Vol. 7, Issue 1, Part B (2025)

Background: Neonatal emergencies significantly contribute to morbidity and mortality in developing countries. This study aimed to analyze neonatal emergencies presenting to the Emergency Department (ED) of a tertiary care hospital in Pakistan and assess resource utilization.

Methods: A retrospective cross-sectional study was conducted reviewing medical charts of 1,403 neonates who visited the ED at Aga Khan Hospital during 2019. Data collected included demographics, presenting complaints, clinical characteristics, resource utilization, and outcomes.

Results: Of 1,403 neonates, 463 (33%) were critically ill and 940 (67%) were non-critical. Critical neonates were younger (median 5 vs 6 days), had lower birth weight (median 2.7 vs 2.8 kg), and were more likely to be premature (<37 weeks’ gestation). The most common diagnoses were neonatal jaundice (41.6%) and presumed sepsis (20%). Critical neonates required more interventions including mechanical ventilation (20%), inotropic support (19%), and had higher NICU admission rates (68%). Mortality was significantly higher in the critical group (5% vs 0%). Factors associated with critical illness included prematurity (OR 3.23, 95% CI 1.92-5.43), breathing difficulty (OR 2.65, 95% CI 1.77-3.95), and congenital anomalies (OR 1.86, 95% CI 1.3-2.65).

Conclusion: This study identifies key characteristics and risk factors of critically ill neonates presenting to the ED in a low-middle income country setting. The findings emphasize the need for early identification of at-risk neonates, improved prenatal care, and enhanced emergency care infrastructure to optimize outcomes in this vulnerable population.