title: Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India.
abstract: OBJECTIVE
  To evaluate impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India.
  
  
  METHODS
  Before-and-after intervention trial setting: limited resource teaching hospital;
  
  
  METHODS
  Before and after study.
  
  
  METHODS
  A package of simple interventions was evolved. The interventions included: rational admissions and early discharge, entrusting mothers in care-giving, enforcing asepsis routines, aggressive enteral feeding, abandoning unnecessary interventions, protocol-based management, rational antibiotics and training and empowerment of nurses.
  
  
  METHODS
  The categorical and continuous variables were compared with chi (2) and two-tailed tests, respectively.
  
  
  RESULTS
  Neonatal mortality rate declined significantly during the intervention period as compared to control period (20.3 versus 29.3 per 1000 live births; relative risk 0.69, 95% confidence interval (CI) 0.57 to 0.85). Most significant decline occurred in sepsis-related deaths. The survival of neonates with birth weight 1000 to 1499 improved over two folds (56.7% versus 24.5%, P<0.01). There was a significant decline in antibiotics use (635/878, 72.3% versus 299/897, 23.2%; P=0.00). The duration of stay in neonatal unit was decreased by a mean of 1.5 day (95% CI 0.9 to 2.8 days) after interventions.
  
  
  CONCLUSIONS
  Simple interventions can result in a significant decline in neonatal mortality in hospitals with limited resources. This package is likely to be effective in hospitals with a high proportion of the sepsis deaths.
authors.affiliation: Department of Pediatrics, AIIMS, Ansari Nagar, New Delhi, India. aranag@rediffmail.com
authors.forename: R
authors.initials: R
authors.lastname: Agarwal
authors.forename: K
authors.initials: K
authors.lastname: Agarwal
authors.forename: U
authors.initials: U
authors.lastname: Acharya
authors.forename: P
authors.initials: P
authors.lastname: Christina
authors.forename: V
authors.initials: V
authors.lastname: Sreenivas
authors.forename: S
authors.initials: S
authors.lastname: Seetaraman
mesh_terms: D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007194:India; D007224:Infant Care; D007226:Infant Mortality; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal