Outborns or inborns: Clinical audit of the two intensive care units of Cairo University Hospital

ObjectiveTo document and analyze mortality and morbidity of infants admitted to the inborn and outborn neonatal intensive care units (NICUs) of Cairo University Hospital in Egypt.MethodsAdmission data, mode of delivery, gestational age, birth weight, diagnosis, period of stay and outcome (discharge or mortality) were retrospectively collected from January to December 2014 for infants admitted to either one of the two NICUs of Cairo University Hospital.ResultsA total of 1725 babies were admitted, 600 (34.8%) were inborn and 1125 (65.2%) were outborn. The majority of inborns admitted (72.5%) were preterms, compared to a majority of full term admitted outborns (67.7%) (p < 0.001). Neonatal hyperbilirubinemia represented the main cause of admission among outborns. Mortality was significantly higher among inborns (37.2%) than outborns (17.2%) (p < 0.0001). Prematurity was the leading cause of death among inborns (78.48%) and was significantly higher than in outborns (57.22%) (p < 0.001), but when compared to admission ratio, premature expiries (especially <28 weeks of gestation) were high in both NICUs (83.3% for inborns and 93.8% for outborns) with no statistical difference. Early neonatal deaths (during the first week of life) represented the majority of inborns and outborns expiries (75.34% and 63.92% respectively). Other causes of death among inborns included septicemia, hypoxic encephalopathy, and congenital malformations whilst among outborns, prematurity and congenital malformations showed the highest case fatality (46.6% and 47.2% respectively).ConclusionPrematurity is a significant cause of death in our NICUs. We speculate that improving survival requires regular recording and identification of our problems, with applying best practices using available and may be novel therapies.