Risk factors of mortality in outborn neonates, an experience from central India: A prospective observational study.

BACKGROUND

Despite various measures, the neonatal mortality rate in outborn neonates is significantly high and makes impossible to achieve sustainable developmental goals.

OBJECTIVES

To recognize the risk factors of mortality in outborn neonates.

METHODS

A prospective observation cohort was studied at Government Medical College, Nagpur, for a duration of two and a half years on all outborn neonates. Neonates who died within an hour, whose parents left the hospital against medical advice, and not willing to participate were excluded. Demographic, maternal, and neonatal clinical parameters and transport data were collected. Clinical diagnosis was done by using standard definitions. All the neonates were followed up till discharge or death. Mortality rate and risk factors of mortality were identified. Chi-square test, Mann-Whitney test, and unpaired "t" test were used for comparison between survival and nonsurvival neonates. Univariate and multiple logistic regression models were used to identify independent risk factors of mortality by adjusted odds ratio and 95% confidence interval. P < 0.05 was considered as significant.

RESULTS

Inadequate antenatal care (adjusted odds ratio [aOR] 1.93, 95% confidence interval [CI] 1.00-3.78, P = 0.04), increased travelling distance (aOR 1.00, 95% CI 1.00-1.00, P < 0.0001), preterm birth (aOR 0.89, 95% CI 0.85-0.93, P < 0.0001), abnormal respiratory rate (aOR 0.97,95% CI 0.96-0.98, P = 0.001), abnormal heart rate (aOR 0.96, 95% CI 0.95-0.98, P < 0.0001), hypothermia (aOR 0.72, 95% CI 0.54-0.96, P = 0.02), low oxygen saturation (aOR 0.90, 95% CI 0.87-0.93, P < 0.0001), and poor perfusion (aOR 1.93, 95% CI 1.68-2.21, P < 0.0001) were the independent risk factors of mortality.

CONCLUSION

Inadequate antenatal care, increased travelling distance, preterm birth, abnormal respiratory rate, abnormal heart rate, hypothermia, low oxygen saturation, and poor perfusion are independent predictors of mortality. Improvement of utilization and delivery of maternal/neonatal care, transport system, and early recognition of risk factors of mortality are keys to attain of SDG.