https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/12 Tue, 02 Aug 2016 07:53:00 +0000 Ibrahim Med. Coll. J. 2007; 1(2): 1-4 Key Words: Neonates, morbidity, mortality, baby care. Address for Correspondence: Dr. Jebun Nahar, Department of Paediatrics, Ibrahim Medical College & BIRDEM, 122 Kazi Nazrul Islam Avenue, Shahbag, Dhaka-1000   Introduction The Millennium Development Goal for child survival cannot be met without substantial reduction in neonatal mortality. Very few studies have reported information on the neonatal situation in our country. This retrospective study was done at BIRDEM hospital to identify the main causes of neonatal morbidity and mortality.   Methods A total of 361 neonates were included in this cohort. The ratio of male (55.4%) and female (44.6%) neonates was 1:0.7. Most of the babies were born in this hospital (83%). About four-fifths of neonates were born by lower uterine caeserian section (81.4%) and two-thirds were admitted within first 24 hours of delivery. There were 219 (60.7%) premture deliveries with a mean gestational age of 35.6 ± 3.4 weeks and 174 LBW neonates with mean birth weight of 2420 ± 808 gm. According to their weight for gestational age, 78.4%, 13.9% and 7.8% were age appropriate for gestational age (AGA), small for gestational age (SGA) and large for gestational age (LGA) respectively. Major causes of morbidity were prematurity (60.7%), LBW (48.2%), jaundice (23.3%), SPA (10.8%), TTN (10.8%), RDS (6.4%) and sepsis (6.4%) (Table-1). Infants of diabetic mothers (63%) were also one of the major causes of morbidity.   Table-1: Neonatal morbidities at admission   Morbidity Sick neonates n (%) Deaths      n (%) Relative Risk of death (95% CI) Proportion of total (%)* Prematurity 210 (60.5) 27 (12.9) 0.55 (0.3-1.1) 71.1 LBW 167 (48.1) 25 (15.0) 3.9 (1.8-8.3) 65.8 IUGR 50 (14.4) 09 (18.0) 0.6 (0.3-1.1) 23.7 RDS 23 (6.6) 14 (60.9) 8.2 (5-13.6) 36.8 SPA 36 (10.4) 7 (19.4) 2 (0.9-4.1) 18.4 Sepsis/Pneumonia 26 (7.5) 6 (23.1) 2.3 (1.9-5) 15.9 MAS 06 (1.7) 1 (16.7) 1.3 (0.2-8.5) 2.6 *Congenital anomalies 03 (0.9) 3 (100.0)   7.9   *A neonate having more than one morbidity is counted in each category. Hence, the sum may be more than the total neonates or deaths in the study population.   Mortality rates in neonates were analysed. Half of all neonatal deaths occurred in the babies weighing less than 1500g of birth weight and in premature babies having gestational age less than 34 weeks (Table-3). Table-3: Neonatal mortality by birth weight and gestation period Birthweight/gestation Total No of deaths(%) <1500g 56 (16.1) 21 (55.3) 1500-2499g 111 (32) 08 (21.1) 2500g-3999g 167 (48.1) 08 (21.1) >/4000g 13 (3.7) 01 (02.6) <34weeks 71 (20.5) 19 (50.0) 34-37weeks 140 (40.3) 09 (23.7) >37weeks 136 (39.2) 10 (26.3) Outcome of babies born in this hospital (inborn) and of babies referred from other hospitals (outborn) was analyzed. Among inborn babies 23 (8%) expired, while 15 (25.4%) expired among outborn. The difference was significant (p <0.05). Primary causes of neonatal deaths for inborn and outborn are shown in Table-4. Prematurity with LBW and prematurity with or without respiratory distress syndrome were the dominant causes of death among inborn babies, while prematurity with RDS and SPA were the most important causes of mortality among the outborn neonates.   Table-4: Primary Causes of Neonatal Mortality Inborn & Outborn Compared   In our study about two-thirds of neonates were premature. High proportion of high-risk pregnancies may be responsible for this high incidence of prematurity. Respiratory distress (10.4%), jaundice (13.7%) and infection (10%) were the main presenting features among the admitted premature babies in our study. In a hospital based study6, the incidence of premature delivaries were 16.3%. Premature babies suffered adverse effects like respiratory distress, apnoea, infection and jaundice. According to one UNICEF report3, one third of neonates are born with LBW in Bangladesh. The high proportion of LBW (48.2%) in this study was similar to those reported from other tertiary level care centers in the country7,8.  Perinatal asphyxia is an important cause of neonatal morbidity and mortality. Several grades of perinatal asphyxia was observed in 103 (28.5%) newborns in the present study. Among them 38 (36.9%) had severe perinatal asphyxia. The incidence of perinatal asphyxia in our finding was similar to Chandra et al.’s finding from India11. In developing countries, neonatal sepsis is a great problem and dominates as the major cause of death16. It accounted for 16% of neonatal deaths in our study. 1.   Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 9-18. 3.   UNICEF. The State of the World’s Children 2005. New York: UNICEF 2005. 5.   Chowdhury EM, Akter HH, Chongsuvivatwong V and Geater FA. Neonatal mortality in rural Bangladesh: An exploratory study. J. Health Population 2005; 23(1): 16-24. 7.   Rashid A, Ferdous S, Chowdhury T and Rahman F. Morbidity pattern and hospital outcome of neonates admitted in a tertiary level hospital in Bangladesh. Bangladesh J Child Health 2003; 27(1): 10-3. 9.   Hasan HSM, Fateha US, Abdullah AHM and Azad K. Neonatal jaundice: Experience at BIRDEM. Proceedings of the 4th National Conference and Scientific Seminar of Bangladesh Neonatal Forum 2004; Dhaka. 11.  Chandra S, Ramji S and Thirpuram S. Perinatal asphyxia: Multivariate analysis of risk factors in hospital births. Indian J. Paediatrics 1997; 34:      206-12. 13.  Manji KP, Massawe AW and Mgone JM. Birth weight and neonatal outcome at the Muhimbili Medical Centre, Dares-Salaam, Tanzania. East African Medical J 1998; 75(7): 382-7. 15.  Pankaj G, Rajeev K and DK Shukla. NICU in a community level hospital. Indian J. Paediatrics 2005; 72(1): 27-30. 17.  Ahmed FU, Alam MB, Bhuiyan SN. Birth weight specific neonatal mortality and morbidity in a birth cohort. Bangladesh J. Child Health 1999; 23(1/2): 1-5. 2026 Ibrahim Medical College. All rights reserved.