biomedl Sci 2011;8:1-4.  Back to cited text no. 7
    
8.
Seyal T, Husnain F, Anwar A. Audit of neonatal morbidity and mortality at neonatal unit of Sir Gangaram Hospital Lahore. Ann King Edward Med Coll 2011;1:9-13.  Back to cited text no. 8
    
9.
Nahar J, Zabeen B, Akhter S, Azad K, Nahar N. Neonatal morbidity and mortality pattern in the special care baby unit of Birdem. Ibrahim Med Coll J 2007;1:1-4.  Back to cited text no. 9
    
10.
Narayan R. A study of pattern of admission and outcome in a neonatal intensive care unit at high altitude. Sri Lanka J Child Health 2012;41:79-81.  Back to cited text no. 10
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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