{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T21:04:25Z","timestamp":1788469465546,"version":"build-2803163510"},"reference-count":10,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T00:00:00Z","timestamp":1689811200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To explore potential reasons for differences in preterm neonatal mortality in neonatal intensive care units (NICUs) in India and Pakistan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A prospective observational study, the Project to Understand and Research Stillbirth and Preterms in Southeast Asia (PURPOSe) was conducted July 2018 to February 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Three hospitals in Davangere, India, and a large public hospital in Karachi, Pakistan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Of a total of 3,202 preterm infants enrolled, 1,512 were admitted to a study NICU.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We collected data for neonates, including length of stay, diagnoses, and diagnostic tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Neonatal mortality, tests performed, diagnoses ascertained.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For infants of equivalent weights and gestational ages, neonatal mortality in Pakistan was twice that in the Indian NICU. The mean newborn length of stay in Pakistan was 2 days compared with 10 days for India. Fewer diagnostics and other investigations were used to determine neonatal condition or guide treatment in the Pakistani NICU. Because of limited information from testing in Pakistan concerning clinical respiratory distress, respiratory distress syndrome appeared to be over\u2010diagnosed, whereas other conditions including pneumonia, sepsis, necrotising entercolitis and intraventricular haemorrhage were rarely diagnosed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In the Pakistani site, the limited resources available to the NICU appeared related to a shorter length of stay and decreased diagnostic testing, likely explaining the higher mortality. With improved care, reduction in mortality among preterm neonates should be achievable.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17581","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T07:51:18Z","timestamp":1689839478000},"page":"68-75","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Neonatal mortality among preterm infants admitted to neonatal intensive care units in India and Pakistan: A prospective study"],"prefix":"10.1111","volume":"130","author":[{"given":"Sarah","family":"Saleem","sequence":"first","affiliation":[{"name":"Department of Community Health Sciences Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyam Sunder","family":"Tikmani","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivaprasad S.","family":"Goudar","sequence":"additional","affiliation":[{"name":"KLE Academy of Higher Education and Research's J N Medical College  Belagavi Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kay","family":"Hwang","sequence":"additional","affiliation":[{"name":"Social, Statistical and Environmental Health Sciences RTI International  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sangappa","family":"Dhaded","sequence":"additional","affiliation":[{"name":"KLE Academy of Higher Education and Research's J N Medical College  Belagavi Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gowder","family":"Guruprasad","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Bapuji Educational Association's J.J.M. Medical College  Davangere Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveen G.","family":"Nadig","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Bapuji Educational Association's J.J.M. Medical College  Davangere Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun B.","family":"Kusagur","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Bapuji Educational Association's J.J.M. Medical College  Davangere Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingaraja Gowda C.","family":"Patil","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Bapuji Educational Association's J.J.M. Medical College  Davangere Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. S.","family":"Siddartha","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Bapuji Educational Association's J.J.M. Medical College  Davangere Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Yogeshkumar","sequence":"additional","affiliation":[{"name":"KLE Academy of Higher Education and Research's J N Medical College  Belagavi Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8871-5072","authenticated-orcid":false,"given":"Manjunath S.","family":"Somannavar","sequence":"additional","affiliation":[{"name":"KLE Academy of Higher Education and Research's J N Medical College  Belagavi Karnataka India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Roujani","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mashal","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Paediatrics National Institute of Child Health  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmood","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Department of Paediatrics National Institute of Child Health  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Hanif","sequence":"additional","affiliation":[{"name":"Department of Paediatrics National Institute of Child Health  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla M.","family":"Bann","sequence":"additional","affiliation":[{"name":"Social, Statistical and Environmental Health Sciences RTI International  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8659-5444","authenticated-orcid":false,"given":"Elizabeth M.","family":"McClure","sequence":"additional","affiliation":[{"name":"Social, Statistical and Environmental Health Sciences RTI International  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Goldenberg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the PURPOSE Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,20]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"UNICEF.Neonatal mortality 2018. Data available from: Neonatal mortality\u2013UNICEF DATA [cited 2022 Jan 10]."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60820-4"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-020-01020-8"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-020-01023-5"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-018-0528-1"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16820"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-020-01001-x"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2019.03.020"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1179\/2046905515Y.0000000046"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31593-8"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.17581","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T01:44:17Z","timestamp":1708566257000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.17581"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,20]]},"references-count":10,"journal-issue":{"issue":"S3","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1111\/1471-0528.17581"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.17581","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,20]]},"assertion":[{"value":"2023-04-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}