Reasons for admission, causes of death and costs of admission to a tertiary referral neonatal unit in India.

The aim of this study was to determine the reasons for admission, charges made, and causes of death in a tertiary referral neonatal unit in India. Records of the Christian Medical College Hospital, Vellore, Tamil Nadu, India, were reviewed for the period 1 January-31 December 1992. The principal cause of death was ascertained with reference to predetermined diagnostic criteria. There were 5592 livebirths, 138 stillbirths and 1809 admissions to the nurseries (1603 inborn, 206 outborn). Suspected sepsis accounted for 24 per cent of admissions, 14 per cent required preterm care, 13 per cent phototherapy and 8 per cent were full term low birth weight babies admitted for observation. There were 87 early neonatal deaths, 4 per cent (49) of inborn admissions and 18 per cent (38) of outborn admissions. A further 11 babies were discharged to receive terminal care at home and nine were discharged, critically ill, against medical advice. Causes of death were respiratory problems of prematurity (49 per cent), lethal congenital malformations (22 per cent), complications of asphyxia (20 per cent) and sepsis (5 per cent). The median duration of nursery care was 2 days (range 1-21) and the median charge made Rs 714 (range 122-5036). Although the pattern of admissions and deaths still reflects the substantial problems of suspected sepsis, asphyxia, and congenital malformations, problems of immaturity may be on the increase. We caution against hospital-based statistics that fail to take account of babies who are discharged alive in the knowledge that death is imminent. Considered strategies for the provision or selective provision, of neonatal care in India, are called for.