Reasons for Admission, Causes of Death

and Costs of Admission to a Tertiary

Referral Neonatal Unit in India
1. Neena Modi* and
2. Chellum Kirubakaran**

+ Author Affiliations
*
1. Department of Paediatrics & Neonatal Medicine, Royal Postgraduate Medical
School, Hammersmith Hospital London W12 0NN, UK
2. **Department of Child Health Unit II and Neonatal Services, Christian Medical
College Vellore 632004, Tamil Nadu, India

Abstract
SUMMARY 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
January31 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 121) and the median charge made Rs 714 (range 1225036).
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.

Perinatal mortality in Vellore Part I: A

study of 21,585 infants
Malati A. Jadhav and Lalana G. Christopher
Abstract
At Christian Medical College Hospital, Vellore, there were 21,585 consecutive births during a five
year period of 19791983. The overall perinatal mortality rate was 407, stillbirth rate was 236 and
early neonatal mortality rate was 175. Although the perinatal mortality rate was only half that
reported from other teaching hospitals in India, it is three times the rate reported for Avon area
hospitals providing special and intensive care. The highest perinatal mortality rate 455 was noted in
1979; the lowest 386 in 1982. The highest stillbirth rate 266 was noted in 1980, the lowest 193 in
1981 (p<05). Throughout it was consistently higher than early neonatal mortality rate. The highest
early neonatal mortality rate 208 was noted in 1979 the lowest 139 in 1980 with 33 per cent
reduction; (p<05) however in 1983 it was 171. At the end of five years perinatal mortality rate,
stillbirth and early neonatal mortality rates were not reduced significantly. If 223 unsalvagable
infants, 131 with congenital lethal malformation and 92 others with birth weight below 1000 gm
were excluded, then all the three rates for 21,360 normally formed infants weighing above 1000 gm
would be statistically significantly lower (perinatal mortality rate 307, stillbirth rate 184 and early
neonatal rate 125 (p<01).