Neonatal period is the most vulnerable period of human life as it accounts for very high mortality. Most newborn deaths are preventable by improving the quality of care during delivery and care at birth. Simple interventions like skilled birth attendance and access to emergency obstetric care can reduce NMR (https://www.unicef.org; and https://www.savethechildren.net).

Of the 25 million babies born in India every year one million die, India alone contributes to 25% of neonatal mortality around the world NMR accounts for >50% of IMR and a small gain in this domain has a huge impact on overall quality of life (QoL) [1].

A number of previous studies have attempted to identify factors associated with neonatal mortality. Sepsis, respiratory distress syndrome, preterm birth, low birth weight, low socioeconomic status, cesarean section delivery, and neonatal age on admission, are among the factors associated attributable factors of neonatal mortality [2,3].

It has been estimated that about 70% of neonatal deaths could be prevented if proven interventions are implemented effectively at the appropriate time. It was further estimated that health facility-based interventions can reduce neonatal mortality by 23-50% in different settings. Facility-based newborn care, thus, has a significant potential for improving the survival of newborns in India [4,5].

Neonatal mortality statistics serve as sensitive indicators of the availability, utilization, and effectiveness of maternal child health service in the community. It is important to study the mortality pattern as it helps to implement new treatment protocols, interventions, planning and policy making which helps in better survival and improvement in the quality of life among survivors [6,7]. Implementations of effective neonatal care interventions are imperative for survival of neonates in developing countries. The framework of sustainable development goals by the year 2030 is to end preventable deaths and reduce neonatal mortality. Health system research on the evaluation of interventions and outcomes should be strengthened to complement this goal. Therefore, this study was designed to evaluate neonatal mortality and associated factors among newborns admitted to the Specialized Neonatal Care Unit (SNCU) at Kamla Nehru Hospital Shimla district of Himachal Pradesh, India.

Objectives of the Study

To study the pattern of Neonatal Mortality in Specialized Neonatal Care Unit at Kamla Nehru Hospital Shimla district of Himachal Pradesh from the year 2016 to 2020. 

Research Approach

Descriptive survey 

Study Design

A retrospective review

Setting of the Study

Kamla Nehru Hospital Shimla district of Himachal Pradesh

Study Duration

Between Jan2016- December 2020

Study Population

Neonates admitted to the Specialized Neonatal Care Unit of Kamla Nehru Hospital Shimla district of Himachal Pradesh

Sample Size

All Neonates admitted to the Specialized Neonatal Care Unit of Kamla Nehru Hospital Shimla district of Himachal Pradesh between Jan2016- December 2020

Permission

Obtained from the concerned authorizes of Kamla Nehru Hospital Shimla district of Himachal Pradesh.

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 Kamla Nehru Hospital Shimla district of Himachal Pradesh covering the period January 2016 to December 2020 was conducted.

A total of 6607 neonates were admitted in the SNCU of Kamla Nehru Hospital Shimla in 5 years from Jan 2016 to Dec 2020.Among them 5593 (84.65%) were discharged after recovery, 313(4.74%) were referred to higher institution, 335(5.07%) were left against medical advice and 366(5.54%) were died in SNCU (Table 1).

Table 1: Trend of Neonatal Mortality in SNCU of Kamla Nehru Hospital Shimla

On retrospective analysis, we found that among  the total of 366 neonatal death maximum 115(31.42%) were due to Respiratory distress syndrome, followed by 93(25.41%) due to sepsis/Pneumonia/Meningitis,69(18.85%) due to HIE/Moderate-severe Birth Asphyxia, , 35(9.56%) due to prematurity, 27(7.38%) due to other causes, 23(6.28%) due to major congenital malformation and 4(1.09%) due to Meconium aspiration syndrome (Table 2).

Table 2: Trend of Cause of Neonatal Mortality in SNCU of Kamla Nehru Hospital Shimla

When we analyzed the data according to total duration between admission and neonatal death in SNCU of Kamla Nehru Hospital Shimla, we found that maximum neonate 155(42.35%) stayed for 1-3 days in SNCU, 97(26.50%) for 4-7 days ,58(15.85%) for less than 1 day and 56(15.30%) for more than 7 days (Table 3).

Table 3: Total Duration between Admission and Neonatal Death in SNCU of Kamla Nehru Hospital Shimla

When we analyzed the data according to Age at death while at SNCU of Kamla Nehru Hospital Shimla, we found that maximum neonate 236(64.48%) were of 1-6 days when died, 76(20.77%) were more than 7 days of age, while 54(14.75%) were of less than 1 day when died (Table 4).

Table 4: Age at death while at SNCU of Kamla Nehru Hospital Shimla

When we analyzed the data according to Weight at admission in SNCU of Kamla Nehru Hospital Shimla, we found that maximum neonate 147(40.16%) had weight between 1000-1499 gm, followed by 90(24.59%) had 1500-2499gm, 88(24.04%) had between <1000gm while 41(5.21%) had weight >2500gm (Table 5).

Table 5: Weight at Admission in SNCU of Kamla Nehru Hospital Shimla

On retrospective analysis, we found that among the total of 366 neonatal death, 305(83.3%) were preterm while 61(16.7%) were having term birth (Table 6).

Table 6: Gestation Period While Admission in SNCU of Kamla Nehru Hospital Shimla

This study was conducted to delineate the outcome and factors leading to mortality of neonates admitted to SNCU of Kamla Nehru Hospital Shimla. A total of 6607 neonates were admitted in the SNCU of Kamla Nehru Hospital Shimla in 5 years from Jan 2016 to Dec 2020.Among them 5593 (84.65%) were discharged after recovery, 313(4.74%) were referred to higher institution, 335(5.07%) were left against medical advice and 366(5.54%) were died in SNCU. Among  the total of 366 neonatal death maximum 115(31.42%) were due to Respiratory distress syndrome, followed by 93(25.41%) due to sepsis/Pneumonia/Meningitis,69(18.85%) due to HIE/Moderate-severe Birth Asphyxia, 35(9.56%) due to prematurity, 27(7.38%) due to other causes, 23(6.28%) due to major congenital malformation and 4(1.09%) due to Meconium aspiration syndrome.

The study report published by ICMR reports sepsis (32.8%) as the major cause for neonatal mortality followed by birth asphyxia (22.3%) and prematurity (16.8%) (ICMR Young Infant Study Group. 2008).  In the study done at JIPMER, sepsis was the cause for death in 52.3% of followed by birth asphyxia and injuries (29.23%). These causes were similar to other studies where findings are in concordance with present study findings [8-12]. Majority of deaths in our study was attributable to birth asphyxia and RDS, this may probably be due to poor antenatal care, malnourished pregnant women, and delay in referral from peripheral hospitals.

The pattern of morbidity is different in developed countries as major causes were admissions due to extreme prematurity, asphyxia, and congenital malformations. This study found lower rate of neonatal mortality compared to other studies conducted in India but the rate appears higher while comparing with developed countries where health facilities have better equipped infrastructure and higher doctor-patient ratio [13,14]. The data from this study will act as baseline from which effect of various interventions for newborn care can be evaluated and will help in health policy planning for hilly areas of Himachal Pradesh. It will also help in giving evidence-based counseling to parents of newborns in SNCU regarding the survival chances of newborns admitted in Kamla Nehru Hospital Shimla (depending on birth weight and gestation). 

According to this study Respiratory distress syndrome, Neonatal sepsis, Pneumonia, Meningitis, Birth Asphyxia and Prematurity are leading causes of mortality in newborns. In spite of many advances in neonatal care above factors still continue to be the leading causes of mortality in neonates. The majority of morbidities and subsequently the mortalities can be prevented by improving antenatal care, maternal health, timely intervention, referring at appropriate time to tertiary care centres for high-risk cases, preventing preterm deliveries and care of neonates at centres with facility.

Government should take necessary initiative keeping in mind the difficult geographic terrain in Himachal Pradesh. Giant steps need to be taken before India can forego this dubious distinction of being the country responsible for nearly a fourth of global neonatal deaths.

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