Neonatal mortality among preterm infants admitted to neonatal intensive care units in India and Pakistan: A prospective study

• Published in: BJOG : an international journal of obstetrics and gynaecology 2023-11, Vol.130 (S3), p.68-75
• Main Authors: Saleem, Sarah, Tikmani, Shiyam Sunder, Goudar, Shivaprasad S., Hwang, Kay, Dhaded, Sangappa, Guruprasad, Gowder, Nadig, Naveen G., Kusagur, Varun B., Patil, Lingaraja Gowda C., Siddartha, E. S., Yogeshkumar, S., Somannavar, Manjunath S., Roujani, Sana, Khan, Mashal, Shaikh, Mehmood, Hanif, Muhammad, Bann, Carla M., McClure, Elizabeth M., Goldenberg, Robert L., Dhaded, Sangappa M., Nagmoti, Mahantesh B., Harakuni, Sheetal U., Aradhya, Gayathri H., Nadig, Naveen, Kusgur, Varun, Raghoji, Chaitali R., Dhananjaya, Shobha, Sarvamangala, B., Prakash, Veena, Joish, Upendra Kumar, Mangala, G. K., Rajashekhar, K. S., Sunilkumar, Byrananhalli, Kulkarni, Vardendra, Nagaraj, T. S., Jeevika, M. U., Harikiran, Reddy R., Pujar, Sneharoopa, Sunder, Shiyam, Kadir, Masood, Zafar, Afia, Ahmed, Imran, Uddin, Zeeshan, Ghanchi, Najia, Mirza, Waseem, Yasmin, Haleema, Raza, Jamal, Prakash, Jai, Haider, Furqan, Aceituno, Anna, Parlberg, Lindsay, Moore, Janet L., Parepalli, Suchita, Kim, Jean, Bann, Carla
• Format: Article
• Language: English
• Subjects: Hemorrhage; Infant mortality; Infants; Intensive care; Intensive care units; Length of stay; low‐ and middle‐income countries; Mortality; Neonates; Newborn babies; Premature babies; preterm birth; preventable mortality; Respiratory distress syndrome; Sepsis
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.17581

Objective To explore potential reasons for differences in preterm neonatal mortality in neonatal intensive care units (NICUs) in India and Pakistan. Design A prospective observational study, the Project to Understand and Research Stillbirth and Preterms in Southeast Asia (PURPOSe) was conducted July 2018 to February 2020. Setting Three hospitals in Davangere, India, and a large public hospital in Karachi, Pakistan. Population Of a total of 3,202 preterm infants enrolled, 1,512 were admitted to a study NICU. Methods We collected data for neonates, including length of stay, diagnoses, and diagnostic tests. Main outcome measures Neonatal mortality, tests performed, diagnoses ascertained. Results For infants of equivalent weights and gestational ages, neonatal mortality in Pakistan was twice that in the Indian NICU. The mean newborn length of stay in Pakistan was 2 days compared with 10 days for India. Fewer diagnostics and other investigations were used to determine neonatal condition or guide treatment in the Pakistani NICU. Because of limited information from testing in Pakistan concerning clinical respiratory distress, respiratory distress syndrome appeared to be over‐diagnosed, whereas other conditions including pneumonia, sepsis, necrotising entercolitis and intraventricular haemorrhage were rarely diagnosed. Conclusion In the Pakistani site, the limited resources available to the NICU appeared related to a shorter length of stay and decreased diagnostic testing, likely explaining the higher mortality. With improved care, reduction in mortality among preterm neonates should be achievable.