Predictors of morbidity and mortality of extramural neonates with respect to TOPS score: prospective experience from a tertiary care centre of western India

Authors

  • Charul R. Mehta Department of Pediatrics, B. J. Medical College, Ahmedabad, Gujarat, India
  • Diwakar K. Singh Department of Pediatrics, B. J. Medical College, Ahmedabad, Gujarat, India
  • Aashna Verma Department of Pediatrics, B. J. Medical College, Ahmedabad, Gujarat, India
  • Mehul Patel Department of Pediatrics, B. J. Medical College, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20230425

Keywords:

Perfusion, Hypoxia, TOPS Score, Morbidit, Mortality

Abstract

Background: The transport of sick newborns in India is still at a premature stage. Many of these newborns thus transported are cold, blue, and hypoglycaemic, and 75% of the babies transferred this way have serious clinical implications. The aim of this study was to study the clinical status of neonates transported to our hospital and predict the outcome in terms of morbidity and mortality, based on the TOPS score.

Methods: This prospective, observational, longitudinal, simple randomized study was carried out over 12 months in the Department of Paediatrics, Civil Hospital Ahmedabad, Gujarat, and a total of 750 patients were enrolled. A detailed history and clinical examination were carried out through a preformed proforma.

Results: The parameter that was found to be most altered was temperature (70.6%), 52% had hypoxia, 48.6% had poor perfusion and 20% patients had hypoglycemia. Hypoxia was the strongest predictor of mortality. 74.8% of the neonates referred to our hospital had TOPS score of 4-6, and had the highest mortality (41.3%). 25.2% of the newborns were having a TOPS score of 7-8.

Conclusions: TOPS is a simple, reliable score which can help in the quick assessment of neonates on arrival. Hypothermia was the most common altered parameter at the time of presentation followed by hypoxia and hypoperfusion. Mortality was found to be statistically significant in those sick newborns, who presented with more than one altered parameter of TOPS.

References

Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effects of home based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet. 1999;354(9194):1955-61.

Mathur NB Arora D. Role of TOPS (a simplified assessment of neonatal acute physiology) in predicting mortality in transported neonates. Acta Paediatr. 2007;96(2):172-5.

Thwala M. The Quality of Neonatal inter-facility transport system within the Johannesburg Metropolitan region. 2012.

Hapani PT, Berwal A, Dave H. Application of tops score in sick neonates received at level 3 nicu and its impact on the outcome of the neonate. IOSR J Dent Med Sci. 2019;18(3):11-5.

Begum A, Ashwani N, Kumar CS. TOPS: a reliable and simplified tool for predicting mortality in transported neonates. IOSR J Dent Med Sci. 2016;15:53-8.

Sehgal A, Roy MS, Dubey NK, Jyothi MC. Factors contributing to outcome in newborns delivered out of hospital and referred to a teaching institution. Indian Pediatrics. 2001;38(11):1289-94.

Buch PM, Makwana AM, Chudasama RK, Doshi SK. Status of newborn transport in periphery and risk factors of neonatal mortality among referred newborns. J Pharma Biomed Sci. 2012;16(9):1-6.

Dalal E, Vishal G, Solanki D. Study on neonatal transport at tertiary care centre. Int J Sci Res. 2013;2(12):289-92.

Wardhani DM, Haksari SW. Risk factors of neonatal mortality of referred babies with birth weight of 1000-< 2500 grams. J Med Sci (Berkala ilmu Kedokteran). 2009;41(3):143-51.

Cornblath M, Howdon JM, Williams AF. Contraversies regarding definition of neonatal Hypoglycaemia: Suggested operational threshold. Paediatrics. 2000;105(5):1141-5.

Hoque M, Haaq S, Islam R. Causes of neonatal admissions and death at rural hospital in Kwazulunatal, South Africa. South Afr J Epidemiol Infect. 2011;26(1):27-9.

Njokanma OF, Olanrewaju DM. A study of neonatal deaths at the Ogun State University Teaching Hospital, Sagamu, Nigeria. J Trop Med Hyg. 1995;98(3):155-60.

Okechukwu AA, Achonwa A. Morbidity and mortality patterns of admissions into the Special Care Baby Unit of University of Abuja Teaching Hospital, Gwagwalada, Nigeria. Niger J Clin Pract. 2009;12(4):389-945.

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Published

2023-02-23

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Original Research Articles