Neonatal mortality is defined as “death within the first twenty-eight days of life.” It is a core indicator for neonatal health & its wellbeing. Overall, it is an important componentof under-five mortality.Therefore, it is receiving particular attention from manyHealth authorities. Even though the under-5 mortality rate reduced by 47 percent (from 9.9 million to 5.6 million children from the year 2000 to 2016 around the globe, the neonatal mortality rate fell by 39% over the similar periodonly. Of the 5.9 million under five deaths reported in the year 2015, 2.7 million died during the neonatal period.[1,2]

Due to various problems Neonatal period is a very vulnerable period of life. Most of these cases are preventable.Advancement in perinatal and neonatal care have significantly helped in decreasing NMR in developed nations, but the mortality and morbidity are still very high in developing nations. Of the twenty-fivemillion babies born in India each year one million die, India alone contributes to 25 percent of neonatal mortality around the globe. Preterm and low birth weight (LBW) babies are at more risk of both perinatal mortality and morbidity.[3]

The major direct causes of neonatal mortality are prematurity or pre-term birth, infection,asphyxia, diarrhea,andcongenital anomalies.[4,5]

Data is scarce regarding the trend of neonatal mortality pattern in the state of Himachal Pradesh. This study was undertaken to study the disease pattern and outcome of neonates admittedto theSpecialized Neonatal Care Unit of pediatric ward of IGMC(Indira Gandhi medical college), Shimla.

Objectives of the Study

To study the trends of Neonatal Mortality in Specialized Neonatal Care Unit of pediatric ward of Indira Gandhi Medical College and Hospital (IGMC), Shimla from the year 2016 to 2020. Our centre serves as a referral centre for the entire state and this study was conducted on all outborns admitted to our centre between January 2016 to December 2020.

Research Methodology

• Research Approach-Descriptive survey 

• Study Design- A retrospective review

• Setting of the study- Indira Gandhi Medical College and Hospital, Shimla

• Study duration- between Jan2016- December 2020

• Study population-Neonates admitted to the Specialized Neonatal Care Unit of pediatric ward of IGMC,Shimla

• Sample size- All Neonates admitted to the Specialized Neonatal Care Unit of pediatric ward of IGMC,Shimlabetween Jan2016- December 2020

• Permission- obtained from the concerned authorities of Indira Gandhi Medical College and Hospital, Shimla

• Data analysis with appropriate statistical test in terms of frequencies and percentage

Retrospective review of medical records of all neonates admitted to the Specialized Neonatal Care Unit of pediatric ward of IGMC, Shimla covering the period January 2016 to December 2020 was conducted.

A total of 4018 outbornneonateswere admitted in the SNCU of IGMC Shimla in 5 years from Jan 2016 to Dec 2020.Among them 3034 (75.51%) were discharged after recovery, 305 (7.59%) were referred to higher institution, 372(7.90%), left against medical advice and 307(7.64%)died in SNCU.(Table-1).

Table-1: Trend of Neonatal Mortality in SNCU of IGMC,Shimla

On retrospective analysis, we found that among the total of 307outborn neonatal deaths maximum 110(35.83%) were due to sepsis/Pneumonia/Meningitis, followed by 60(19.54%) due to Respiratory distress syndrome,50(16.29%) due to HIE/Moderate-severe Birth Asphyxia, 36(11.73%) due to other causes, 24(7.84%) due to prematurity, 13(4.23%) due to un-established causes, 12(3.91%) due to Meconium aspiration syndrome, and 2(0.65%) due to major congenital malformation.(Table-2)

Table-2: Trend of Cause of Neonatal Mortality in SNCU of IGMC,Shimla

Figure Image is Available in PDF Format

Figure-1: Trend of Cause of Neonatal Mortality in SNCU of IGMC, Shimla

When we analyzed the data according to total duration of stay between admission and neonatal death in SNCU of IGMC, Shimla, we found that majority outborn neonates 127(41.37%) stayed for 1-3 days in SNCU, 73(23.78%) for more than 7 days, 61(19.87%) for 4-7 days and 46(14.98%) for less than 1 day. (Table-3).

Table-3: Total duration between admission and Outbornneonatal death in SNCU of IGMC, Shimla

When we analyzed the data according to Age at death while at SNCU of IGMC, Shimla, we found that maximum outbornneonate165(53.75%)were more than 7 days of age when died, 129(42.02%) were of 1-6 days while only 13(4.23%) were of less than 1 day when died. (Table-4)

Table-4: Age at time of death while at SNCU of IGMC, Shimla

When we analyzed the data according to Weight at admissionin SNCU of IGMC, Shimla, we found that maximumoutborn neonate 118(38.44%) had weight between 1500-2499 gm, 102(33.22%) had >2500gm, 71(23.13%) had between 1000-1499 gm while 16(5.21%) had weight <1000gm. (Table-5)

Table-5: Weight at admission in SNCU of IGMC, Shimla

On retrospective analysis, we found that among the total of 307 neonatal death, 131(42.67%) were preterm while 176(57.33%) were having term birth. (Table-6)

Table-6: Gestation period while admission in SNCU of IGMC, Shimla

This study was conducted to delineate the outcomeand enumeratefactors leading to mortality of outbornneonates admitted to SNCU of IGMC (Indira Gandhi Medical College), Shimla. A total of 4018outborn neonates were admitted in the SNCU of IGMC (Indira Gandhi medical college Shimla in five years from Jan 2016 to Dec 2020.Among them 3034 (75.51%) were discharged after recovery, 305 (7.59%) were referred to higher institution, 372(7.90%) were left against medical advice and 307(7.64%) were died in SNCU. Similar, findings were observed in the study done [6] We foundthat among  the total of 307 neonatal death, maximum 110(35.83%) were due to sepsis/Pneumonia/Meningitis, followed by 60(19.54%) due to Respiratory distress syndrome,50(16.29%) due to HIE/Moderate-severe Birth Asphyxia, 36(11.73%) due to other causes, 24(7.84%) due to prematurity, 13(4.23%) due to un-established causes, 12(3.91%) due to Meconium aspiration syndrome, and 2(0.65%) due to major congenital malformation. Majority of deaths in our study was attributable to sepsis, birth asphyxia and RDS, this may probably be due to poor antenatal care, malnourished pregnant women, less availability of health facility, delivery by untrained professionals and delay in referral from peripheral hospitals. These finding were in concordance to studies done [7-10] Many previous studies also concluded that these factors mentioned above were the direct and indirect causes of neonatal mortality. This is similar to the causes of the rest of India and other Asian countries where infections, prematurity-related conditions, perinatal hypoxia &congenital malformations were the main causes.[11,12]. These results contrasted with developed countries where extreme prematurity-related conditions, especially gastro-intestinal (GIT) complications & congenital malformations, are the predominant causes as better neonatal care ensures lesser sepsis and better survival of children with respiratory distress, MAS, and jaundice. Also, this difference is probably due to lack of regularantenatal care (ANC), delayed referral of high-risk mothers & lack of effective and prompt neonatal resuscitation in developing countries. Transportation is also a poor linkage for babies who are resuscitated and then, they are referred to higher institutions without any stabilization, temperature maintenance, oxygenation & ventilation if they are in apnea.[13,14]

Poor child rearing practices which are followed at home, environmental exposure and social & many family taboos may be responsible for neonatal morbidities especially late onset sepsis and other systemic infections. Adequate and appropriate anticipation, early diagnosis& treatment, practice of giving timely antibiotic in selected cases before referral could decrease the risk of death due to sepsis in neonates

Limitations: Because of retrospective nature of the present study, cause of death was determined by the extent & details of information in the official records only

Sepsis, birth- asphyxia and RDS are the important preventable causes of neonatal mortality, which need to be urgentlyaddressed, if India hopes to achieve theSustainable Development Goals (SDGs). Early & prompt management of low birth weight (LBW), preterm births and neonatal complications should be the priority matter for controlling and preventing local neonatal deaths. Knowing factors related to specific contexts& designing interventions for the associatedburdens is very important.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Indira Gandhi Medical College, Shimla

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