Med. Forum, Vol. 31, No.

9 115 September, 2020

Causes of Admission and Outcome

Original Article Causes of
Admission and
Among Newborns in Neonatology Ward of Outcome Among
Newborns
Mardan Medical Complex Mardan Khyber
Pakhtunkhwa, Pakistan
Kiramat Ullah, Mohammad Fazil, Qasim Khan and Sumera Akram
ABSTRACT
Objective: To study the main causes of admission and outcome among newborns in Nursery ward of Mardan
Medical Complex Mardan Khyber Pakhtunkhwa, Pakistan.
Study Design: Retrospective descriptive study
Place and Duration of Study: This study was conducted at the Mardan Medical Complex Neonatology Unit from
January 2019 to December 2019.
Materials and Methods: Data of all the neonatal admissions in the nursery unit was recorded in Mardan Medical
Complex neonatology unit and analyzed for age, sex, the reason for admission, duration of hospital stay and the final
outcome of these patients.
Results: A total of 4759 neonates were admitted to the neonatal unit Mardan Medical Complex. Among them, males
were 2285 (48.07%) and females were 2474 (51.99%). The average length of stay was 6.2 days (SD 6 days).
According to the data neonatal sepsis represent about 30.95% of all admission in 2019. Neonatal jaundice accounted
for 15.17%. Birth asphyxia (15.67%), preterm constitute 10.29%, meconium aspiration syndrome was 5.77%,
hypoxic ischemic encephalopathy 4.60%, respiratory distress syndrome 9.81%, hypoglycemia1.32%, hypothermia
2.64%, neonatal seizure 1.22%, tetanus 0.19% and others constitute 2.33% of the admitted cases. Among total
admissions 3801 (79.86%) patient were discharged with a satisfactory condition while 958 (20.13%) patient died.
The highest number of admitted patient was observed in the month of July 2019 while highest death rate was
observed in month of august2019.
Conclusion: This study conclude that the most common causes of the neonatal admission were neonatal sepsis,
neonatal jaundice (NNJ), preterm, meconium aspiration syndrome, birth asphyxia, respiratory distress syndrome,
hypoxic ischemic encephalopathy, hypoglycemia, hypothermia, neonatal seizure and tetanus. The commonest cause
for the mortality was neonatal sepsis, birth asphyxia and neonatal jaundice. There is need of increased awareness in
health workers who conduct deliveries at home or in home for time referral to tertiary level hospital.
Key Words: Newborns; Admission; Outcome; Awareness
Citation of article: Kiramat Ullah, Fazil M, Khan Q, Akram S. Causes of Admission and Outcome Among
Newborns in Neonatology Ward of Mardan Medical Complex Mardan Khyber Pakhtunkhwa, Pakistan. Med
Forum 2020;31(9):115-119.

INTRODUCTION children in world is during perinatal and neonatal

period. The contribution of neonatal mortality ranged
As neonate face a lot of problems during perinatal from 40-70% of infant mortality. Two-third of the
period hence it is recognized as the most dangerous infant death in India is due to neonatal death. In the first
period1. The high vulnerable time for infant is the two days of life about 45% of death occur3. Birth
neonatal period because in neonatal period the child are asphyxia, sepsis, congenital abnormalities, prematurity,
completing many physiological adjustments that are low birth weight and surgical problems are the major
required for extra-uterine existence2. In developing causes for neonatal mortality in India. The mortality
countries 98% of the death in total death of nine million rate can be decreased by improving the neonatal care4.
Prematurity and malformation are the major cause of
Children Ward MMC/BKMC, Mardan
death in advanced countries while in less developed
Correspondence: Dr. Kiramat Ullah, Assistant Professor, countries the most important causes of neonatal death
Children Ward MMC/BKMC, Mardan are infections (29%), prematurity (29%), asphyxia
Contact No: 03349155923 (23%), congenital malformations (8%), and other
Email: [email protected] (11%)2. during antepartum or intrapartum
approximately half of the perinatal death occur while
Received: April, 2020
the rest of the death occur in first week of life in most
Accepted: June, 2020
Printed: September, 2020 developing nation state. In developing countries the
perinatal and neonatal death occur due to many factors
Med. Forum, Vol. 31, No. 9 116 September, 2020
including poor maternal health, adverse social criteria was Individual recordings in the register which
conditions, and inadequate care during pregnancy, were not properly filled were omitted.
delivery, and the immediate postpartum period3. Data collection technique: The data source for our
Therefor it is important to measure and monitor the study was the neonatal unit registers at Mardan Medical
perinatal morbidity and mortality to develop different complex Mardan Khyber Pakhtunkhwa, Pakistan which
strategies to improve the perinatal heath care at various comprised of neonate information recorded at
level. The instability of life during this period, of all the admission such as date of admission, age, weight of the
death occurring, is due to high neonatal mortality and child, status at birth, diagnosis, treatments given,
morbidity rate. During the first year of life in the United outcome status and records of maternal information like
States, two-thirds are in a birth condition. The death parity, antenatal follow up, gestational age and mode of
rate for the first year is not comparable by the Rate in delivery. All these data were collected using a uniform
any other lifetime to seventh decade 2,4. extraction format developed by taking in to account all
There are many causes of newborn admission to the relevant variables in the standard neonatal unit
neonatal unit as high-risk infants other than prematurity registers. Mostly clinical sign and symptoms were the
as patients with genetic disorder, blood group base for diagnosis or based on WHO definition for pre-
sensitization, multiple gestation, intrauterine growth maturity (live born Neonates delivered before 37 weeks
restriction, neonatal jaundice,mother illness such as from 1st day of last menstrual period(LMP)8. Serum
hypertension, diabetes mellitus and some drug bilirubin along with G6PD estimation was done for the
administration during pregnancy, respiratory distress, diagnosis of neonatal jaundice. Clinical grounds
premature rupture of membrane, bodyweight either together with the positive blood culture and CSF
Less than 2.500 or greater than 4.000g or birth less than examination was used for the diagnosis of the neonatal
37 or more than 42 weeks of gestation and congenital sepsis. Samat-staging was base for the clinical diagnose
malformation2. Number of studies have been done on of birth asphyxia.
the causes of admission of newborn in which majority
of admission is due to low birth weight followed by RESULTS
neonatal infection 5,6. The important causes for the
The total number of babies admitted to neonatal unit of
increased mortality in newborn admission is due to
Mardan Medical complex Mardan KPK from fist
prematurity followed by birth asphyxia than neonatal
January 2019 to 31st December 2019 was 4759 babies
infection7. The high mortality rate of neonate in a
Among them, males were 2285 (48.07%) and females
country is reflected by many factors including poor
were 2474 (51.99%). (Table 1) The average length of
availability of quality and quantity of set-up and proper
stay was 6 days (SD 6 days). (Table 2) Neonatal sepsis
utilization of neonatal care of that country. To define
was the main cause of admission to neonatal unit. Out
the causes for admission and outcomes among newborn
of 4759 admitted newborn 1470 newborn (30.95%)
in Pakistan a very limited data is available. We
were admitted due to neonatal sepsis. Neonatal sepsis
therefore sought to conduct the study in neonatal unit of
was followed by Birth asphyxia (15.67), Neonatal
Mardan Medical complex Mardan Khyber
jaundice accounted for 15.17%), preterm constitute
Pakhtunkhwa, Pakistan to determine the causes and
10.29%, respiratory distress syndrome (9.81%),
outcomes of the admitted newborn. This study will help
meconium aspiration syndrome was 5.77%, hypoxic
us in making guidelines and will also prove very
ischemic encephalopathy 4.60%, hypothermia 2.64%,
fruitful to local health pediatrician and researchers in
hypoglycemia 1.32%, neonatal seizure 1.22%,
minimizing mortalities and morbidities associated with
tetanus 0.19% and others constitute 2.33% of the total
the different diseases among newborn patient. This
admitted cases. (Table 3) Among total 4759 admitted
study will be helpful in finding all the gaps in the
neonate 3801 (79.86%) patient were discharged to their
required infrastructure of neonatal unit of Mardan
home with a satisfactory condition while 958 (20.13%)
Medical complex Mardan Khyber Pakhtunkhwa,
patient expired. (Figure 1) Those among the expired
Pakistan
patients 958 (20.13%), the major causes of death was
MATERIALS AND METHODS neonatal sepsis that constitute 218 patient (22.73%).
The other causes of death followed by neonatal sepsis
This study was done at a neonatal unit of Mardan were preterm constitute 22.21%, Birth asphyxia
Medical complex Mardan Khyber Pakhtunkhwa, (18.35%), respiratory distress syndrome (14.28%),
Pakistan. The study was conducted from 1st January meconium aspiration syndrome was 7.92%, hypoxic
2019 to 31st December 2019. A hospital based ischemic encephalopathy 6.04%, Neonatal jaundice
retrospective study was 4759 neonates admitted in the accounted for 4.06%, hypothermia 0%, hypoglycemia
neonatal unit of Mardan Medical complex Mardan 0% neonatal seizure 0%, tetanus 0.93% and others
Khyber Pakhtunkhwa, Pakistan. constitute 3.33% of the total expired cases. (Table 4).
Inclusion Criteria was all newborns with available data
admitted in the Neonatal Unit while the Exclusion
Med. Forum, Vol. 31, No. 9 117 September, 2020
Table No.1: The total number of babies admitted
gender wise to the neonatal unit in Mardan Medical
Complex
Male Female Total
Total No 2285 2474 4759
percentage (48.07%) (51.99%) 100%
Table No.2: Length of stay in the neonatal unit in
Mardan Medical Complex
No. Max. Min. Range Mean Standard Variance
deviation
4759 31 1 30 6.22, 6.0 36.0
Figure No.1: Outcome of admissions to the neonatal
Table No.3: Causes of admissions to the neonatal unit in Mardan Medical Complex
unit in Mardan Medical Complex
Causes of admission Frequency percentage DISCUSSION
Neonatal sepsis 1473 30.95% This study was done to find out the reason for newborn
Preterm 490 10.29% admission and outcome of the causes in children ward
Birth asphyxia 746 15.67% of Mardan Medical Complex Khyber Pakhtunkhwa,
Respiratory distress 467 9.81% Pakistan from 1st January 2019 to 31st December
syndrome 2019. In many developing countries low birth weight is
Meconium aspiration 275 5.77% a majorhealthproblem8-11. The results obtained from
syndrome our study shows that the maximum number of newborn
Hypoxic ischemic 219 4.60% patient (30.95%) admitted was due to neonatal sepsis
encephalopathy and this in contrast to the other study done in Pakistan
Neonatal jaundice 722 15.17% by Fazlur R et al.7 in which the number of
Hypothermia 126 2.64% maximum patient admitted was due to low birth weight
Hypoglycemia 63 1.32% (41.20%). This is also in contrast to another study done
Neonatal seizure 58 1.22% by Parkash J et al6 in which the number of maximum
Netanus 9 0.19% patient admitted was also due to low birth weight
Others 111 2.33% (55.4%). In developing countries neonatal infection are
Total 4759 100% the major cause for neonatal morbidity and neonatal
mortality12.The percentage of neonatal sepsis
Table No.4: Disease wise mortality pattern among (30.95%) in our study is comparable to the study done
neonates admitted to Mardan Medical Complex by Fazlur R et al.7 in which neonatal sepsis constitute
Causes of Frequency Death %age 26.03% while lower than another study done in
admission (N) Karachi by Parkash J et al (45.21%)5, and less than the
Neonatal sepsis 1473 218 22.73% study done by M Hoque et al. (21.0%)14. The major
Preterm 490 213 22.21% factor for the neonatal infection is the home based
Birth asphyxia 746 176 18.35% delivery done by traditional birth attendant under un-
Respiratory 467 distress 137 14.28% hygienic condition. Additionally, in our study the
syndrome number of cases of birth asphyxia is 15.67% which is
Meconium 275 76 7.92% in accordance to the study done by Fazlur R et al.
aspiration (16.52%)6, while higher than Raghvendra N (12%)18
syndrome and lower than M Hoque et al. (38.2%)14. Use of un-
Hypoxic ischemic 219 58 6.04% sterile delivery practices and poor obstetric care were
encephalopathy the main predisposing factors for neonatal infection.
Neonatal jaundice 722 39 4.06% Birth asphyxia and neonatal jaundice are next main
Hypothermia 126 00 00% causes of newborn admission in our study that
Hypoglycemia 63 00 00% constitute 15.67%, 15.17% correspondingly. Birth
Neonatal seizure 58 00 00% asphyxia result of our study 15.67% is comparable to a
Tetanus 09 9 0.93% study done by Fazlur R et al.7 (16.52%)6 and 18.85% in
Others 111 32 3.33% a study done by Parkash J et al6. While birth asphyxia
Total 4759 959 100% in Rawalpindi is reported 31%15.
Med. Forum, Vol. 31, No. 9 118 September, 2020
Neonatal jaundice constitute 15.17% of the admitted monitoring, referred on time and resuscitation at the
newborn which shows a lower value then the other time of birth. There is need of increased awareness in
study done by Fazlur R et al (20%)6. From Lahore health workers who conduct deliveries at private clinic
neonatal jaundice was reported 8.33%16, and from or in home for time referral to tertiary level hospital.
Bangladesh it was reported 30.71%16.
Author’s Contribution:
According to our study 3801 (79.86%) patient were
Concept & Design of Study: Kiramat Ullah
discharged satisfactorily to their home after proper
Drafting: Mohammad Fazil
treatment. This high percentage of discharge newborn
Data Analysis: Qasim Khan, Sumera
patient may be due to better awareness amongst
Akram
workers of health and all the potential management in
Revisiting Critically: Kiramat Ullah,
spite of having limited resources. According to our
Mohammad Fazil
study the neonatal mortality was 20.13% which is
Final Approval of version: Kiramat Ullah
higher than other study done by Fazlur R et al.7 in
which 14.87% mortality was recorded while our Conflict of Interest: The study has no conflict of
mortality rate was lower than another study done by interest to declare by any author.
Parkash J et al6 in which 25.85% mortality was
recorded. Another study was done in Lahore in which a REFERENCES
very high mortality rate 34% was recoded18 which is
1. World Health Organization. World Health Report
very high than our study. The mortality rate of the
2005- Make Every Mother and Child Count.
neonate depends upon mainly the critical condition of
Geneva: World Health Organization 2005.
the neonate at the time of admission19. According to our
2. Carlo W. Prematurity and Intrauterine Growth
study the major cause of the neonatal death was
Restriction. Kliegman R. Nelson textbook of
neonatal sepsis which is 22.73% followed by birth
pediatrics. 20th ed. Canada: Elsevier; 2016.p.
asphyxia which constitute 22.21%. our these results of
821-829
neonatal sepsis and birth asphyxia are in accordance
3. United nations children's fund; 2008. Available
with the study done by Fazlur R et al.7 which recorded
at: https://nrhm.gujarat.gov.in/images/pdf/unice
14.1% and 21% respectively. According to the study
_scnu_toolkit.pdf.
done by Parkash J et al6 in Karachi, the reported
4. Lawn JE, Cousens S, Zupan J. 4 million neonatal
mortality rate due to neonatal infection is much higher
deaths: When? Where? Why? Lancet 2005;365:
(46.44%) than our study while same results were
891-900.
figured in a study from India20. Furthermore, in our
5. Yemen Ministry of health, Yemen national
study the average length of stay of neonate admitted to
health, and demographic Survey 2013, May2014.
our neonate unit was 6.2 days which is in accordance to
6. Parkash J, Das N. Pattern of admissions to a
a study done by M Hoque et al.14 in which an average
neonatal Unit. J Coll Physicians Surg Pak
stay of 9.2 days was reported. Immediate intervention
2005;15(6):341-4.
and early recognition of neonatal problems led to rare
7. Rahim F, Jan A, et al. Pattern and outcome of
complication and sequelae. In order to get better
admissions to the neonatal unit of Khyber
outcomes, it is necessary to do thorough examination of
Teaching Hospital, Peshawar. Pak J Med Sci
neonate just after birth for early recognition and timely
2007;23(2):249- 253.
referral of surgical condition.
8. Haneef SM, Tabssum S, Qureshi Z, llahi S.
CONCLUSION Pattern of neonatal disease, Pak Paediatr J
1985;9:42-50.
According to our study the number of admitted neonate 9. Abbasi KA. Neonatal disease profilein Larkana
due to neonatal sepsis are comparatively high as before and after establishment of neonatal ward. J
compared to other causes of admission. The mortality Pak Med Assoc1995;45:235-6.
rate in our study was generally low but higher for the 10. Chishti AZ, Iqbal MA, Anjum A, Maqbool S.
neonate with neonatal sepsis. These results are in Risk factor analysis ofbirth asphyxia at the
accordance with the other studies from the developing children’s hospital, Lahore. Pak Padiatr J
countries. The death rate are avoidable significantly due 2002;26:47-53.
to postpartum, intrapartum and antenatal care. The 11. Wu Z, Viisainen K, Wans Y, Hemminki F.
major factor for the neonatal infections are the home Perinatal mortality in rural China: retrospective
based delivery done by traditional birth attendant under cohort study. BMJ 2003;327:1319-20.
un-hygienic condition. Use of un-sterile delivery 12. Rahman S, Hameed A, Roghani MT, Ullah Z.
practices and poor obstetric care are the main Multidrug resistant neonatal sepsis in Peshawar.
predisposing factors for neonatal infection. In order to Arch-Dis Child Fetal Neonatal Ed 2002;87:
reduce the high case morbidity and mortality it is F52-4.
mandatory to have antenatal and intrapartum
Med. Forum, Vol. 31, No. 9 119 September, 2020
13. Sallam AK, common causes of child mortality in websitehttp://www.oriongroup. net/orion/20
Sanaa, yemen-saudi Med J 2005; 26(7):112-5. Medical Journal Vol.6.
14. Hoque M, Haaq S, et al. causes of neonatal 18. Raghvendra Narayan, A study of the pattern of
admission and deaths at a rural hospital in admissions and outcome in a neonatal intensive
Kwazulu-Natal South Africa. South Afr J care unit at high altitude. Sri Lanka JChild Health
Epidemiol Infect 2011;26(1):26-9. 2012;41(2):79-81.
15. Tariq P, Kundi Z. Determinants of neonatal 19. Jamal M, Khan N. Neonatal morbidity and
mortality. J Pak Med Assoc 1999;49:56-60. mortality in high risk pregnancies. J Coll
16. Ejaz I, Khan HI, Baloch GR. Neonatal mortality Physician Surg Pak 2002;12:657-61.
reports from a tertiary hospital in Lahore/causes 20. Thora S, Awadhiya S, Chansoriya M, Kaul KK.
and outcome. Pak Paediatr J 2001;25:35-8. Perinatal and infant mortalityin urban slums
17. Islam MN. Situation of neonatal health in under IUCD scheme. Ind Paediatr1996;33:19-23.
Bangladesh orion 2000;6: Available at