scholarly journals Quality Of Referral, Admission Status And Outcome Of Neonates Referred To Pediatric Emergency Of A Tertiary Care Institution In North India

2021 ◽  
Author(s):  
Neeraj Mishra ◽  
Shiv Sajan Saini ◽  
Jayashree Muralidharan ◽  
Praveen Kumar
Keyword(s):  
Tertiary Care ◽  
Birth Asphyxia ◽  
Newborn Care ◽  
Pediatric Emergency ◽  
North India ◽  
Main Mode ◽  
Sick Newborn ◽  
Admission Status ◽  
Mode Of Transport

Abstract Background: We evaluated quality of referral, admission status and outcome of neonates.Methods: We enrolled newborns admitted between March 2016 and October 2016, excluding neonates referred from outpatient department. Information was collected from referral slips, interviewing accompanying persons and observation.Results: 61% were referred from government hospitals with “Sick Newborn Care Units” contributing to maximum. Main mode of transport was ambulance in 80% and referral notes were available in the majority but incomplete in majority. Sepsis (39%), jaundice (16%) and birth asphyxia (13%) were most common diagnoses. Half of the newborns were hemodynamically unstable. 27% had poor circulation, 15% were hypoxic, 9% hypoglycemic and 8% hypothermic. 22% either died or “Left Against Medical Advice” with a high probability of death.Conclusion: National ambulance service is utilized for transporting newborns. However, there are quality gaps which need attention to develop it into efficient referral system.

Clinical profile and predictors of mortality among the referred neonates at a tertiary care centre in north India: a prospective observational study

2020 ◽  
Vol 50 (3) ◽  
pp. 221-227
Author(s):  
Jasbir Singh ◽  
Poonam Dalal ◽  
Geeta Gathwala
Keyword(s):  
Tertiary Care ◽  
Birth Asphyxia ◽  
Newborn Care ◽  
Family Health ◽  
Favourable Outcome ◽  
Clinical Profile ◽  
North India ◽  
Tertiary Care Centre ◽  
Predictors Of Mortality ◽  
Sick Newborn

The National Family Health Survey (NFHS-4) shows encouraging improvement in infant and under-five mortality rates in India. However, the neonatal mortality rate (NMR) still remains high as India contributes to about one-fifth of global deaths. This prospective study was conducted from 15 January to 30 April 2016 to examine the clinical profile and predictors of mortality among referred neonates at our centre. Among 301 neonates, prematurity (40%) was the most common indication for referral followed by need for ventilation (38%) and birth asphyxia (28%). Approximately 73% neonates were referred within 24 h of birth. Ninety (29.9%) neonates died; of these, 63% died within 24 h of presentation. Prematurity, birth asphyxia, hypothermia, shock at presentation and extreme low birth weight were the most significant predictors of mortality. Adequate training of peripheral health personnel, dedicated teams for neonatal referral and strengthening of peripheral sick newborn care units (SNCUs) seem to be promising interventions for favourable outcome.

scholarly journals Prescribing pattern of drugs in sick newborn care unit in a tertiary care hospital, Haldwani, Uttarakhand, India

2017 ◽  
Vol 6 (4) ◽  
pp. 832
Author(s):  
Pooja Agrawal ◽  
Bhavana Srivastava ◽  
Sanjay Gaur ◽  
Renu Khanchandani ◽  
Bithorai Basumatary
Keyword(s):  
Drug Utilization ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Newborn Care ◽  
Case Fatality ◽  
Current Data ◽  
Care Hospital ◽  
Prescribing Pattern ◽  
New Born ◽  
Sick Newborn

Background: Sick Newborn Care Unit (SNCU) is meant to reduce the case fatality among sick newborns. Although it has been shown that patterns of drug utilization in SNCU are changing dynamically, current data on drug utilization patterns in SNCU is limited. This study was done to find out drug utilization pattern in newborn admitted at SNCU.Methods: This prospective observational drug utilization study was carried out in SNCU of Government Medical College and Hospital, Haldwani (Uttrakhand). The pattern of drug use in 206 sick newborn admitted at SNCU was assessed.Results: 75.25% sick newborns were in early neonatal period and 63.11% sick newborns were male. 33.98% sick newborn were preterm and mean±SD of weight of sick newborn was 2.16±0.6kg. Neonatal sepsis was commonest reason for admission followed by birth asphyxia . Three or more drugs (average 2.35drug/ Range 3-9 drug) were given to 52.91% new born and two drugs were given to 40.78% new born. Commonest route of drug administration was intravenous (97.08%), followed by intramuscular (72.82%), followed by orally (13.59%) and 11.65% new born received drug by inhalation. Most frequently used drugs in SNCU were antibiotics (Ampicillin, Gentamicin, Amikacin, Cefotaxime). Only two adverse drug reactions (mild rash by ampicillin and fever) were reported during study period. Out of 206 sick newborn, 18.93% died. Most common causes for death were respiratory distress syndrome (41.03%) followed by sepsis (23.08%) and hypoxic ischemic encephalopathy (17.95%).Conclusions: Antibiotics were of major concern in SNCU. The uncertainty regarding the choice of antibiotic can be minimized by periodic survey of etiological agent and their antibiotic susceptibility pattern.

scholarly journals Cancellation of Elective Surgeries in A Tertiary Care Hospital in North India

2021 ◽  
Author(s):  
Nyla Farooq ◽  
Tauyiba Farooq Mir
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
North India ◽  
Care Hospital ◽  
Cancellation Rate ◽  
Surgical Treatments ◽  
Operational Time

Background: Cancellation of elective surgical treatments is a quality-of-care issue as well as a huge waste of health-care resources. Patients may experience emotional distress as a result of this, as well as difficulty for their families. Aim: To find the significant reasons of cancellation of scheduled surgical cases. Methods: A total of 300 elective operations in our institution were chosen. The completed surgeries were planned on the scheduled operation day, and the anaesthesiologist noted down a list of cancellations along with their reasons. Results: A total of 300 patients were scheduled for surgery. A total of 60 patients were cancelled, resulting in a 20% cancellation rate. Lack of operational time was the most prevalent reason for cancellation. Conclusion: The majority of the reasons for cancellation should have been avoided with proper list preparation and the surgical team's meticulous planning.

scholarly journals A profile on the spectrum of neonatal mortality and morbidity pattern of extramural neonates in the Specialised Neonatal Care Unit (SNCU) in a tertiary care hospital

2018 ◽  
Vol 5 (2) ◽  
pp. 427 ◽  
Author(s):  
Anuradha D. ◽  
Rajesh Kumar S. ◽  
Aravind M. A. ◽  
Jayakumar M. ◽  
J. Ganesh J.
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Respiratory Distress ◽  
Neonatal Mortality ◽  
Low Birthweight ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Newborn Care ◽  
Care Hospital ◽  
Neonatal Deaths

Background: Every year, nearly four million newborn babies die in the first month of life. India carries the single largest share (around 25-30%) of neonatal deaths in the world. Neonatal deaths constitute two thirds of infant deaths in India. 45% of the deaths occur within the first two days of life. It has been estimated that about 70% of neonatal deaths could be prevented if proven interventions are implemented effectively at the appropriate time. It was further estimated that health facility-based interventions can reduce neonatal mortality by 23-50% in different settings. Facility-based newborn care, thus, has a significant potential for improving the survival of newborns in India. This research has been planned with an aim to study the profile of pattern of admissions in a SNCU and their outcomes following admission and management in the unit.Methods: All babies referred for neonatal problems (less than 28 days) and admitted in NICU will be included. Both term and preterm babies will be considered. The criteria for admission includes various causes like low birth weight, preterm, birth asphyxia, respiratory distress, hyperbilirubinemia, congenital anomalies, risk factors (maternal, neonatal, prenatal), infections and outcome will be analysed.Results: Among the 2927 admissions term babies and boys outnumbered. The common causes for admission were birth asphyxia, respiratory distress, low birthweight and preterm. Most babies had an uncomplicated stay. The mortality in the extramural neonates was due to neonatal sepsis, extreme preterm and congenital malformations.Conclusions: Intensive and interventional management, along with good neonatal monitoring and care can reduce the mortality and improve the survival of low birth weight babies and other treatable problems. Thus, a combined effort of management by pediatricians, nursing care, neonatal intensive care unit can improve the survival rates of neonates.

scholarly journals Assessment of quality of life of type-2 diabetes mellitus patients in tertiary care teaching hospital in North India

2019 ◽  
Vol 9 (1) ◽  
pp. 107
Author(s):  
Aditya Parashar ◽  
K. K. Jha ◽  
Arun Kumar ◽  
Sheetal Singh Tomer ◽  
Dharmendra Singh Yadav ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Tertiary Care ◽  
North India ◽  
Cross Sectional ◽  
Physical Strength

Background: Quality of life (QoL) is a standard indicating a person’s life in better condition as compared to a diseased person or patient. Diabetes itself is not a dangerous disease if managed properly, but it becomes life-threatening after a certain time period because of the patient’s poor interest in disease management and treatment adherence. Diabetes mellitus is an endocrine system disorder that invokes lack of insulin secretion in the bloodstream. The study was conducted to assess the QoL of type-2 diabetes mellitus patients with QoL instrument.Methods: Questionnaire based cross-sectional, prospective study was conducted at Teerthanker Mahaveer Hospital, Moradabad, for a duration of 6 months from January - June 2019, on 196 patients of type-2 diabetes mellitus.Results: On an average 56.5% people have accepted that due to the diabetic condition their working proficiency is decreased. 80.3% of patients have accepted that they were facing problems due to diabetic symptoms. Similarly, 84% of patients have accepted that the ongoing treatment was quite expensive than their expectations. Finally, the last section of the patient’s emotional/mental satisfaction showed that 49.7% of patients were very satisfied with their family support while 13.7% of patients were not satisfied.Conclusions: QOL instrument for Indian diabetes patient’s instrument helped to evaluate the patient’s physical strength, psychological strength of the patient during disease condition, the response provided from the family members and relatives, the economical status of the patient and its effects on their living.

scholarly journals Admissions to a Low-Resource Neonatal Unit in Malawi Using a Mobile App: Digital Perinatal Outcome Audit (Preprint)

2019 ◽  
Author(s):  
Caroline Crehan ◽  
Erin Kesler ◽  
Indira Angela Chikomoni ◽  
Kristi Sun ◽  
Queen Dube ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Birth Asphyxia ◽  
Newborn Care ◽  
Case Fatality ◽  
Mobile App ◽  
Proof Of Concept ◽  
Discharge Data ◽  
Low Resource ◽  
Modifiable Factors

BACKGROUND Mobile health (mHealth) is showing increasing potential to address health outcomes in underresourced settings as smartphone coverage increases. The NeoTree is an mHealth app codeveloped in Malawi to improve the quality of newborn care at the point of admission to neonatal units. When collecting vital demographic and clinical data, this interactive platform provides clinical decision support and training for the end users (health care professionals [HCPs]), according to evidence-based national and international guidelines. OBJECTIVE This study aims to examine 1 month’s data collected using NeoTree in an outcome audit of babies admitted to a district-level neonatal nursery in Malawi and to demonstrate proof of concept of digital outcome audit data in this setting. METHODS Using a phased approach over 1 month (November 21-December 19, 2016), frontline HCPs were trained and supported to use NeoTree to admit newborns. Discharge data were collected by the research team using a discharge form within NeoTree, called <i>NeoDischarge</i>. We conducted a descriptive analysis of the exported pseudoanonymized data and presented it to the newborn care department as a digital outcome audit. RESULTS Of 191 total admissions, 134 (70.2%) admissions were completed using NeoTree, and 129 (67.5%) were exported and analyzed. Of 121 patients for whom outcome data were available, 102 (84.3%) were discharged alive. The overall case fatality rate was 93 per 1000 admitted babies. Prematurity with respiratory distress syndrome, birth asphyxia, and neonatal sepsis contributed to 25% (3/12), 58% (7/12), and 8% (1/12) of deaths, respectively. Data were more than 90% complete for all fields. Deaths may have been underreported because of phased implementation and some families of babies with imminent deaths self-discharging home. Detailed characterization of the data enabled departmental discussion of modifiable factors for quality improvement, for example, improved thermoregulation of infants. CONCLUSIONS This digital outcome audit demonstrates that data can be captured digitally at the bedside by HCPs in underresourced newborn facilities, and these data can contribute to a meaningful review of the quality of care, outcomes, and potential modifiable factors. Coverage may be improved during future implementation by streamlining the admission process to be solely via digital format. Our results present a new methodology for newborn audits in low-resource settings and are a proof of concept for a novel newborn data system in these settings.

scholarly journals Clinical profile and outcome of neonates admitted in sick newborn care unit with hypernatremic dehydration and association with breastfeeding in a tertiary care hospital in Northern India

2021 ◽  
Vol 8 (6) ◽  
pp. 1074
Author(s):  
Mohit Bajaj ◽  
Chiranth R. ◽  
Swati Mahajan ◽  
Pancham Chauhan
Keyword(s):  
Sodium Level ◽  
Tertiary Care ◽  
Newborn Care ◽  
Main Step ◽  
Care Hospital ◽  
Sick Newborn ◽  
Hilly Region ◽  
The Mean ◽  
Time Of Admission ◽  
Hypernatremic Dehydration

Background: Neonatal hypernatremic dehydration is a very commonly seen potentially devastating condition. Inadequate breastfeeding, gastrointestinal losses, warm weather and improperly diluted mixed feeding are the main etiologies linked with neonatal hypernatremic dehydration. We conducted this study to evaluate the etiology, risk factors, clinical symptoms and outcomes of neonates admitted with hypernatremic dehydration and its association with breastfeeding from hilly region in northern India.Methods: The authors retrospectively studied records from extramural sick newborn care unit (SNCU) from April 2018 to June 2019. Inclusion criteria for the study included admitted neonates with documented hypernatremia (serum sodium level >145 mmol/L). Results: Nine hundred and twenty-two neonates were admitted in sick newborn care unit during this study period. One hundred and three (13.39%) newborns were admitted with hypernatremic dehydration at the time of admission. All newborns had deranged kidney function tests at time of admission. Most commonly found presenting complaints were poor feeding (85.71%), fever (45.71%), loose stools (42.8%) and decreased urine output (8%). The mean (SD) sodium on admission was 154.04 (7.41) meq/L. The mean (SD) time taken to correct hypernatremia was 35.6 (14.6) hours. Six of total admitted newborn developed neurological complications (2 had developed cerebral venous thrombosis and 4 had developed seizures). Mortality rate was 4.4%. Top fed neonates (50.41%) had higher percentage of mean sodium level and acute kidney injury at time of admission.Conclusions: Hypernatremic dehydration is preventable and treatable condition. Looking in to and addressing etiology in a timely manner is main step in management. All mothers should be taught correct breastfeeding technique. More breast examination during prenatal and postnatal periods and careful neonatal weight record postnatally could decrease the incidence of neonatal hypernatremic dehydration. Top feeding should be discouraged and only exclusive breastfeeding for 6 months. 

scholarly journals Experience of managing first fifty COVID-19 positive peripartum women in a tertiary care centre in North India

2021 ◽  
Vol 10 (3) ◽  
pp. 1036
Author(s):  
Vijay Zutshi ◽  
Neha Mohit Bhagwati ◽  
Alka .
Keyword(s):  
Pregnant Women ◽  
Severe Disease ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Fetal Distress ◽  
North India ◽  
Tertiary Care Centre ◽  
Mild Disease ◽  
Qrt Pcr ◽  
The Mean

Background: SARS-CoV-2 has caused significant morbidity and mortality worldwide. Analysis of the clinical profile of COVID-19 positive pregnant women is important to understand the pathophysiology, transmission and outcome of the disease in Indian population.Methods: It is a retrospective observational study of first fifty pregnant patients tested positive for COVID-19 by qRT PCR admitted for delivery in our hospital.Results: In this audit, first fifty COVID-19 pregnant women were studied and the mean age of the patients in this study was 26 years. 98% of these women were admitted for obstetric indications. Seventy two percent of these women were admitted with spontaneous onset of labour. Based on disease severity, 49 (98%) were either asymptomatic or exhibited mild disease and only 1 (2%) had severe disease who succumbed to her illness. Forty six percent patients delivered vaginally and 54% required cesarean delivery. The most common indication for LSCS was fetal distress (43%). Eighteen percent had preterm delivery. Among the newborn babies, one died due to severe birth asphyxia. Sixteen percent babies required NICU stay. Five babies tested positive for COVID-19 of which one baby was positive on day one of life.Conclusions: As per our results, majority of the COVID-19 positive pregnant women had mild disease. There has been increase in cesarean section rate as compared to the previous hospital figures. Only one baby tested positive within 24 hours of delivery so the possibility vertical transmission can not be commented upon as of today.

scholarly journals Profile of neonatal mortality in special newborn care unit of tertiary care hospital

2019 ◽  
Vol 6 (6) ◽  
pp. 2319
Author(s):  
Ashutosh Kumar Sharma ◽  
Ajay Gaur
Keyword(s):  
Respiratory Distress ◽  
Neonatal Mortality ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Newborn Care ◽  
Neonatal Morbidity ◽  
Study Data ◽  
Categorical Variables ◽  
Care Hospital ◽  
Danger Signs

Background: In India presently around 8 million LBW infant are born each year. India accounts for 24% of global neonatal mortality. Improving NMR is an essential component of reducing U-5MR. The aim of this study was to determine the causes of morbidity and mortality in neonates admitted in our hospital.Methods:  This study was conducted at SNCU of Kamala Raja Hospital, Gwalior providing level III neonatal care. This is a retrospective hospital based observational study. Data from SNCU online database were taken for a period of 3 year from March 2016 to March 2019. Data obtained included sex, birth weight, Gestation age, morbidity profile, Diagnosis, and Mortality profile, Duration of stay and outcome. Categorical variables were tabulated and Statistical analysis was done.Results:  A total of 12,027 neonates were recruited, 63.07% were males and 36.92% were females. 54.87% were extramural, while 45.13% were intramural neonates. Prematurity was the most common morbidity 56.98% in the admitted neonates. Major contributors to the neonatal morbidity were Birth asphyxia (24.61%), others (21.60%), Respiratory Distress(14.06%), Sepsis(13.77%). The mortality rate in the present study is 25.45%. Major contributors for neonatal mortality includes Respiratory distress (37.76%), Birth Asphyxia (26.75%), Sepsis(13.91%). Mortality was more in out born babies 33.03% compared to inborn babies 22.03%. Conclusions:  Improving antenatal care, more deliveries at institutions with SNCU facility, improved access to health facility, early identification of danger signs,   timely referral of high risk cases, capacity building, can reduce neonatal mortality and its complications.

scholarly journals Trends in use in a Canadian pediatric emergency department

CJEM ◽  
2014 ◽  
Vol 16 (05) ◽  
pp. 405-410 ◽  
Author(s):  
Quynh Doan ◽  
Emerson D. Genuis ◽  
Alvis Yu
Keyword(s):  
Emergency Department ◽  
Patient Outcomes ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Ed Overcrowding ◽  
Secondary Outcomes ◽  
Ed Crowding

ABSTRACTIntroduction:Emergency department (ED) crowding is a significant problem in Canada and has been associated with decreased quality of care in general and pediatric emergency departments (PEDs). Although boarding of admitted patients in the ED is the main contributor to adult ED overcrowding, factors involved in PED crowding may be different. The objective of this study was to report the trend in PED services use and to document the degree of overcrowding experienced in a Canadian PED.Methods:A retrospective cohort study was conducted using administrative data from a tertiary care PED from 2002 to 2011. The primary outcome was PED use (total volume of visits and case severity per triage levels using the Canadian Triage and Acuity Scale [CTAS] score and admissions). Secondary outcomes included measures of PED overcrowding, such as rates of patients leaving without being seen (LWBS) and length of stay (LOS).Results:Total volumes increased by 30% over the 10-year study period, whereas hospitalizations remained stable at approximately 10%. Trends in CTAS levels did not indicate meaningful changes in the severity of cases treated at our PED. LWBS proportions among CTAS 3, CTAS 4, and CTAS 5 groups and LOS for all CTAS groups progressively and statistically increased from year to year.Conclusions:Over the course of the study period, there was a substantial increase in PED visits,which likely contributed to the worsening markers of PED flow outcomes. Further study into the effects of PED crowding on patient outcomes is warranted.

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