Evaluation of the Predictors of Mortality in Very Low Birth Weight Neonates in Neonatal Intensive Care Unit – A Hospital-based Prospective Observational Study

Abstract

Introduction: Very low birth weight (VLBW) neonates are defined by birth weight ≤1500 g. They constitute 4%–7% of all neonates but contribute >30% of all neonatal deaths. Assessment of factors predicting mortality in such infants, both maternal and neonatal, can help us prioritize our resources and improve our health structure. Aim: The aim was to study factors affecting neonatal mortality in VLBW neonates in the neonatal intensive care unit (NICU). Materials and Methods: This hospital-based prospective observational study was conducted on neonates ≥26 weeks and birth weight ≤1500 g admitted in the NICU. Predesign structured pro forma was made for history and data collection. Detailed antenatal and natal history was taken, neonates were examined along the course of treatment, and the outcome was recorded in the form of discharge and death. All tests were performed at a 5% level of significance; thus, an association was significant if P < 0.05. Univariate analysis and logistic regression analysis were done to determine the predictors of mortality. Results: One hundred newborns were enrolled, of which 32 expired. Respiratory distress syndrome followed by sepsis was the major cause of death. Univariate analysis showed that primigravida, history of premature rupture of membrane, anemia, meconium-stained liquor, maternal fever, use of antenatal steroids, fetal distress, resuscitation requirement, gestational age, Apgar score, need for surfactant, and delayed capillary refill time were found to be directly linked with neonatal mortality. On multivariate analysis, requirement of resuscitation (P = 0.001), gestational age ≤30 weeks (P = 0.032), the need for surfactant (P = 0.036), anemia (P = 0.019), maternal fever (P = 0.003), use of antenatal steroid (P = 0.031), and fetal distress (P = 0.02) were found to be significant predictors of neonatal mortality. Conclusions: Most of the predictors can be managed by following proper treatment protocols and implementing newer policies. Therefore, emphasis should be given to prevention, early anticipation, and management of these predictors and building better health infrastructure.

Keywords

• mortality
• neonates
• predictors
• very low birth weight infants