NICU in a community level hospital

Abstract

Objective: To study the clinical profile and outcome of neonates in NICU of a community hospital and highlight the importance and problems in neonatal care at a community level hospital.

Methods: Retrospective analysis of case records during the period Jan. 2001- Dec. 2003. Data regarding antenatal care, maternal morbidity, place of birth, age at admission, birth weight, gestational age, diagnosis, relevant investigations, duration of stay and outcome were recorded on a preset proforma. A cost analysis for average expenses per newborn per day for different morbidities was also done. Neonatal data was analyzed among survivors and expired using appropriate statistical tests. Probability of less than 5% was taken significant. Factors found significant on univariate analysis were subjected to logistic regression model to study independent predictor of fatality.

Results: A total of 168 neonates were admitted during the study period. The overall survival rate was 65%. 42(25%) neonates expired and 5.4% were referred to higher centers. The commonest morbidity in survivors was hyperbilirubinemia. Prematurity with HMD and neonatal sepsis were the commonest cause of mortality. 36(24.3%) expired within 48 hr of admission (Mean 33.2 hr). 31(17.8%) could not be referred and none survived. The difference of birth weight, gestational age and duration of stay was statistically different in survivors & expired. These variables retained their significance on multivariate analysis and thus were independent predictors of fatality. An average expense of Rs 400-500/day/newborn was charged in the NICU.

Conclusion: In a country of limited resources, 65 % neonates requiring NICU can be managed at community level hospitals.