Reasons Of Self-Discharge From Nursery Of A Tertiary Care Hospital.

BACKGROUND: Patients who leave against medical advice (LAMA) from a health facility is a recognized problem. In neonatology practice this issue is particularly sensitive as repercussions can be severe. The purpose of this study was to evaluate the factors influencing the decision of parents to self-discharge their babies against medical advice. METHODS: This descriptive case series was conducted in the Department of Neonatology, of the Children's Hospital and the Institute of Child Health, Lahore from January to June 2015. A total of 240 patients who self-discharged/were included. RESULTS: There were (59.6%) males and (40.4%) females with a male to female ratio of 2:1.5. Term babies constituted (67.9%), spontaneous vaginal deliveries (59.1%) and (55.8%) were delivered at hospitals. Seventy seven new-borns (32.2%) had birth asphyxia followed by neonatal sepsis (27.9%). Sixty four (64.5%) self-discharged within first week of admission. More babies were signed LAMA at week end (32.1%). Likewise (53.1%) babies were self- discharged during the night shift. Highest rate of LAMA was seen in parents belonging to low socioeconomic class (72.1%). Ninety eight parents (40.8%) had no formal education while well-educated parents were found to be 35 (14.6%). The commonest reason for selfdischarge was "perceived poor clinical outcome" (36.7%) by parents. CONCLUSIONS: Multiple factors were implicated in self-discharges from neonatology unit. Commonest reasons cited by parents were perception of poor clinical outcome and family pressures. Other contributory factors were male gender; those delivered vaginally, diagnosis of birth asphyxia, first week of life, at weekends and night hours. Low socioeconomic class and education of parents was also a major causative factor.

Detrimental Complications Of Meconium Aspiration Syndrome And Their Impact On Outcome.

BACKGROUND: Meconium aspiration syndrome (MAS) is respiratory distress in an infant born through meconium stained amniotic fluid (MSAF) whose signs cannot be otherwise explained. MAS is associated with different complications. Many studies have been conducted in developed world to find the outcome associated with MAS but data from developing countries is lacking. Present study was conducted to determine the impact of chemical pneumonitis, pulmonary hypertension (PHN) and air leak on outcome of new-borns with MAS. METHODS: This cross sectional descriptive study was conducted in a tertiary care Neonatology unit. The babies diagnosed with MAS were included in the study. All patients were monitored for development of complications. Outcome in terms of mortality was recorded. Outcome was compared by chisquare test and p-value <0.05 is considered significant. RESULTS: Seventy two babies were included in the study. Mean gestation was 37±0.56 weeks and birth weight was 2.87±0.49 kg. Male to female ratio was 1.57:1 and mean age of admission was 9.59±5.27 hours. Chemical pneumonitis, PHN and chemical pneumonitis with PHN were observed in 23.6%, 20.8% and 26.4% neonates respectively. Mortality rate was 19.44%. The mortality was highest in babies having chemical pneumonitis with PHN (p-value=0.013) followed by chemical pneumonitis group (p-value=0.02) and PHN group (p-value=0.032). CONCLUSIONS: About three fourth babies with MAS developed one or more complications. Mortality is significantly increases with the development of complications so as more the complications more is the mortality.