Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

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Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
Knowledge is treasure of a wise man. The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help ones reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journalsNo manuscriptsNo authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2012 | Month : April | Volume : 6 | Issue : 2 | Page : 282 - 285

Study of the Morbidity and the Mortality Patterns in the Neonatal Intensive Care Unit at a Tertiary Care teaching Hospital in Rohtas District, Bihar, India

Mani Kant Kumar, Sachida Nand Thakur, Brish Bhanu Singh

1. Assistant Professor 2. Professor 3. Assistant Professor NAME OF DEPART MENT(S)/INSTITUTION(S) TO WHICH THE WORK IS ATTRI BUTED: Department of Paediatrics, Narayan Medical College and Hospital, At+PO- Jamuhar, Sasaram, Dist- Rohtas, Bihar, India. PIN - 821 305.

Correspondence Address :
Mani Kant Kumar, Assistant Professor, Department of
Pediatrics, Narayan Medical College and Hospital,
At+PO- Jamuhar, Sasaram, Dist- Rohtas, Bihar,
India. PIN - 821305
E-mail: manikant7@yahoo.com

Abstract

Objective: To study the morbidity and the mortality patterns in the neonatal intensive care unit at a tertiary care teaching hospital in the Rohtas district of Bihar.

Design: Retrospective study. The medical records of all the neonates who were admitted to the NICU were reviewed.

Settings: Neonatal Intensive Care Unit of a tertiary care teaching hospital which is located in the Rohtas district of Bihar. The study was carried out over a period of 1 year during January 2010 to December 2010.

Participants: 236 neonates with some illness who were admitted to the NICU, who belonged to the Rohtas district of Bihar.

Outcome: The patterns of the morbidity and the mortality among the neonates who were admitted to the NICU in the Rohtas district. ‘Survival’ was defined as the discharge of a live neonate/ infant from the hospital.

Results: A total of 285 babies were admitted to our NICU, of which 258 babies belonged to the Rohtas district. Of the 258 babies, 22 babies had left the hospital against medical advice (LAMA). A total of 236 neonates were included for the data analysis. The ratio of the male (59.6%) and female (40.4%) Neonates was 1.48:1. The major causes of the morbidity were low birth weight (LBW) (39.8%), prematurity (38.6%), neonatal sepsis (23.3%), neonatal hyperbilirubinaemia (20.4%), birth asphyxia with hypoxic ischaemic encephalopathy (HIE) (18.2 %), intrauterine growth retardation (IUGR) (14 %) and hyaline membrane disease (9.7 %). The most common causes of the referral from other hospitals were severe birth asphyxia with HIE (32.5%), neonatal sepsis (22.9%), prematurity with low birth weight (13.4 %), and prematurity with respiratory distress syndrome (12%). In this study, the overall NICU mortality rate was 13.6% ( 32/236). The babies who were born outside our hospital had a 2.5 times higher mortality rate as compared to the babies who were born in our hospital. Most of the deaths were associated with low birth weight (including LBW, VLBW and ELBW) (59.2%), prematurity (46.9%), sepsis (34.4 %), hypoxic ischaemic encephalopathy (HIE) (31%), Hyaline membrane disease or Respiratory distress syndrome (RDS) (25%) and intra uterine growth retardation (IUGR) (12.5%).

Conclusion: This study identified LBW, prematurity, neonatal sepsis, neonatal hyperbilirubinaemia, and HIE as the major causes of the morbidity and low birth weight, prematurity, neonatal sepsis, HIE, and Hyaline membrane diseaseor Respiratory distress syndrome (RDS) as the major contributors to the neonatal mortality. Adequate antenatal care to the at risk mothers and advances in the neonatal intensive care with the use of sophisticated technology will improve the neonatal outcome.

Keywords

NICU, Neonatal Morbidity, Neonatal Mortality, Rohtas, Bihar

Introduction
In India alone, of the 25 million babies who are born every year, one million die, accounting for 25% of the mortality around the world. According to the National Family Health Survey - 3 (NFHS-3) report, the current neonatal mortality rate (NMR) in India of 39 per 1,000 live births, accounts for nearly 77% of all the infant deaths (57/1000) and nearly half of the under-five child deaths (74/1000) (1). The rate of the neonatal mortality varies widely among the different states of India, ranging from 11 per 1000 live births in Kerala to 48 per 1000 live births in Uttar Pradesh. The neonatal mortality rate in Bihar (42 per 1000 live birth) is more than that of the national figure due to the lack of health infrastructures. Preterm birth is one of the major clinical problems in obstetrics and neonatology, as it is associated with increased perinatal mortality and morbidity (2).

The major direct causes of the neonatal deaths were preterm birth, infections, and asphyxia. In a report which was published in The Lancet, the major direct causes of the deaths were pre-term birth Original Article N eonatology Section(27%), infection ( 26%), asphyxia ( 23%), congenital anomalies ( 7%), others (7%), tetanus(7%) and diarrhoea (3%) (3). There is only scanty data which is available regarding the neonatal morbidity and mortality patterns in the Indian neonatal intensive care units (NICU) and even if it was there, it would be available mainly from the tertiary care level 3 NICUs in the metropolitan cities (4). The data from the tertiary care NICUs in the rural areas which primarily serve the very poor people is scarce. To the best of our knowledge, there are hardly any published studies from Bihar which provide the morbidity and mortality patterns in tertiary care NICUs which are located in rural areas, which mainly serve the rural population. The objective of the study was to study the morbidity and mortality patterns in an NICU of a tertiary care teaching hospital which was located in the Rohtas district of Bihar.

Material and Methods

This hospital based retrospective study was carried out in the neonatal intensive care unit (NICU), Department of Pediatrics, atNarayan Medical College and Hospital (NMCH), Jamuhar, Rohtas, Bihar, India, for a period of 1 year from January 2010 to December 2010. The institutes ethical committee approved the study protocol.

Our hospital caters mainly to rural and semi-urban patients, with a significant number of them being below the poverty line (BPL) income group patients. Approximately 800 deliveries are conducted per year, with a majority of them being conducted on unbooked mothers and mothers with complicated obstetric or antenatal histories, who are referred from district/rural hospitals. All the admitted neonates were enrolled on a structured protocol, which included the data on antenatal care, maternal morbidity, mode and place of delivery, age, weight at admission, gestational age, diagnosis, relevant investigations, duration of stay and outcome.

Inclusion criteria: All the neonates who were admitted to the NICU belonged to the Rohtas district.

Exclusion Criteria: (a) Neonates who did not belong to the Rohtas district, (b) Babies who left the hospital against medical advice. The calculation of the survival was done after subtracting them from the total admission, as their outcome was not known.

Statistical analysis: The birth weight and the gestational age were expressed in mean ± SD. The data were analyzed by using the Open Epi statistical software, version 2.3.1. The mean, standard deviation, odds ratio and the relative risk were calculated by using appropriate statistical methods. P value of < 0.05 was considered to be statistically significant for any given measures.

Results

A total of 285 babies were admitted to our NICU, of which 258 babies belonged to the Rohtas district. Of these 258 babies, 22 babies (who left the hospital against medical advice (LAMA) or were transferred to other hospitals) were excluded from the study. A total of 236 neonates were included for the data analysis. Of these 236 babies, 141 were males and 95 were females. The ratio of the male (59.8%) and female (40.2%) neonates was 1.48: 1. One hundred and fifty three babies (65%) were born in this hospital and 83 (35%) babies were referred from peripheral hospitals and nursing homes. There were 91 (38.6 %) premature deliveries with a mean gestational age of 34.4 ± 3.6 weeks and 94 (39.8 %) LBW neonates with a mean birth weight of 2280 ± 754 gm. The major causes of the morbidity were low birth weight (LBW) (39.8%), prematurity (38.6%), neonatal sepsis (23.3%), neonatal hyperbilirubinaemia (20.4%), birth asphyxia with hypoxic ischaemic encephalopathy (HIE) (18.2 %), intra-uterine growth retardation (IUGR) (14 %) and hyaline membrane disease (9.7 %), as shown in (Table/Fig 1).

The most common causes of the referral from primary health centres and private nursing homes for the out born neonates were severe birth asphyxia with HIE (32.5%), neonatal sepsis (22.9%), prematurity with low birth weight (13.4 %), and prematurity with respiratory distress syndrome (12%) (Table/Fig 2). In this study, the overall NICU mortality rate was 13.6 % ( 32/236). There was no statistical significant difference in the outcome between the male and female neonates (p< 0.33), as shown in (Table/Fig 3).

On comparing the survival among the different groups, it was seen that there were significant differences between the VLBW group and the normal birth weight group (p<0.012), and between the ELBW group and the normal birth weight group (p< 0.009). However, there was no statistically significant difference betweenthe LBW group and the normal group (p<0.116) (Table/Fig 4) . The relative risk of the deaths in the VLBW and the ELBW groups as compared to the normal birth weight group was 3.9 and 6.5 times respectively.

Out of the 32 deaths, 13 deaths (40.2% of total deaths) occurred in the normal birth weight group, while 19 deaths [(19/32) 59.9%] occurred in the less than 2.5kg birth weight group (Table/Fig 5). The outcome of the babies who were born in this hospital (inborn) and of the babies who were referred from other hospitals (out born) was analyzed. Among the inborn babies 9.8% (15/153) expired, while 20.5% (17/83) expired among the out born babies. The difference in the mortality rate was significant (odds ratio 2.37 95% CI 1.11- 5.03), (p = 0.0135). The case fatality and relative risk of the deaths which were associated with the morbidities were calculated as shown in (Table/Fig 6).

Discussion

Accurate data on the morbidity and mortality are useful for many reasons. It is important for the providers of primary care, investigators, local and national health administrators, and for decision makers to design interventions for prevention and treatment and to implement and evaluate health care programs. The data from hospitals in the smaller cities and from the NICUs of low resource settings is very limited. In smaller cities, the number of NICUs are less and the number of level 3 NICUs are even lesser and there are very few published reports from these hospitals (5). In our study, the the admissions of male babies were more than those of females. These may be related to the preference for the male child in the society and the biological vulnerability of the males to infection. The male preponderance for admissions has been documented in previous studies (6).

In our study, 40% of the neonates were low birth weight (LBW) and 39% neonates were delivered prematurely. This may be due to the poor maternal health status, poor antenatal check up and the poor socio-economic status of the families, because our hospital predominantly catered to the rural population with very high degree of unemployment and poverty. Similar findings were reported in earlier studies from other developing countries with a poor socioeconomic status. In a hospital based study, the incidence of the premature deliveries was 16.3% (7). According to the UNICEF “The State of the World’s Children 2010” report, 28% neonates are born with low birth weight in India (8). In this study, the other common morbidities were neonatal sepsis (23.3%), neonatal jaundice (20.4%), birth asphyxia with hypoxic ischaemic encephalopathy (HIE) (18.2 %), intrauterine growth retardation (IUGR) (14 %) and hyaline membrane disease (9.7 %).

Neonatal sepsis was the most important cause of morbidity and mortality, especially among the LBW and the preterm babies in the developing countries. According to the National Neonatal Perinatal Database (2002-03), the incidence of neonatal sepsis in India was 30 per 1000 live-births. The database which comprised 18 tertiary care neonatal units across India, found sepsis to be one of the commonest causes of neonatal mortality, which contributed to 19% of all the neonatal deaths (4). Neonatal jaundice was the most common problem amongst the neonates. In our study, 20.4 % of the newborns (18.6% term neonates and 23 % preterm neonates) had jaundice. In a study from Pakistan, an overall home based surveillance detected that the rate of hyperbilirubinaemia (bilirubin >5 mg⁄ dl) among 1690 newborns was 39.7 ⁄ 1000 live births (95% CI 29.3–47.6) and that 27.6% were referred for treatment to hospitals (9). In our study, the lower prevalence could be attributed to the poor nutrition status of mother and the poor antenatal services.

Birth asphyxia is an important cause of neonatal morbidity and mortality. The incidence of moderate to severe grade birth asphyxia with HIE was observed in 18.2 % (43/243) neonates in the present study, which is similar to the finding of Chandra et al (10). In this study, the commonest causes of death were LBW (59.2%), prematurity (46.9%), neonatal sepsis (34.4%), HIE (31.3%) and respiratory distress syndrome (25%). In contrast, in an ICMR study, prematurity (16.8%), birth asphyxia (22.3%) and infections which included septicaemia, pneumonia, meningitis and other infections (32.8%) were found to be the predominant causes of death (11). In a study at JIPMER, systemic infections were found to cause 52.3% of the deaths, followed by birth asphyxia and injuries (29.23%) (12). But, the present study reiterates the point that the high proportion of the deaths which were attributed to LBW and prematurity may be due to poor antenatal care, poor nutritional status of the pregnant women, especially in the rural areas, the poor health infrastructure, and delayed referral from peripheral hospitals.

Low birth weight (LBW) deaths accounted for 59 % of the total deaths in our study. In a study from a sub-district level hospital from India, Kumar et al reported a similar mortality rate (13). Our study also showed that preterm babies with a birth weight which was less than 1500g were strongly associated with high mortality. Yasmin et al from Bangladesh also reported that VLBW and lower gestational age (<32weeks) carried a high mortality risk (14). The neonatal mortality in babies who were delivered at NMCH, Jamuhar was only 9.8% as compared to 20.5% in babies whowere referred from other hospitals. Neonates who were referred From other hospitals (outborn) had 2.5 times higher mortality than those who were born in our hospital (inborn). The better outcome in the babies who were born at NMCH was most likely due to the timely perinatal interventions at the tertiary care level and the early availability of effective neonatal intensive care.

In the developing countries, neonatal sepsis and HIE are the major causes for hospitalization in the NICU and they dominate as the major causes of death. In our study, neonatal sepsis and HIE accounted for 34.4% and 31.3 % of the neonatal deaths respectively. The neonates with severe birth asphyxia had two times more mortality than those who had no asphyxia. Rashid et al from Bangladesh (developing country) reported a similar outcome (15). Garg et al, from a community level NICU, have reported birth asphyxia as the leading cause of death, followed by sepsis (16). There is a broad agreement that in infants with more than 2500 g of birth weight, the death is influenced by the obstetric management and that in those who are LBW, it was the quality of the neonatal care that had an important bearing on the outcome. With the present study having identified LBW, prematurity, neonatal sepsis and HIE as the major causes of death, there is a need for further developments in obstetric and neonatological units for better antenatal (obstetric) and intensive neonatal care with the use of more sophisticated technology.

Conclusion

This study identified LBW, prematurity, neonatal sepsis, neonatal hyperbilirubinaemia, and HIE as the major causes of morbidity and low birth weight, prematurity, neonatal sepsis, HIE, and Hyaline membrane disease or Respiratory distress syndrome (RDS) as the major contributors to neonatal mortality. With LBW and prematurity being the commonest contributors of death, attempts to prolong the pregnancy each week might improve the neonatal outcome considerably. This study has some limitations. As it was a hospital based study and as most of the patients had a low socio-economic status, the results of this study may not reflect the true burden which is prevalent in the community as a whole.

Acknowledgement

We express our sincere gratitude to Prof. (Dr) M L Verma, Dean, Narayan Medical College and Hospital, Jamuhar, for permission to publish this study. A special thanks to the staff of the MedicalRecords Department for their whole hearted unconditional support and co-operation in this study.

Contributors: MKK and SNT were involved in conception, collection of data and in drafting of the manuscript. MKK, SNT and BBS were involved in analyzing the data and critical revision of the manuscript. MKK will act as guarantor for the article.

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DOI and Others

DOI: JCDR/3687:1994

Financial OR OTHER COMPETING INTERESTS:
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Date Of Submission: Nov 22, 2011
Date Of Peer Review: Jan 14, 2012
Date Of Acceptance: Feb 09, 2012
Date Of Publishing: Apr 15, 2012

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