Crisis in the Cradle: 1 in 3 newborns referred out of district hospitals

Srinagar, Nov 22: The National Health Mission (NHM) in Jammu & Kashmir has ordered an audit of neonatal health services after new data revealed unusually high referral and "left against medical advice" (LAMA) rates across district-level Special Newborn Care Units (SNCUs) and Neonatal Intensive Care Units (NICUs).

In a communication (No. SHS/NHM/J&K/CH/14440, dated November 20, 2025), the Mission Director's office said that an ongoing assessment of SNCU and NICU performance for the 2025-26 financial year has found multiple facilities referring between 29% and 36% of admitted newborns to higher centres.

Officials said such levels are overburdening tertiary-care hospitals and increasing the risk of in-transit complications and avoidable delays.

"As per the analysis of SNCU and NICU performance for FY 2025-26, a significant proportion of newborns are being referred to higher centres or are shown as LAMA," the communication said. "In some districts, the referral rate is as high as 35%, which places an increased burden on tertiary NICUs and may lead to avoidable neonatal complications or deaths during transport."

Five districts show referral rates above 33% according to the annexure shared with all 33 SNCU/NICU facilities. The highest referral rates were recorded at SNCU DH Ramban - 36% followed by SNCU DH Kulgam - 34%; SNCU AH GMC Baramulla - 33%; SNCU CHC Kupwara - 33% and SNCU DH Reasi - 33%.

Officials said the figures suggest persistent gaps in case management, trained staff, or essential neonatal equipment at peripheral hospitals.

SNCUs in Anantnag (20%) and Handwara (21%) also showed elevated referral numbers despite higher admission volumes, further indicating reliance on tertiary-care centres for services that should be available at the district level.

While referral rates at the Union Territory's top NICUs remain low, these facilities are carrying the heaviest mortality burden due to the influx of critically ill infants from across J&K.

Three institutions alone reported nearly 700 neonatal deaths during the assessment period- NICU SMGS Hospital Jammu - 290 deaths; NICU Children's Hospital Bemina - 261 deaths and NICU LD Hospital Srinagar - 139 deaths.

Health officials said many of these newborns arrived after long-distance transfers from districts with limited neonatal care capacity.

The NHM has flagged a sharp uptick in LAMA incidents, with 387 cases recorded across SNCUs and NICUs.

SMGS Jammu reported the highest number of LAMA cases (148), followed by AH GMC Rajouri (105).

Officials say families often withdraw newborns from care due to financial pressures, prolonged treatment, or perceived lack of improvement.

The communication reminded districts that the newly established Paediatric Centre of Excellence (CoE) at SMGS Hospital Jammu, and another under development at Children's Hospital Bemina - are equipped to provide real-time tele-consultation and clinical guidance.

"Its effective utilisation can play a crucial role in improving case management at the district level and reducing unnecessary referrals," the NHM said.

District hospitals have been directed to conduct a comprehensive audit examining- causes of high referral and LAMA rates; case-management practices; availability and functionality of neonatal equipment; staffing and training gaps and systemic challenges affecting district-level newborn care.

Hospitals must submit findings and "actionable recommendations" to strengthen peripheral SNCUs/NICUs" at the earliest," the directive said.

Copies of the order were sent to the Health and Medical Education Department, Deputy Commissioners (DCs), Chief Medical Officers (CMO’s), Paediatric departments of all government medical colleges, and NHM divisional teams. The letter was signed by Dr Harjeet Rai, State Nodal Officer for the NHM, J&K.