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India's fight to improve neonatal care

It’s World Prematurity Day tomorrow. Anu Prabhakar talks to neonatologists and healthcare experts to learn why India still has a long way to go to save its babies

As Charles Darwin would probably agree, being born in India is more like a game called ‘survival of the fittest’. Consider the statistics: The number of babies who die before completing 28 days is 29 per 1,000 live births. The picture only gets grimmer while talking about premature babies. According to non-government organisation Save the Children’s 2012 report titled Born Too Soon: The Global Action Report on Pre-term Birth, India stood first in a list of countries that had the most number of deaths due to pre-term births.

World Prematurity day

Medical and healthcare experts point out that in a country bogged down by its multiple battles with diseases such as malaria, dengue and tuberculosis, preterm births (and deaths) rarely received the kind of attention it deserved until recently. They, however, remain hopeful. On September 18, while launching its new Indian Newborn Action Plan, the new government vowed to bring the number of neonatal deaths to a single digit by 2030.

Decoding a preterm birth
Although highly contested, a normal pregnancy is expected to last 40 weeks. Any baby of ‘less than 37 weeks gestational age’ is considered premature. Some babies are born as early as 24 weeks. “But thanks to technological advancements, we are able to save such children. But if a child is born earlier than that, then his/her chance of survival will depend on the kind of care s/he gets at the hospital and so on,” explains Dr KP Sanghvi, consultant neonatologist and pediatrician.

Premature and low birth weight infants share a  warmer at a hospital in Srinagar
Premature and low birth weight infants share a  warmer at a hospital in Srinagar. Pic courtesy/KIDROP

Reasons for a preterm labour and delivery are many — In vitro fertilisation (IVF) or assisted pregnancy is one of them. “In the case of IVF pregnancies, there are multiple births. While trying to accommodate more than one baby, the uterus stretches to its maximum before contracting, which is when the mother goes into labour,” elaborates Sanghvi. Lifestyle choices are also to blame. Dr Sudha Rao, professor and chief, Division of Neonatology, Wadia Hospital, points out that a working woman is unable to take time off from work until one month before her delivery. Physical stress in a city like Mumbai comes in all forms — like travelling by the local train, for instance. Medical researchers have also linked poor dental health to premature births, as bacteria from the expecting mother's mouth can, through blood, travel to the amniotic fluid in her womb. “Dental care and personal hygiene are very important,” agrees Dr Rao.

Caring for a preemie
“Eighty five per cent of neonatal deaths can be prevented,” explains Dr Nandkishor S Kabra, Director NICU at Surya Children’s Hospital. During the first year of the baby’s life, parents must be extra cautious as the child may get admitted repeatedly to the hospital for respiratory and other issues, adds the expert. A foetus receives the most important nutrients to fight infections from the mother during the last trimester of the pregnancy — something which a preterm baby misses out on. So micronutrients and complimentary feeds, coupled with regular immunisation check-ups are compulsory says Dr Sushma Malik of Nair Hospital. “The mother should breastfeed her baby. We ask the mother to give kangaroo care (or skin to skin contact) to her baby. To prevent infections, too many relatives and strangers should not be allowed to touch the baby. Also, as the baby cannot control his/her body temperature, he/she should always remain covered,” she adds.

The bigger picture
When Dr Anand Vinekar, founder and principal coordinator of the award-winning initiative Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP), ventured into rural Karnataka in 2007, he was moved by the sight of mothers with their tiny babies. He lists affordability, accessibility to sub specialty care and awareness as key issues when it comes to tackling the issue. “In India, over 3.5 million babies need to be screened for Retinopathy of prematurity (ROP) annually. Every three hours, two babies need treatment for ROP in this country if we extrapolate ROP and population data.

Babies who weigh than 2000 grams at birth should have their first ROP screening before they turn 30 days old,” explains Dr Vinekar. There is also a lack of infrastructural facilities in government hospitals. “Two to three babies share a bed or an incubator. There is a severe limitation of resources, an overload of patients and limited funding, although doctors do a excellent job,” he adds. There are other issues as well. Experts point out that while providing good quality healthcare to all is a major responsibility of the government in other countries, in India, private (and expensive) hospitals continue to dominate the scene.

Perhaps Kabra sums it up best. “As far as preventing neonatal deaths is concerned, we have a long way to go. But we are getting there.”

Tips to remember
>>
Babies who weigh less than 2000 grams at birth should have their first ROP screening before they turn 30 days old
>> Breastfeed the baby
>> Kangaroo care or skin-to-skin contact is the best way to nurture the baby
>> Avoid too many visitors, to prevent an infection

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