Neonatal mortality among preterm infants admitted to neonatal intensive care units in India and Pakistan: A prospective study

Objective: To explore potential reasons for differences in preterm neonatal mortality in neonatal intensive care units (NICUs) in India and Pakistan.Design: A prospective observational study, the Project to Understand and Research Stillbirth and Preterms in Southeast Asia (PURPOSe) was conducted July 2018 to February 2020.Setting: Three hospitals in Davangere, India, and a large public hospital in Karachi, Pakistan.Population: Of a total of 3,202 preterm infants enrolled, 1,512 were admitted to a study NICU.Methods: We collected data for neonates, including length of stay, diagnoses, and diagnostic tests.Main outcome measures: Neonatal mortality, tests performed, diagnoses ascertained.Results: For infants of equivalent weights and gestational ages, neonatal mortality in Pakistan was twice that in the Indian NICU. The mean newborn length of stay in Pakistan was 2 days compared with 10 days for India. Fewer diagnostics and other investigations were used to determine neonatal condition or guide treatment in the Pakistani NICU. Because of limited information from testing in Pakistan concerning clinical respiratory distress, respiratory distress syndrome appeared to be over-diagnosed, whereas other conditions including pneumonia, sepsis, necrotising entercolitis and intraventricular haemorrhage were rarely diagnosed.Conclusion: In the Pakistani site, the limited resources available to the NICU appeared related to a shorter length of stay and decreased diagnostic testing, likely ex-plaining the higher mortality. With improved care, reduction in mortality among preterm neonates should be achievable.