Singh Rajender, Sood Mangla, Bhardwaj Parveen, Sood Ishaan
Department of Pediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
J Family Med Prim Care. 2022 Jun;11(6):3058-3065. doi: 10.4103/jfmpc.jfmpc_2025_21. Epub 2022 Jun 30.
To describe the patient population, priority diseases, and outcomes in neonates admitted to neonatal unit in the Himalayan region of North India.
The retrospective study was conducted at a University teaching hospital in Himachal Pradesh, and captured anonymized data on all admissions in newborn unit over 6-year period.
Total 12449 newborns were admitted, 4669 were outborn, M:F of 1.35:1 and 81% of them were discharged successfully. Overall admissions surged by 76 percent in six years, preterm admissions increased by 41%. During the same period delivery load grew by 24.7%. Majority 64.9% were full-term; 50.4% (6279/12449) of neonates were low birthweight (LBW; <2.5 kg) and 3.8% were Extreme LBW (ELBW; <1.0 kg). Among intramural, out of 20.2% preterm, 1.8% were <28 week; compared to 1.5% <28 week and 14.1% preterm in extramural. The intrauterine growth restriction rate was 17.6% for intramural and 19.3% for extramural, respectively. The most common morbidities were prematurity (40.2% & 27%), jaundice (32.6% & 27.5%), RDS and respiratory problems (19.2% & 9.8%), sepsis (11.3% & 23.5%), and perinatal asphyxia (6.2% and 7.5%) among inborn and outborn respectively. Total 798 (6.4%) newborns died, 10.5% of all deaths happened within 24 hours; mortality was very high amongst ELBW (110/205, 53.7%) and very preterm infants <28 weeks (81/135,60%). Only 993 inborn and 18 outborn received antenatal corticosteroids, with only 383 inborn and 4 outborn receiving four doses of Dexamethasone. Low gestational age, LBW, less of antenatal corticosteroids, outborns, male sex, and congenital deformity were all found to have a significant association with death ( < 0.001).
Preterm accounts for a considerable majority of our total admissions. Greater efforts and investment in better prenatal care, infrastructure, therapeutic facilities, manpower, and periodic training and review of staff nurses are all urgently needed to address the extremely high burden of illnesses and mortality among hospitalized newborns; otherwise, lowering the NMR will remain an unattainable goal.
描述印度北部喜马拉雅地区新生儿病房收治的新生儿群体、重点疾病及治疗结果。
这项回顾性研究在喜马偕尔邦的一家大学教学医院开展，收集了6年间新生儿病房所有入院病例的匿名数据。
共收治12449名新生儿，其中4669名是外转来的，男女性别比为1.35:1，81%的新生儿成功出院。6年间入院总数激增76%，早产入院病例增加了41%。同期分娩量增长了24.7%。大多数（64.9%）为足月儿；50.4%（6279/12449）的新生儿为低出生体重儿（LBW；<2.5千克），3.8%为极低出生体重儿（ELBW；<1.0千克）。在院内分娩的新生儿中，20.2%为早产儿，其中1.8%孕周<28周；而院外分娩的相应比例分别为1.5%<28周和14.1%早产。院内和院外胎儿宫内生长受限率分别为17.6%和19.3%。最常见的疾病分别是：院内分娩的新生儿中，早产（40.2%和27%）、黄疸（32.6%和27.5%）、呼吸窘迫综合征和呼吸问题（19.2%和9.8%）、败血症（11.3%和23.5%）、围产期窒息（6.2%和7.5%）；院外分娩的新生儿中，相应疾病比例分别为上述数值。共有798名（6.4%）新生儿死亡，10.5%的死亡发生在24小时内；极低出生体重儿（110/205，53.7%）和孕周<28周的极早产儿（81/135，60%）死亡率极高。只有993名院内分娩和18名院外分娩的新生儿接受了产前皮质类固醇治疗，其中只有383名院内分娩和4名院外分娩的新生儿接受了4剂地塞米松治疗。低胎龄、低出生体重、产前皮质类固醇治疗不足、院外分娩、男性以及先天性畸形均与死亡显著相关（<0.001）。
早产占我们总入院病例的相当大部分。迫切需要加大力度并投入更多资源用于改善产前护理、基础设施、治疗设施、人力，以及对护士进行定期培训和考核，以应对住院新生儿极高的疾病负担和死亡率；否则，降低新生儿死亡率仍将是一个无法实现的目标。
