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Observational Study
. 2023 Nov;130(Suppl 3):68-75.
doi: 10.1111/1471-0528.17581. Epub 2023 Jul 20.

Neonatal mortality among preterm infants admitted to neonatal intensive care units in India and Pakistan: A prospective study

Sarah Saleem  1 , Shiyam Sunder Tikmani  1 , Shivaprasad S Goudar  2 , Kay Hwang  3 , Sangappa Dhaded  2 , Gowder Guruprasad  4 , Naveen G Nadig  4 , Varun B Kusagur  4 , Lingaraja Gowda C Patil  4 , E S Siddartha  4 , S Yogeshkumar  2 , Manjunath S Somannavar  2 , Sana Roujani  1 , Mashal Khan  5 , Mehmood Shaikh  5 , Muhammad Hanif  5 , Carla M Bann  3 , Elizabeth M McClure  3 , Robert L Goldenberg  6 ; PURPOSE Study Group
Collaborators, Affiliations
Observational Study

Neonatal mortality among preterm infants admitted to neonatal intensive care units in India and Pakistan: A prospective study

Sarah Saleem et al. BJOG. 2023 Nov.

Abstract

Objective: To explore potential reasons for differences in preterm neonatal mortality in neonatal intensive care units (NICUs) in India and Pakistan.

Design: A prospective observational study, the Project to Understand and Research Stillbirth and Preterms in Southeast Asia (PURPOSe) was conducted July 2018 to February 2020.

Setting: Three hospitals in Davangere, India, and a large public hospital in Karachi, Pakistan.

Population: Of a total of 3,202 preterm infants enrolled, 1,512 were admitted to a study NICU.

Methods: We collected data for neonates, including length of stay, diagnoses, and diagnostic tests.

Main outcome measures: Neonatal mortality, tests performed, diagnoses ascertained.

Results: For infants of equivalent weights and gestational ages, neonatal mortality in Pakistan was twice that in the Indian NICU. The mean newborn length of stay in Pakistan was 2 days compared with 10 days for India. Fewer diagnostics and other investigations were used to determine neonatal condition or guide treatment in the Pakistani NICU. Because of limited information from testing in Pakistan concerning clinical respiratory distress, respiratory distress syndrome appeared to be over-diagnosed, whereas other conditions including pneumonia, sepsis, necrotising entercolitis and intraventricular haemorrhage were rarely diagnosed.

Conclusion: In the Pakistani site, the limited resources available to the NICU appeared related to a shorter length of stay and decreased diagnostic testing, likely explaining the higher mortality. With improved care, reduction in mortality among preterm neonates should be achievable.

Keywords: low- and middle-income countries; preterm birth; preventable mortality.

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References

REFERENCES

    1. UNICEF. Neonatal mortality 2018. Data available from: Neonatal mortality-UNICEF DATA [cited 2022 Jan 10].
    1. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162-72.
    1. McClure EM, Garces AL, Hibberd PL, Moore JL, Goudar SS, Saleem S, et al. The Global Network Maternal Newborn Health Registry: a multi-country, community-based registry of pregnancy outcomes. Reprod Health. 2020;17:184.
    1. Aziz A, Saleem S, Nolen TL, Pradhan NA, McClure EM, Jessani S, et al. Why are the Pakistani maternal, fetal and newborn outcomes so poor compared to other low and middle-income countries? Reprod Health. 2020;17:190.
    1. McClure EM, Saleem S, Goudar SS, Dhaded S, Guruprasad G, Kumar Y, et al. The project to understand and research preterm pregnancy outcomes and stillbirths in South Asia (PURPOSe): a protocol of a prospective, cohort study of causes of mortality among preterm births and stillbirths. Reprod Health. 2018;15(Suppl 1):89.

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