Demographic data collected included: place of delivery (inborn or outborn
); gestational age; birth weight; the presence of intrauterine growth restriction; noted asphyxia (based on an Apgar score of <6 at 1 minute and 5 minutes, associated with metabolic acidosis at birth), and the need for resuscitation at birth (such as intermittent positive pressure ventilation or chest compressions).
Antimicrobial resistance especially to Gram Negative organisms is becoming a significant problem necessitating use of drugs like colistin.4 Developing revised recommendations for effective second line antibiotics is likely to be a perpetual need due to ongoing bac ter ial res istance.5 There is also a high rate of community acquired sepsis which usually presents to NICUs as outborn
or referral patients often requiring longer courses of antibiotics.6,7 Neonatal sepsis is diagnosed by clinical judgement,8 and laboratory tools [T LC, the C-reactive protein (CRP), the I:T ratio, procalcitonin and blood culture].9 A subpopulation of patients with neonatal sepsis consists of those with neutropenia.
Tertiary care setting, inborn nursery, outborn
nursery and well-baby clinic of Department of Paediatrics, Govt.
Death rate increases if there is an increase in the number of outborn
(who were not born in the hospital) infants.
We excluded twins or higher-order infants, those for whom a histologic examination of the placenta was not performed, outborn
infants, and those with major structural or chromosomal abnormalities.
All neonates, either outborn
or inborn, who presented to the pediatric ward of the hospital were included in the study.
In 1979-1980, 30% of patients were outborn
, 25% in 1988-1989 and 20% in 2008.
neonates tend to be less mature and more ill than their inborn counterparts.
Hence, the objectives of this study were, (i) to describe morbidity pattern among admitted neonates; (ii) to find out the association between various biological factors and neonatal morbidity; and (iii) to study various factors related to referral among outborn
neonates that may determine the survival.
All of the patients were outborn
, referred to the unit from first, second, or third level nurseries because of diagnosed pathological symptoms, or they were admitted from home through the hospital emergency unit due to sudden illness.
The full model was developed after controlling for birth weight, teenage mother, sex, Apgar score at 5 minutes, chorioamnionitis, outborn
status, completed antenatal steroids, small for gestational age, Caesarean birth and severity of illness group based on Score of Neonatal Acute Physiology-II (SNAP-II).