Journal of Pharmaceutical Research International
34(1B): 72-76, 2022; Article no.JPRI.84394
ISSN: 2456-9119
(Past name: British Journal of Pharmaceutical Research, Past ISSN: 2231-2919,
NLM ID: 101631759)
Neonatal Morbidity Patterns and Admission
Outcomes: A Cross Sectional Study at a Tertiary
Care Hospital in Pakistan
Muhammad Parial Shahani a,b*, Mohd Rizal Bin Haji Abdul Manaf b,
Azimatun Noor Aizuddin b, Kaleemullah Abro a, Vijia Kumar Gemnani a,
Abdul Rehman Shaikh c and Zainab Shahani d
a
Faculty of Community Medicine and Public Health, Shaheed Mohtarma Benazir Bhutto
University, Larkana, Pakistan.
b
Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia,
Malaysia.
c
Department of Pediatrics, CMCH, SMBBMU, Larknana, Pakistan.
d
Isra School of Optometry, Isra University, Karachi, Pakistan.
Authors’ contributions
This work was carried out in collaboration among all authors. Author MPS collected and analyzed the
data. Authors KA, VKG, ARS and ZS entered data in SPSS, Authors MRBHAM and ANA coordinated
the study, revised the final draft critically for important intellectual content. All authors read and
approved the final manuscript.
Article Information
DOI: 10.9734/JPRI/2022/v34i1B35799
Open Peer Review History:
This journal follows the Advanced Open Peer Review policy. Identity of the Reviewers, Editor(s) and additional Reviewers,
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Received 29 November 2021
Original Research Article Accepted 07 January 2022
Published 10 January 2022
ABSTRACT
Objective: To determine the neonatal mortality and ascertain the disease patterns at neonatal
ward in a tertiary care hospital
Material and Methods:
Design: Hospital based cross sectional study.
Participants: Two thousand, two hundred and seventy five neonates were registered using
st st
retrospective data from 1 January 2020 to 31 Dec 2020. We recorded gender, birth weight,
cause of admission, and admission outcome. Data was analyzed using Microsoft excel data
spread sheet.
Results: There were 2275 patients registered from CPDR (complete patient data record register)
st st
from 1 January 2020 to 31 Dec 2020. The mean birth weight was 2.35 kg, with lowest birth
_____________________________________________________________________________________________________
Shahani et al.; JPRI, 34(1B): 72-76, 2022; Article no.JPRI.84394
weight of 0.9kg and highest birth weight of 4.8kg (SD 0.8 and SE 0.01, CI 0.025). Out of 2175
admitted neonates 506 (23.2%) died, 1250 (57.4%) were discharged after desired improvement,
most common presenting complaint and cause of admission was HIE grade 1 , followed by Sepsis,
418 (18.5%), 380(16.9%), respectively.
Conclusions: Hypoxic Ischemic Encephalopathy grade I is the most common morbidity pattern in
our study, the mortality rate was observed very high, indicators of birth weight were also poor.
There is a great need for improvement of antenatal care for mothers to enhance different measures
of newborn welfare and wellbeing.
Keywords: Neonatal mortality; neonatal morbidity; low birth weight; newborn; Pakistan.
1. INTRODUCTION [5]. Hence, There was dire need of the time to
evaluate the patterns of disease while neonatal
According to the studies low birth weight admission and measure the percentage of
neonates have 25-30 times higher risk for neonatal mortality. Therefore the objective of this
neonatal mortality compared to those with normal study was to evaluate the disease patterns and
birth weight [1,2]. Children born with birth weight the mortality rate at the tertiary care hospital.
lower than 2500 g at the time of birth, stay at risk
of increased mortality during their neonatal 2. MATERIALS AND METHODS
period, infancy, childhood and even much later in
the life [3-5]. More than 20 million children are Study Design: Hospital based cross sectional
born low birth weight all over the world, which study.
measures nearly 15.5% of all the births. Low
birth weight stands as a considerable public Participants: 2275 five neonates were
st
health problem in several parts of the world. It is registered from the available record from 1
st
realistically associated with short and long January 2020 to 31 december 2020. Gender,
standing fearsome outcomes. In low income birth weight, cause of admission and admission
countries, the prevalence of LBW is 18.5% on outcome were included as variables. Data was
average, being highest in South Asian countries, analyzed using Microsoft excel data spread
where as in Pakistan it was 19% according sheet.
recent data [6,7].
Study Setting: The study was conducted in
The span of first 28 days of a neonate is highly neonatal ward at Chandka Medical College
important period of life since more than 2/3 of the Hospital Larkana.
infant deaths in Pakistan occur during the first
month. It is predicted that 4 million out of total Data Analysis: We used Microsoft Excel spread
130 million neonates born worldwide, die within sheet to enter and analyze the data. Descriptive
four weeks of their life. Nearly half of the statistics were used for numerical data. Pivot
neonatal deaths occur during the first 24 hours of tables were created for categorical data.
life [8-11]. The most common causes of neonatal
mortality are sepsis 34%, prematurity 28% and 3. RESULTS
birth asphyxia 24% in developing countries.
Whereas most common causes for developed There were 2275 patients registered from CPDR
countries are prematurity and malformations [12]. st
(complete patient data record) from 1 January
In developing countries, 30-50% of the neonates st
2020 to 31 Dec 2020. The mean birth weight
die out of sepsis every year [9], however majority was 2.35kg, with lowest birth weight of 0.9kg and
of the causes of neonatal mortality in developing highest birth weight of 4.8kg (SD 0.8 and SE
countries are preventable. Pakistan is ranked as 0.01, CI 0.025) Table 1A.
rd
on 3 highest position worldwide since 7% of
world neonatal deaths occur in Pakistan with a Out of 2175 admitted neonates 506 (23.2%)
rate of 48 per 1000 live births and with a could not survive, 1250 (57.4%) were discharged
cumulative of 298000 neonatal deaths in the after desired improvement, parents of 106 (4.6%)
country every year [13,14]. One of the main neonates managed to get requested discharge
factors of neonatal death is weight at the time of (DOR), 287 (13.2%) left against medical advice
the birth. WHO also declared that around 15% of LAMA and remaining 1.2% were referred to other
the neonatal deaths occur due to low birth weight
73
Shahani et al.; JPRI, 34(1B): 72-76, 2022; Article no.JPRI.84394
st st
hospital for either intensive care or surgical 1 January 2020 to 31 December 2020. In this
intervention Table 1B. study we observed that the mean birth weight
was 2.35 kg, with lowest birth weight of 0.9kg
Most common presenting complaint and cause of and highest birth weight of 4.8 kg (SD 0.8 and
admission was HIE grade 1, followed by Sepsis, SE 0.01, CI 0.025). Mean birth weight
Preterm and BA with 418 (18.5%), 380(16.9%), observed in our study was significantly lesser
315 (14.01%) and 224(9.9%) respectively Table than published research by Naveed et al. (mean
1C. 3.0 kg) [15]. Also much lower than
publish research in Nepal in 2010 (mean 2.75
4. DISCUSSION kg) [16]. This relates with overall decrease
weight at the time of birth in south Asian
A total of 2257 neonates were registered using countries [17].
CPDR, compete patient data record register from
Table 1. Details of birth weight, admission outcomes and cause of admission at the hospital
A. Birth Weight of admitted Neonates
Details of Birth Weight of admitted Neonates
Mean 2.352397712
Standard Error 0.012345171
Median 2.5
Mode 2.5
Standard Deviation 0.888568265
Minimum 0.9
Maximum 4.8
Largest(1) 4.8
Smallest(1) 0.9
Confidence Level (95.0%) 0.024208988
B. Outcome of Admission at Neonatal Ward
Status No. %
DC 1250 57.47
DOR 106 4.87
EXPIRE 506 23.26
LAMA 287 13.2
REF TO CLF 3 0.14
REF TO KHI 12 0.55
REF TO PEADS SURGERY 11 0.51
Grand Total 2175 100
C. Cause of Admission at Neonatal Ward
Cause of Admission No. %
HIE I 418 18.59
SEPSIS 380 16.9
PRETERM 315 14.01
BA 224 9.96
RDS 190 8.45
HIE II 156 6.94
NNJ 118 5.25
LBW 104 4.63
TTN 70 3.11
MAS 56 2.49
PNEUMONIA 34 1.51
PSB I 32 1.42
HIE III 24 1.07
Others (less than 1% each) 127 5.67
Grand Total 2248 100
74
Shahani et al.; JPRI, 34(1B): 72-76, 2022; Article no.JPRI.84394
In our study, out of 2175 admitted neonates 506 CONSENT
(23.26%) could not survive, this constitutes a
huge number. However, our finding is consistent As per international standard or university
with a study conducted in Pakistan (Deaths standard, Participants’ written consent has been
23%). Our reported neonatal mortality is higher collected and preserved by the author(s).
compared to published research by Yasmin et al.
(123/1000) from Bangladesh [18]. A possible ETHICAL APPROVAL
explanation for this may be that the hospital
setting was actually a tertiary care set up where The approval for the study was approved from
most of referral cases arrive at late stages. Ethical committee University Kebangsaan
findings of our study are lower as compared to Malaysia and hospital administration and
Bangladesh (28%) and reasonably lower than Chandka Medical College hospital Larkana,
those from India 59.2% [19]. In our study, the Pakistan.
most common presenting complaint and cause of
admission was HIE grade I , followed by Sepsis, ACKNOWLEDGEMENT
Preterm and BA with 418 (18.59),
380(16.90),315 (14.01%) and 224(9.96) We would like to extend our gratitude to
respectively. While the disease pattern observed honorable Professor Aneela Atta Ur Rahman
by Shirazi .H in his study that was nearly Vice Chancellor SMBBMU, Larkana and the
relatable, as, Disease pattern of admission head of the Pediatric departments unit II Prof
showed that 1397(25%) babies had sepsis, 1058 Shanti Lal Bhojwani for their generous
(19%) had birth asphyxia and 1088(19.4%) had cooperation to conduct this study.
respiratory distress syndrome [20]. Greater
number of babies with sepsis reveals that the COMPETING INTERESTS
neonates had infection he blood at the time birth.
Usually the mother also gets admission in critical Authors have declared that no competing
stages which expose the poor antenatal care in interests exist.
our area. Mothers with antenatal sepsis
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