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Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India

Journal of Perinatology volume 27, pages 44–49 (2007)Cite this article

Abstract

Objective:

To evaluate impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India.

Study design:

Before-and-after intervention trial setting: limited resource teaching hospital; Design: Before and after study.

Interventions:

A package of simple interventions was evolved. The interventions included: rational admissions and early discharge, entrusting mothers in care-giving, enforcing asepsis routines, aggressive enteral feeding, abandoning unnecessary interventions, protocol-based management, rational antibiotics and training and empowerment of nurses.

Statistical methods:

The categorical and continuous variables were compared with χ2 and two-tailed tests, respectively.

Results:

Neonatal mortality rate declined significantly during the intervention period as compared to control period (20.3 versus 29.3 per 1000 live births; relative risk 0.69, 95% confidence interval (CI) 0.57 to 0.85). Most significant decline occurred in sepsis-related deaths. The survival of neonates with birth weight 1000 to 1499 improved over two folds (56.7% versus 24.5%, P<0.01). There was a significant decline in antibiotics use (635/878, 72.3% versus 299/897, 23.2%; P=0.00). The duration of stay in neonatal unit was decreased by a mean of 1.5 day (95% CI 0.9 to 2.8 days) after interventions.

Conclusions:

Simple interventions can result in a significant decline in neonatal mortality in hospitals with limited resources. This package is likely to be effective in hospitals with a high proportion of the sepsis deaths.

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Acknowledgements

We thank the nurses, resident doctors and the families of the neonates who were responsible for care of these neonates. We thank Professors Vinod Paul and Ashok Deorari of All India Institute of Medical Sciences, New Delhi for critical review of this paper and Drs Madhulika Allawadhi, Abhishek Kothari and K Kilnani for support to ROP screening program. We also thank Professor Adarsh Bhargava, Head, Department of Obstetrics and Gynecology, SMS Medical College for ongoing support and guidance.

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Authors and Affiliations

  1. Department of Pediatrics, AIIMS, Ansari Nagar, New Delhi, India

    R Agarwal, K Agarwal, U Acharya, P Christina, V Sreenivas & S Seetaraman

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  1. R Agarwal
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  2. K Agarwal
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  3. U Acharya
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  4. P Christina
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Correspondence to R Agarwal.

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Agarwal, R., Agarwal, K., Acharya, U. et al. Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India. J Perinatol 27, 44–49 (2007). https://doi.org/10.1038/sj.jp.7211620

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