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institution to know the changing trends after improvement Died between 2-7
days of age, n = 15
in maternal and neonatal services over the years.
B abies examined at
7th day of age, n =
72
Died between
Aims and Objectives: 8th day to 1 month
of age, n = 7
Material & Methods: In the present study, out of the 100 enrolled neonates,
64% were male and 36% were females. 70% babies were
This prospective observational cohort study was conducted admitted within 24 hours of age and 94% within 7 days of
in a teaching hospital of Central India from January 2008 to birth. The mean birth weight in our study was 1.70.8 kg as
May 2008. During this period data was collected in a pre- compared to 20.39 kg in 1988 study (p value=0.006). 69%
designed proforma from 100 consecutively admitted low of newborns in our study weighed 2kg as opposed to 45%
birth weight neonates born intramurally or extramurally. in the earlier study done in 1998. The mean gestational age
Birth weight was recorded in the hospital or was taken in our study was also less i.e, 33.82.99 weeks, versus
from reference letter issued by referring hospital if the 35.83.9 weeks in previous study (p value=0.001). The
baby was admitted after 24 hours and gestational age admissions of VLBW babies increased in 2008 to 35% from
was assessed by new Ballard gestational age assessment 7% in 1988. The mortality in present study in VLBW were
system. These neonates were followed up to one month of 74.2%. The sex ratio was nearly similar in both periods and
age and outcome was assessed in terms of diseased/healthy, so also the mortality rate in both sexes. The mean duration
alive/dead, duration of hospital stay and weight gain on of stay in 2008 in surviving babies was 9.95.7 days and
follow up at one month of age. Disease was diagnosed was 4.95.9 days in the expired babies. Similar data could
on the basis of standard criteria [3, 4]. Whenever needed not be obtained from previous study. The mean age of
necessary investigations were done. Data of the study was mothers in our study was 23.73.7 years and 22.44.19
compared with the similar study done 2 decades earlier years in 1988 study. The incidence of teenage mothers
in this hospital by Dr Anjali Patwardhan titled A study decreased from 21% to 6% over two decades. We had a
of morbidity and mortality patterns in low birth weight larger cohort of preterm newborns in our study, 77% versus
babies during first three months of life and common factors 43% in earlier study. The mortality in low birth weight
affecting birth weight. This study was done as dissertation babies increased from 23% to 30% while mean birth weight
for M.D. Bhopal University in 1988. and gestational age of expired newborns fell from 1.70.4
kg to 1.30.36 kg and 36.63.69 weeks to 31.46.55 weeks
Computerized analysis of data was done by the software respectively from 1988 to 2008.
SPSS window 11.5, for dichotomous variables chi square
test was used, and for comparison of means of independent The main cause of morbidity in both cohorts was sepsis
variables t test was used. whereas hyperbilirubinemia, respiratory distress, birth
asphyxia and apnea were other contributing cause in
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later study. In 1988 study, birth asphyxia and aspiration Major indications for admission in our study were
pneumonia were the causes of morbidity followed by birth prematurity, poor feed acceptance and respiratory distress.
trauma, apnea and hyperbilirubinemia in equal number LBW infants are at particular risk of infection as compared
of cases. Tetanus neonatorum was seen in 5% newborns to their normal counterparts both as a result of increased
in earlier study and none in later study done. Neonatal susceptibility as well as poor capability to mount an
sepsis was found to be chief contributing factor to neonatal inflammatory response against infectious organisms [9].
mortality in 2008 followed by respiratory distress, apnea Globally, systemic infections are single most common
and aspiration pneumonia whereas aspiration pneumonia cause of neonatal mortality [10].Suspected neonatal
followed by tetanus neonatorum, birth asphyxia was infections are amongst common causes of care-seeking
responsible for deaths in earlier study (Table:1). The in neonates brought to hospital from community and
difference of birth weight and gestational age was are also second common reasons of hospital admission
statistically significant between the two cohorts (Table:2). following discharge after birth [11, 12, 13]. Incidence of
Sex and place of birth did not affect the outcome. infections with multidrug resistant bacteria is also higher
in settings where burden of neonatal infections is high
[14]. Hyperbilirubinemia has a higher incidence in low
Discussion: birth weights and was second commonest morbidity in our
study. The recent every newborn Lancet Series (2014) has
A positive trend in epidemiology of low birth weight has provided new insights into the impact of evidence based
been noted in our study. Preterm birth complications, interventions in years to come. It has been estimated that
intrapartum related complications (birth asphyxia) and high coverage and quality of preconception, antenatal,
neonatal sepsis or meningitis or other infections are intrapartum, and postnatal interventions could save
leading causes of neonatal deaths and contributed around additional neonatal deaths by 2025 (over 70% of current
80% of neonatal mortality worldwide [5]. The mean burden) [10]. Janani Shishu Suraksha Karyakram (JSSK)
gestation age and birth weight of admitted low birth has increased the proportion of deliveries occurring in
weight babies has significantly decreased in twenty years health services [15]. In addition with opening of special
in our hospital, pointing to better survival chances of newborn care units at district hospitals, facility based care
this group at birth and possibly timely referral. A rise in has received tremendous boost in India over last few years.
mortality (30% versus 23%) in two decades could thus be
explained by accessibility of more preterm and low birth
weight newborns to tertiary health care. As per Million Conclusion:
Death study 2005, three causes accounting for 78% of
all neonatal deaths in India are prematurity and low birth Thus LBW continues to be widely used as a useful composite
weight, neonatal infections, birth asphyxia. Mortality rates indicator of maternal, neonatal, social, educational and
from neonatal infections are higher in poorer states (31%) development status in both developed and developing
than richer states (17.5%) but were high in all regions [6]. countries. The prevention of morbidity and mortality in
In 2010, the scenario, regards causation of neonatal deaths low birth weight infants starts well within antenatal period.
in India remained same as shown by Liu et al (Lancet The antenatal prevention begins well before conception and
2012); Preterm births (35%), severe infections (31%) and includes improvement of socioeconomic status, maternal
complications during child birth and asphyxia still lead to education, adequate nutrition, avoiding teenage pregnancy,
more than 80% of deaths among newborns [7].Noteworthy timely referral, administration of anetenatal steroids,
in our study is the rise in mean age of mothers of low antibiotics to mothers with premature rupture of membranes
birth weight newborns. The fall in incidence of teenage and proper management of women with chronic diseases.
mothers is similar to the observation by Ashok Kumar [8]. With better neonatal services and awareness of neonatal
A strong correlation exists between maternal age and low problems in the country, it is expected that outcome of
birth weight .Interventions like RCH and health awareness low birth weight babies will improve further. At the same
aimed at delaying pregnancy in young adolescents can help time, measures for reducing neonatal infections should
in reducing burden of LBW. Besides, efforts should also be deserve high priority in every neonatal unit. Dividends of
directed at prolonging duration of gestation. increasing health facility births and improved availability of
facility based sick newborn care may be lost if systems and
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processes are not in place to prevent neonatal infections. 8. Ashok Kumar, Tej Singh et al .Outcome of Teenage
Pregnancy. Indian Jof Pediatr 2007; 74; 927-931.
3. Meharban Singh. Care of the Newborn, Sagar. 11. Clinical signs that predict severe illness in children
Publications, New Delhi, Edition: 6th 2004, under age 2 months: a multicentre study. Lancet
Edition:7th 2010. 2008;371;135-142.
4. J. P. Cloherty - Manual of neonatal care (Lippincott 12. Report 2002-2003; National Neonatal Perinatal
Manual Series)7th Edition. Database Network. National Neonatal Perinatal
Database Network. New Dehi;National Neonatology
5. Liu L,Oza S,Hogan D, et al Global, regional, and Forum of India 2004.
national causes of child mortality in 2000-13, with
projections to inform post-2015 priorities: an updated 13. Report 2002-2003; National Neonatal Perinatal
systematic analysis. 2015 Jan 31; 385 (9966):430- Database Human Reproduction Research Centre
40. doi: 10.1016/S0140-6736(14)61698-6. Epub Network. National Neonatal Perinatal Database
2014 Sep 30. Human Reproduction Research Centre Network.
New Delhi: National Neonatology Forum of India
6. Million Death Study Collabrators: Causes of 2006.
neonatal and child mortality in India: a nationally
representative mortality survey The Lancet;Vol 14. Zaidi AK, Huskins WC, Thaver D, Bhutta ZA,
376,p1853-1860,27 November 2010. Abbas Z, Goldmann DA. Hospital-acquired
neonatal infections in developing countries. Lancet.
7. Liu L,Johnson HL,Cousens S et al(2012) for Child 2005;365:1175-1188.
Health Epidemiology Reference Group of WHO
and UNICEF(2012).Global, regional, and national 15. Lim SS, Dandona L, Hoisington JA, James SL,
causes of child mortality :an updated systematic HoganMC, Gakidou E. Indias Janani Suraksha
analysis for 2010 with time trends since 2000. The Yojana,a conditional cash transfer programme
Lancet; Vol 379;9832;Pages 2151-2161. to increase births in health facilities: an impact
evaluation. Lancet. 2010;375;2009-2023.
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