Net death rate of an institution is not the same as gross death rate. In Kota government hospital over 106 infants have died. If we want to do preventive Public Health audit, we need to compare the gross death rate with the institutional net death rate; both are different terms. 

Institutional net death rate does not consider deaths occurring in the first 48 hours of admission. It assumes that very sick and serious infants are unlikely to survive if they die within 48 hours of admission.

If the institutional death rate within 48 hours of admission is high, efforts must be made in strengthening the Pre-Hospital infrastructure and care.

In a tertiary care hospital with referral of most serious case, about 43% deaths will take place in first 24 hours of life. Asphyxia and low birth weight are the main causes of death in early neonatal period, whereas sepsis had maximum contribution in deaths during late neonatal period.  Severe hypothermia, severe respiratory distress, admission within first 24 hours of life, absence of health personnel during transport and referral from any hospital have significant correlation with mortality.

In the present crisis at the JK lone Hospital in Kota more than 60% of the deaths have occurred within 48 hours of admission and cannot be there for accounted for the net death rate of the hospital.

The same indicates failure of Pre-hospital Primary Health Care and a need for strengthening the village level care, prehospital urgent care services and the need for auditing the prescribed home care and institutional deliveries.

Solution

1. To reduce the deaths occurring in first 48 hours also strengthen the pre-hospital neonatal care services
2. To control crude death rate (all deaths after admission) strengthen the hospital care with enough staff and beds. The occupancy of NICU should be 75-80% and not 300% as in the present case