Its NICU has a neonatal mortality rate of 22 against the national figure of 39

Sree Avittam Tirunal (SAT) Hospital, one of the largest tertiary-level public sector maternal and child care hospitals in South India, has managed to maintain a neonatal mortality rate (NMR) that is much lower than the national average this year too, despite the fact that almost 30 per cent of the babies born here are high-risk newborns with complex problems.

The annual report released by the hospital for 2012 indicates that its neonatal intensive care unit (NICU) maintained a NMR of 22 (per 1,000 live births), lower than the NMR in 2011, which was 23. The national NMR is 39.

“The national NMR is based on all live births across the country, a majority of which are not necessarily high-risk newborns. Our monthly NICU admissions are over 200 and all are high-risk cases,” says K.E. Elizabeth, superintendent of the hospital.

She says that given the limitations within which the hospital functions – its in-born nursery has 18 beds, while at any time, it has to accommodate 30 to 40 babies – the NMR it has achieved is remarkable.

The hospital handles nearly 800 to 900 deliveries a month, and nearly 35 to 40 per cent of the cases are high-risk pregnancies referred from peripheral hospital or neighbouring districts in Tamil Nadu.

Most babies have complex problems such as prematurity, respiratory distress, neonatal jaundice, birth asphyxia, infections, and a variety of congenital disorders.

In 2012, there were 9,278 live births at the hospital, of which 28.2 per cent or 2,619 babies had to be admitted to the in-born nursery (IBN). The out-born nursery (OBN) admissions (high-risk babies born in other hospitals and referred to SAT) last year numbered 1,794.

In 2011, the IBN admissions numbered 2,643, while the OBN admissions numbered 1,613.

Despite the increase in total admissions in 2012, the hospital managed to lower its IBN death rate to 7.86 per cent, against the 8.21 per cent in 2011. The OBN death rate too was brought down to 8.2 per cent in 2012 from 9.6 per cent in 2011.

Dr. Elizabeth says the incidence of sepsis, a fatal condition for newborns, was just 0.5 per cent among all live births in the hospital last year.

The leading causes of deaths of babies here were complications of prematurity, respiratory distress, and Hyaline Membrane Disease requiring surfactant therapy. Nearly 22 per cent of the babies born in the hospital are preterm babies.

Surfactant therapy

Respiratory failure following surfactant deficiency is a major cause of morbidity and mortality in low birth weight or preterm babies. Surfactant replacement therapy is thus essential for reducing the NMR.

“Surfactant therapy is quite expensive as the drug costs about Rs.20,000 a dose and it could not be offered free of cost. Since January, we have been able to provide this drug to babies free of cost,” Dr. Elizabeth says.