Predictors of mortality in extramural very low birth weight neonates: a prospective observational study

Authors

  • Rajkumar M. Meshram Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India
  • Ruchi A. Gedam Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India
  • Shivangi Garg Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India
  • Kalyani S. Kadu Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India
  • Madhabika R. Chakraborty Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India
  • Swaroop B. Kumar Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20205515

Keywords:

Morbidity, Mortality, Extramural neonate, Predictors of mortality, Risk factors, Very low birth weight

Abstract

Background: Over the past few decades, the burdens of very low birth weight (VLBW) preterm infants are increasing due to advances in obstetrics and perinatal services. Objectives of the study were to assess predictors of mortality of extramural VLBW neonates.

Methods: Prospective one year cohort study was undertaken on VLBW neonates fulfilling the inclusion criteria at a tertiary institute. Maternal and neonatal demographic data were analyzed.

Results: Male to female ratio was 1.26:1. One hundred and thirty seven (74.9%) neonates had birth weights from 1000-1499 g while 46 (25.1%) had birth weights <1000 g (ELBW) and 90% were preterm. One hundred and sixty five (90.2%) neonates were admitted in early neonatal period. Anaemia was the commonest maternal illness and preeclampsia/eclampsia was the most common obstetric complication. Respiratory distress, temperature instability and lethargy were common clinical presentations. Respiratory distress, sepsis and perinatal asphyxia were common diagnoses on admission. Mortality rate in VLBW neonates was 59.6% and respiratory distress was the commonest cause of death. Male gender (p=0.01), home delivery (p=0.04), vaginal delivery (p=0.05) and positive septic screen (p=0.003) had significantly higher mortality while mode of delivery (aOR 0.27 CI 0.086-0.83 p=0.02) and positive septic screen (aOR 4.0 CI 1.67-9.84 p=0.002) were independent risk factors for mortality.

Conclusions: In extramural VLBW neonates, male gender, home delivery, vaginal delivery and positive septic screen had significantly higher mortality whilst mode of delivery and positive septic screen were independent risk factors for mortality.

Author Biographies

Rajkumar M. Meshram, Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India

Associate professor.                                                                              Department of Pediatrics

Ruchi A. Gedam, Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India

Post Graduate Student

Shivangi Garg, Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India

Post Graduate Student

Kalyani S. Kadu, Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India

Post Graduate Student

Madhabika R. Chakraborty, Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India

Post Graduate Student

Swaroop B. Kumar, Department of Pediatrics, Government Medical College, Nagpur, Maharashtra, India

Post Graduate Student

References

Sankar MJ, Neogi SB, Sharma J, Chauhan M, Srivastava R, Prabhakar PK, et al. State of newborn health in India. J Perinatol. 2016;36:3-8.

Neonatal mortality- UNICEF DATA. Available at: https://data.unicef.org/topic/child-survival/neonatal-mortality/. Accessed on: 10 October 2020.

Mortality rate, neonatal (per 1,000 live births)-India/Data. Available at: https://data.worldbank.org/indicator/SH.DYN.NMRT?locatios=IN. Accessed on: 10 October 2020.

Newborn death and illness-WHO. Available at: http://who.int/pmnch/media/press_materials/fs. Accessed on: 10 October 2020.

Neonatal health/UNICEF. Available at: https://unicef.org/India/what-we-do/newborn –and-child-health. Accessed on: 10 October 2020.

Chen SD, Lin YC, Lu CL, Chen SCC. Changes in outcome and complication rates of very- low- birth -weight infants in one tertiary centre in Southern Taiwan between 2003 and 2010. Pediatr Neonatol. 2014;55:291-6.

Jeschke E, Biermnn A, Gunster C, Bohler T, Heller G, Helmut D, et al. Mortality and major morbidity of very-low-birth-weight infants in Germany 2008-2012: A report based on administrative data. Front Pediatr. 2016;4:23.

Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et al. Trends in neonatal morbidity and mortality for very low birth weight infants. Am J Obstetr Gynecol. 2007;196(2):147.

Tripathy SK, Chatterjee K, Behera N. Mortality and morbidity of very low birth weight and extremely low birth weight babies in neonatal period. Int J Contemp Pediatr. 2019;6(2):645-9.

Bansal A. Comparison of outcome of very low birth weight babies with developed countries: a prospective longitudinal observational study. J Clin Neonatol. 2018;7(4):254-8.

Kusuda S, Fujimura M, Uchiyama A, Totsu S, Matsunami K. Trends in morbidity and mortality among very low birth weight infants from 2003 to 2008 in Japan. Pediatr Res. 2012;72(5):531-8.

Mari G, Bursac Z, Goedecke PJ, Dhnireddy R. Factors associated with improvement in mortality and morbidity rates of very-low-birth-weight infants: a cohort study. Global Pediatr Health. 2018;5:1-10.

Kaur A, Thapar K, Chhabra GS, Jaslean. Morbidity and mortality of very low birth weight babies in a tertiary level NICU. J Nepal Paediatr Soc. 2015;35(3):257-63.

Sobaih B, Hadid A, Fariss A, Banoo R, AlKharfi T, AlFaleh K. Mortality and short term outcome of very low birth weight infants at a tertiary care centre in Saudi Arabia: 9 years data. Kuwait Med J. 2014;46(3):233-6.

Kabilan S, Kumar MS. Morbidity and mortality pattern of very low birth weight infants admitted in SNCU in a South Asian tertiary care centre. Int J Contemp Pediatr. 2018;5(3):720-5.

Lakshmanaswamy A, Senthilkumar P, Abinaya G, Sthyan VK. Study of neonatal morbidity and mortality in a neonatal intensive care unit in a tertiary care centre. IOSR J Dent Med Sci. 2019;18 (3):33-7.

Mukherjee S, Shaw SC, Devgan A, Srivastava AK, Mallige A. Survival and morbidities in very low birth weight infants in a tertiary care teaching hospital. Int J Contemp Pediatr. 2017;4(6):2170-4.

Bairwa M, Rajput M, Sachdeva S. Modified Kuppuswamy’s socioeconomic scale: social researcher should include updated income criteria, 2012. Ind J Comm Med. 2013;38:185-6.

Naskar N, Swain A, Das KD, Patnayak AB. Maternal risk factors, complications and outcome of very low birth weight babies: prospective cohort study from a tertiary care centre in Odisha. J Neonat Biol. 2014;3:3.

Hasan ANMS, Biswas BK, Saha AK, Kundu LC, Khan MZI, Rashid MA, et al. Outcome of very low birth weight neonates in a tertiary level hospital outside capital of Bangladesh: a study in FaridpurMedical College Hospital. Faridpur Med Coll J. 2016;11(1):15-9.

Parekh ZR, Bhradwaj R, Parmar G, Shah A. Study of referral pattern of neonates at tertiary care centre and role of TOPS score in assessing morbidity and mortality. Nat J Comm Med. 2018;9(3):157-60.

Verma SK, Nagaura CP, Goyal VK, Raheja KK, Singh A, Sharma P, et al. Status of transported neonates and evaluation of TOPS as a survival score. Ind J Neonat Med Res. 2017;5(2):1-5.

Su YY, Wang SH, Chou HC, Chen CY, Hsieh WS, Tsao PN, et al. Morbidity and mortality of very low birth weight infants in Twain- changes in 15 years: a population based study. J Formosan Med Assoc. 2016;115:1039-45.

Kumar R, Mundhra R, Jain A, Jain S. Morbidity and mortality profile of neonates admitted in special newborn care unit of a teaching hospital in Uttarakhand, India. Int J Res Med Sci. 2019;7(1):241-6.

Brasher M, Patil M, Hagan J, Suresh GK. Mortality and morbidity in outborn extremely low birth weight neonates: a retrospective analysis. J Perinatol. 2020;40(2):337-43.

Ballot DE, Chirwa TF, Cooper PA. Determinants of survival in very low birth weight neonates in a public sector hospital in Johannesburg. BMC Pediatr. 2010;10:30.

Ballot DE, Chirwa T, Ramdin T, Chirwa L, Mare I, Davies VA, et al. Comparison of morbidity and mortality of very low birth weight infants in a central hospital in Johannesburg between 2006/2007 and 2013. BMC Pediatri. 2015;15:20.

Ruegger C, Hegglin M, Adams M, Bucher U, for the Swiss Neonatal network. Population based trends in mortality, morbidity and treatment for very preterm-and very low birth weight infants over 12 years. BMC Pediatr. 2012;12:17.

Zile I, Ebela I, Rozenfelde IR. Risk factors associated with neonatal deaths among very low birth weight infants in Latvia. Curr Pediatr Res. 2017;21(1):64-8.

Porta R, Capdevila E, Botet F, Verd S, Ginovart G, Moliner E, et al. Morbidity and mortality of very low birth weight multiples compared with singletons. J Maternal-Fetal Neonat Med. 2019;32(3):389-97.

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Published

2020-12-23

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Original Research Articles