Clinical profile and outcome of newborns admitted to a secondary-level neonatal intensive care unit in tribal region of Odisha

Introduction: Neonatal deaths constitute major proportion of under-five mortalities in India. Secondary-level neonatal intensive care units (NICUs) currently provide care to majority of sick newborns in India. Only few clinical studies have described the management outcome of newborns admitted into these secondary-level NICUs in India. Methods: The current study was conducted in Koraput District Headquarter Hospital and associated Medical College Hospital located in tribal regions of Odisha catering to 13.8 lakhs population of predominantly lower socioeconomic status. The study included in-depth retrospective case record analysis of all the NICU admissions in 3 months between April and June 2018, after a broad overview of all admissions in 3 years between July 2015 and June 2018. Predesigned pro forma was used to document clinical profile, indication for admission, microbiological characteristics of neonatal sepsis, and outcome in terms of discharge, death, referral, or left against medical advice. Results: Of 4127 total NICU admissions between July 2015 and January 2018, 3159 (76%) newborns were discharged. The most common indications for admissions in inborn babies were prematurity and related complications (23%), birth asphyxia (19%), and neonatal hyperbilirubinemia (18%). For outborn newborns, along with these causes, neonatal sepsis (20%) was another important cause of NICU admission. Escherichia coli and Klebsiella species were predominant microorganisms to be isolated in blood culture. About 11% of newborns received kangaroo mother care, with median duration of 6 days. Predominant causes of death among newborn babies were prematurity-related complications (51%) and neonatal sepsis (37%). Conclusion: Prematurity-related complications, birth asphyxia, neonatal hyperbilirubinemia, and sepsis are the predominant indications for admission to a secondary-level NICU in India. About three-fourth of neonates can be treated successfully within the existing infrastructure.