Perinatal mortality rate (PNMR) is the most sensitive index of the quality of obstetrical and neonatal services in a particular center, community or country. In developed countries the PNMR has fallen to 10-20 per thousand birth as compared to 60-120 per thousand births in india(1). In the Department of Pediatrics and Obstetrics of Indira Gandhi Medical College, Shimla, a total of 4575 consecutive births were studied over a two year period to assess the PNMR and neonatal mortality rate (NMR).

The PNMR was 50.4 per thousand births while extended PNMR was 57.3 per thousand births. Perinatal hypoxia (35.5%), immaturity (11.5%), infections (9.9%), congenital malformations (8.1%) and hypothermia (3.4%) accounted for most perinatal deaths. Low birth weight (LBW) babies contributed to 87% of all perinatal deaths. NMR was 32.5 per thousand live births and nearly 83% of neonatal deaths were contributed by LBW babies. The ranking of causes of neonatal deaths were birth asphyxia (31.3%), infections (28.5%), immaturity (15.3%), hypothermia (6.3%) and congenital malformations (4.9%). The neonatal mortality among LBW and preterm < 37 week) babies was 9.4% and 19.7%, respectively, being 10 to 20 times higher than normal birth weight and term babies, respectively [p < 0.001].

The PNMR of 50.4 per thousand in present study is in conformity with other Indian hospital based studies (38.5 to 89.5 per thousand births) but higher than the western figures of 10-20 per thousand births(l-3). In our Institution, over the last fifteen years the PNMR has declined from 75.4 per thousand births in 1980 to 50.4 per thousand births in the present study(4). As has been observed by others, perinatal hypoxia, infections, immaturity, congenital malformations contributed to most of the perinatal and neonatal deaths(2,3,5,6). However, hypothermia contributed to 6.3% of the neonatal deaths which is higher than an earlier report of 1.4%(7). The high mortality due to hypothermia may be explained due to cold weather conditions all around the year in this part of the country, despite of the fact that facilities to prevent hypothermia are available in the newborn unit. However, efforts are being made to reduce mortality due to hypothermia by improving warming facilities in the labor room, operation theatres and during transportation of sick newborns to nursery.

Lalita Behl,
Neelam Grover,
Shyam L. Kaushik,
Department of Pediatrics,
Indira Gandhi Medical College,
Shimla 171 001,
India.