Survival till discharge and risk factors of mortality among outborn extremely-low-birth-weight neonates: an experience from Central India
DOI:
https://doi.org/10.18203/2349-3291.ijcp20261534Keywords:
ELBW neonates, Outborn neonates, Transported neonates, Neonatal mortality, Predictors, Survival, Neonatal morbidityAbstract
Background: Outborn extremely-low-birth-weight (ELBW) neonates have a poor outcome compared to institutionally born neonates. Objectives were to evaluate the risk factors of outcome in outborn ELBW neonates.
Methods: This prospective cohort study was conducted at a tertiary care institute in central India over 2.5 years. Exclusion criteria included death within one hour of arrival or withdrawal of medical advice. Demographic, maternal, neonatal, and transport characteristics were noted until discharge or death. Survival until discharge status and risk factors of mortality were identified. Statistical significance was determined using Chi-square, Mann-Whitney, and unpaired t-test; and multiple logistic regression models were used to identify independent risk factors of mortality. P<0.05 was considered significant.
Results: Survival-to-discharge rate was 19.9%. On univariate analysis, neonates who had longer transport distance (p=0.04), no communication before transport (p<0.0001), and no treatment during transport (p=0.0003); and neonates with hypoglycemia (p=0.05), delayed capillary refill time (CRT) (p=0.01), low oxygen saturation (p<0.0001), and hypothermia (p<0.0001) had risk factors of mortality. Age at admission (adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI] 0.96-0.99, p=0.0001), hypothermia (aOR 0.036, 95% CI 0.004-0.31, p=0.003), and no communication before transport (aOR 46.95, 95% CI 7.57-291.25, p<0.0001) were the independent risk factors of mortality.
Conclusion: Outborn ELBW neonates face a high mortality rate. Age at admission, hypothermia, and lack of communication before transport were independent risk factors of mortality. The study highlights that clinical stabilization, specifically management of body temperature and improvement in pre-transport care and communication, is vital for increasing survival rates in this vulnerable population.
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