Strategies which reduced sepsis-related neonatal mortality.

Singh M, Paul VK, Deorari AK, Ray D, Murali MV, Sundaram KR.

PIP: A marked reduction in neonatal mortality was achieved during 1986, which can be attributed
largely to the decline in the incidence of infections as a result of modification of a few of the
routine practices in the Intensive Care Nursery of the All India Institute of Medical Sciences
(AIIMS) in New Delhi. Over 80% of pregnant women attending the antenatal clinics of AIIMS have
1 or more perinatal high risk factors. All deliveries are performed by obstetricians, and each
neonate is managed at birth by 1 or more residents of the neonatology unit. Data on every
neonate is recorded on a specially designed case sheet.

Cause of neonatal death is classified according to the criteria of Wigglesworth. A monthly report of
the census and morbidity mortality data is recorded on a special proforma and discussed in a joint
meeting of the staff of the obstetrics and neonatology services. The information presented is based
on these monthly reports. A table shows the data on the live births in 1985 and 1986 and their
distribution according to birth weight. The total number of live births in the 2 years were nearly
the same. There was no significant difference in the neonatal population in different birth weight
groups. There were 66 neonatal deaths in 1985 but only 43 in 1986.

This significant decline in the neonatal mortality was attributable to reduction in the late neonatal
deaths. The neonatal mortality rate (per 1000 live births) dropped from 36.6 in 1985 to
23.9 in 1986. There was a decline in the neonatal mortality rate in birth weight groups
from 1001-2500 g. The reduction of deaths in the birth weight group of 1001-1500 g
was most pronounced. Neonatal mortality rate (per 1000 live births) dropped from
525.4 in 1985 to 377.7 in 1986 in this group.

The overall neonatal mortality rate in infants weighing 2500 g or less declined from 12.3 to 8.5%.
The difference in the proportion of deaths in relation to individual causes was significant only in the
case of sepsis. The decline in the sepsis-related neonatal mortality was a consequence of 2
factors: the incidence of neonatal sepsis declined from 38.2/1000 live births to
18.8/1000 live births; and a definite though less pronounced improvement occurred in
the case fatality rate -- 24.6% versus 17.7% in 1985 and 1986, respectively. The
significant decline in late neonatal deaths was largely attributed to the reduction in the sepsis-
related late neonatal deaths -- 16 versus 3. Sepsis ranked as number 2 as cause of neonatal
mortality in 1985; it ranked as number 4 in 1986.

Our current NMR is 18 per thousand live births