TY - JOUR
T1 - Neonatal mortality among preterm infants admitted to neonatal intensive care units in India and Pakistan
T2 - A prospective study
AU - Saleem, Sarah
AU - Tikmani, Shiyam Sunder
AU - Goudar, Shivaprasad S.
AU - Hwang, Kay
AU - Dhaded, Sangappa
AU - Guruprasad, Gowder
AU - Nadig, Naveen G.
AU - Kusagur, Varun B.
AU - Patil, Lingaraja Gowda C.
AU - Siddartha, E. S.
AU - Yogeshkumar, S.
AU - Somannavar, Manjunath S.
AU - Roujani, Sana
AU - Khan, Mashal
AU - Shaikh, Mehmood
AU - Hanif, Muhammad
AU - Bann, Carla M.
AU - McClure, Elizabeth M.
AU - Goldenberg, Robert L.
N1 - Publisher Copyright:
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
PY - 2023/11
Y1 - 2023/11
N2 - 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.
AB - 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.
KW - low- and middle-income countries
KW - preterm birth
KW - preventable mortality
UR - http://www.scopus.com/inward/record.url?scp=85165607955&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.17581
DO - 10.1111/1471-0528.17581
M3 - Article
C2 - 37470084
AN - SCOPUS:85165607955
SN - 1470-0328
VL - 130
SP - 68
EP - 75
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - S3
ER -
