title: Variability in survival of very low birth weight neonates in hospitals of India.
abstract: This prospective cohort study was conducted to evaluate variability in mortality of very low birth weight (VLBW) neonates during their birth hospitalization in different hospitals of India. A liveborn neonate was eligible for inclusion in the study if it was born or admitted in a participating hospital between 1st January and 31st December 2012 and weighed 1500g or less at birth. Neonates were given clinical care as per standard protocols. Standardized neonatal mortality ratio (SNMR) was calculated as the ratio of the observed mortality to the expected mortality. Expected mortality rate for each unit was calculated by adjusting for various prognostic factors at the time of birth or admission in the participating unit. Among 1345 neonates [mean birth weight: 1168 ± 240g, median gestation: 30wk (IQR: 28-32)] enrolled in the study 199 (14.8%) died before hospital discharge. Although variation in inter-hospital SNMR was statistically insignificant (P 0.49), 95% CI of SNMR of most hospitals was broad reaching level of clinical significance on both sides of line of equivalence. This indicates the need to establish an ongoing quality-improvement collaborative network to identify and adopt clinical practices associated with decreased mortality.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Murki
authors.forename: Neeraj
authors.initials: N
authors.lastname: Kumar
authors.forename: Deepak
authors.initials: D
authors.lastname: Chawla
authors.forename: Anuradha
authors.initials: A
authors.lastname: Bansal
authors.forename: Ashish
authors.initials: A
authors.lastname: Mehta
authors.forename: Manish
authors.initials: M
authors.lastname: Shah
authors.forename: Swarnarekha
authors.initials: S
authors.lastname: Bhat
authors.forename: Suman
authors.initials: S
authors.lastname: Rao
authors.forename: Naveen
authors.initials: N
authors.lastname: Bajaj
authors.forename: Gurdev
authors.initials: G
authors.lastname: Chowdhary
authors.forename: Ashwani
authors.initials: A
authors.lastname: Singal
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kadam
authors.forename: Naveen
authors.initials: N
authors.lastname: Jain
authors.forename: T
authors.initials: T
authors.lastname: Baswaraj
authors.forename: Rhishikesh
authors.initials: R
authors.lastname: Thakre
mesh_terms: D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D015996:Survival Rate