Modi N, Kirubakaran C
Department of Paediatrics & Neonatal Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
J Trop Pediatr. 1995 Apr;41(2):99-102. doi: 10.1093/tropej/41.2.99.
The aim of this study was to determine the reasons for admission, charges made, and causes of death in a tertiary referral neonatal unit in India. Records of the Christian Medical College Hospital, Vellore, Tamil Nadu, India, were reviewed for the period 1 January-31 December 1992. The principal cause of death was ascertained with reference to predetermined diagnostic criteria. There were 5592 livebirths, 138 stillbirths and 1809 admissions to the nurseries (1603 inborn, 206 outborn). Suspected sepsis accounted for 24 per cent of admissions, 14 per cent required preterm care, 13 per cent phototherapy and 8 per cent were full term low birth weight babies admitted for observation. There were 87 early neonatal deaths, 4 per cent (49) of inborn admissions and 18 per cent (38) of outborn admissions. A further 11 babies were discharged to receive terminal care at home and nine were discharged, critically ill, against medical advice. Causes of death were respiratory problems of prematurity (49 per cent), lethal congenital malformations (22 per cent), complications of asphyxia (20 per cent) and sepsis (5 per cent). The median duration of nursery care was 2 days (range 1-21) and the median charge made Rs 714 (range 122-5036). Although the pattern of admissions and deaths still reflects the substantial problems of suspected sepsis, asphyxia, and congenital malformations, problems of immaturity may be on the increase. We caution against hospital-based statistics that fail to take account of babies who are discharged alive in the knowledge that death is imminent. Considered strategies for the provision or selective provision, of neonatal care in India, are called for.
本研究的目的是确定印度一家三级转诊新生儿病房的入院原因、收费情况及死亡原因。回顾了印度泰米尔纳德邦韦洛尔市基督教医学院医院1992年1月1日至12月31日期间的记录。根据预先确定的诊断标准确定主要死亡原因。共有5592例活产、138例死产以及1809例新生儿入院（1603例为院内出生，206例为院外出生）。疑似败血症占入院病例的24%，14%需要早产护理，13%需要光疗，8%为足月低体重儿入院观察。有87例早期新生儿死亡，占院内出生入院病例的4%（49例）和院外出生入院病例的18%（38例）。另有11名婴儿出院回家接受临终护理，9名婴儿不顾医嘱，病情危重时出院。死亡原因包括早产引起的呼吸问题（49%）、致命性先天性畸形（22%）、窒息并发症（20%）和败血症（5%）。新生儿护理的中位时长为2天（范围1 - 21天），中位收费为714卢比（范围122 - 5036卢比）。尽管入院和死亡模式仍反映出疑似败血症、窒息和先天性畸形等重大问题，但不成熟问题可能在增加。我们提醒不要忽视那些在明知即将死亡的情况下仍存活出院的婴儿的医院统计数据。需要制定在印度提供或有选择地提供新生儿护理的策略。
