Why newborns die? A self-audit

Benjamin M. Sagayaraj, Nidhi Sharma, Lal D. V.


Background: A birth weight specific reduction in neonatal mortality has been noted in babies above 1000 gm. This has been attributed to intensive care management of high-risk pregnancies and new borns. A further decline in mortality can be accomplished by evidence based evaluation of high-risk therapies. This prospective study was conducted to evaluate the postnatal factors correlating with new born mortality. Apgar scores at birth have been correlated with deaths in low birth weight babies. In the present study we tried to correlate the presence of apnea, hyaline membrane disease, necrotizing enterocolitis and sepsis with neonatal mortality. Lethal Congenital malformations were also studied. It is a prospective consecutive enumerative study of all new borns weighing less than 2000 grams.

Methods: The post natal course in the hospital including the presence of apnea, seizures, patent ductus arteriosus, intra ventricular hemorrhage, hyaline membrane disease, hyper bilirubinemia, necrotizing enterocollitis, duration of oxygen therapy and ventilator support were noted. Statistical analysis was done using Fisher Exact test.

Results: There was a significant increase in mortality if the new born had low Apgar score, necrotizing enterocollitis, hyaline membrane disease, apnoea, sepsis or congenital malformations. Nursery biological risk score is a sensitive tool to predict new born mortality.

Conclusions: Nursery biological risk factors can be used to predict the outcome. However the clinical picture is compound with various coexisting pathologies.


Neonate, Mortality, Low birth weight, Resuscitation

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Victoria CG, Wagstaff A, Schellenberg JA, Gwakin D, Claeson M, Habicht JP. Applying an equity Lens to child wealth and mortality: more of same is not enough. The Lancet. 2003;362:233-41.

Battaglia FC, Lula O. A practical classification of new born infants by weight and gestational age. J Pediatrics. 1967;71:2.

Chatrrath R, Saili A. Immune status of full term SGA neonates in India. J Trop Pediatr. 1997;43:345-8.

Sagayaraj BM, Sharma N, Lal DV. New born care: our perspective. Indian J Neonat Med Res. 2014;2,2:13-7.

United Nations Children’s Fund and World Health Organization. Low birth weight: country regional and global estimates. UNICEF. 2004:92-806-3832-37.

Kinsella JP, Abman SH. Recent developments in the pathophysiology and treatment of persistent pulmonary hypertension of new born. Pediatr. 1995;126:853-64.

Sagayaraj BM, Lal DV, Kumar R, Sharma N. Magnifying glass on why new borns die. Indian J Neona Med Res. 2014;2(1):7-10.

Lindner W, Vobbeck S, Hummler H, Pontantandt F. Delivery room management of extremely low birth weight infants: spontaneous breathing or intubation? Paediatrics. 2005;103(5):961-67.

Brazy JE, Eckerman CO, Jerri M, Ridei O, Goldstein I, O’Raand AM. Nursery neurobiological risk score: important factors in predicting outcome in very low birth weight infants. J Paediatr. 1991;118(5):783-92.

Apgar V. A proposal for a new method of evaluation of the new born infant. Curr Res Anesth Anal. 1953;32:260-7.

Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of new born infants. N Engl J Med. 2001;344:467-71.

Gewolb IH, Schwalbe RS, Taciak VL, Harrison TS, Panigrani P. Stool micro flora in extremely low birth weight infants. Arch Dis Child Fetal Neonatal. 1999;80:167-73.

Saavedra JM, Bauman NA, Oung I, Perman JA, Yolken RH. Feeding of Bifidobacterium bifidum and streptococcus thermophiles to infants in hospital for prevention of diarrhoea and shedding of rotavirus. Lancet. 1994;344:1046-49.

Neonatal Resuscitation: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment recommendations. Circulation. 2010;122(2):S516-38.

Carlo WA. In Kliegman RM, Stanton BF, Schor NF, Joseph W. St Geme III. Nelson textbook of Pediatrics. First south Asian Edition. Haryana, India: Reed Elsevier India Pvt Ltd;2011:850.

Shane AL, Stoll BJ. Recent developments and current issues in the epidemiology, diagnosis and management of bacterial and fungal neonatal sepsis. Am J Perinatol. 2013;30(2):131-41.

Walden RV, Taylor SC, Hansen NI, Poole WK, Stoll BJ, Abuelo D. Major congenital anomalies place extremely low birth weight infants at higher risk for poor growth and developmental outcomes. 2007;120(6):e1512-9.

Slavotinek A. In Kliegman RM, Stanton BF, Schor NF, Joseph W. St Geme III. Nelson textbook of Pediatrics. First south Asian Edition. Haryana, India: Reed Elsevier India Pvt Ltd. 1:899.