Patil PN, Khan Z, Patel M, Mahyavanshi DK. Patterns of preterm admission, morbidity, and mortality in a tribal-district neonatal intensive care unit: A retrospective cohort study. World J Clin Pediatr 2026; 15(3): 118603 [DOI: 10.5409/wjcp.118603]
Corresponding Author of This Article
Pushparaj Nilkanth Patil, MD, Associate Professor, Department of Pediatrics, NAMO Medical Education and Research Institute, Sayali Road, Silvassa 396230, India. piyush.patil05@gmail.com
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Pediatrics
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Patil PN, Khan Z, Patel M, Mahyavanshi DK. Patterns of preterm admission, morbidity, and mortality in a tribal-district neonatal intensive care unit: A retrospective cohort study. World J Clin Pediatr 2026; 15(3): 118603 [DOI: 10.5409/wjcp.118603]
World J Clin Pediatr. Sep 9, 2026; 15(3): 118603 Published online Sep 9, 2026. doi: 10.5409/wjcp.118603
Patterns of preterm admission, morbidity, and mortality in a tribal-district neonatal intensive care unit: A retrospective cohort study
Darshankumar K Mahyavanshi, Mitalikumari Patel, Zubair Khan, Pushparaj Nilkanth Patil
Pushparaj Nilkanth Patil, Zubair Khan, Department of Pediatrics, NAMO Medical Education and Research Institute, Silvassa 396230, India
Mitalikumari Patel, Darshankumar K Mahyavanshi, Department of Community Medicine, NAMO Medical Education and Research Institute, Silvassa 396230, India
Author contributions: Patil PN conceptualized and designed the study; Mahyavanshi DK and Patel M conducted data collection and participant recruitment; Mahyavanshi DK and Patil PN performed data analysis and interpretation; Patil PN and Khan Z drafted the manuscript; and all authors approved the final version for submission.
AI contribution statement: No AI tools were used for drafting or generating content. The manuscript was developed entirely by the authors. Data analysis was carried out by a qualified biostatistician. No AI tools were used for this. All study design, data interpretation, and analysis were performed by the authors. The authors created all figures and tables using MS Word.
Institutional review board statement: The study protocol was reviewed and approved by the Institutional Ethics Committee of NAMO Medical Education and Research Institute-NAMO Hospital (Approval No. NAMOMERI-SVBCH/IEC/2023-24/227; dated August 28, 2025).
Informed consent statement: Informed consent was waived by the Institutional Ethics Committee due to the retrospective nature of the study and use of anonymized medical records.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The anonymized dataset and statistical code are available from the corresponding author upon reasonable request. Individual consent for data sharing was waived due to the retrospective design, and all data have been de-identified. No additional data are available.
Corresponding author: Pushparaj Nilkanth Patil, MD, Associate Professor, Department of Pediatrics, NAMO Medical Education and Research Institute, Sayali Road, Silvassa 396230, India. piyush.patil05@gmail.com
Received: January 7, 2026 Revised: February 11, 2026 Accepted: March 17, 2026 Published online: September 9, 2026 Processing time: 206 Days and 23.5 Hours
Abstract
BACKGROUND
Preterm birth remains the leading cause of neonatal morbidity and mortality worldwide. Data from tribal-district neonatal intensive care units (NICUs) in India are scarce, despite these populations bearing a disproportionate burden of adverse perinatal outcomes.
AIM
To evaluate morbidity patterns and identify predictors of mortality among preterm neonates in a tribal-district NICU.
METHODS
The present retrospective cohort study included total 1438 preterm neonates admitted between January 2022 and December 2024 to the tribal-district NICU. Clinical data were extracted from medical records. Mortality was analyzed by gestational age. Multivariable logistic regression, with multiple imputation for missing data, was used to identify independent predictors of in-hospital mortality.
RESULTS
Mortality demonstrated a steep inverse gradient with gestational age, decreasing from 49% among extremely preterm neonates to 4.6% among late preterm infants. The most common morbidities were respiratory distress syndrome (42%-55%) and neonatal sepsis (32%-45%). Early continuous positive airway pressure (CPAP) initiation (< 1 hour) was associated with reduced need for mechanical ventilation (P < 0.001). In multivariable analysis, increasing gestational age [adjusted odd ratios (AOR): 0.82 per week; 95%CI: 0.75-0.89], higher birth weight (AOR: 0.93 per 100 g; 95%CI: 0.89-0.97), culture-positive sepsis (AOR: 3.41; 95%CI: 1.98-5.89), delayed CPAP initiation (AOR: 1.94; 95%CI: 1.15-3.28), and outborn status (AOR: 1.67; 95%CI: 1.01-2.74) were independently associated with mortality. Discharge against medical advice rates remained high (9%-11%).
CONCLUSION
Lower gestational age, lower birth weight, infection, and delayed respiratory stabilization are associated with mortality. Strengthening early neonatal care may improve survival in tribal settings.
Core Tip: Preterm neonates admitted to neonatal intensive care units in tribal districts face a substantial burden of morbidity and mortality. This 3-year retrospective cohort study demonstrates a clear inverse relationship between gestational age, birth weight, and survival. Culture-positive sepsis, delayed initiation of continuous positive airway pressure, and outborn status were independently associated with mortality. Strengthening early respiratory stabilization, improving antenatal care and infection control, and addressing socioeconomic barriers such as discharge against medical advice are essential to advancing neonatal survival and health equity in underserved tribal regions.
