Mumbai: Nirvaan, the boy born at 22 weeks of gestation at Surya Hospital in Santacruz, was discharged from the hospital on Sunday. The infant had left the neonatal intensive care unit (NICU) last week, after spending 132 days there.
The miraculous recovery of the infant, who now weighs 3.72 kg, as against the mere 610 grams at birth, has much to do with the state-of-the-art neonatal care he received, which many premature babies often fail to get.
Paediatrician Bhupendra Avasthi, director of Surya Hospital, says the key to good NICU care is to follow the protocol to the hilt. “There has to be a surveillance mechanism as well … We have one of the largest NICUs in the private sector, and also a very high survival rate,” Dr. Avasthi said.
In the last three years, six babies were born at 23 weeks in Surya Hospital, of which two survived; 40 of the 80 babies born at 24 weeks went home, while 67 of the 94 babies born at 25 weeks survived, as did 90 of the 110 babies born at 26 weeks. A full-term pregnancy goes up to 40 weeks.
Infection control
A large number of premature babies succumb to infection or sepsis, which occur because of lack of hand hygiene, unsterilised or under-sterilised equipment, and inadequate NICU cleaning techniques.
Signs of infection, like respiratory distress or fever, that occur within the first 48-72 hours are classified as early-onset infections generally passed on from the mother to the baby. But after this period, if the baby develops such signs, they are classified as late-onset infections acquired from the hospital.
“After handling a baby, a nurse or a doctor cannot touch another baby without cleaning their hands. We also train them to avoid unnecessarily leaning close to the infant,” said Dr. Avasthi.
According to Dr. Avasthi, they have one nurse for every two babies on ventilator support, and one per three babies who are not on ventilator support round-the-clock. The neonatology nursing staff plays a big role in immediately identifying an infant in distress. By constantly monitoring the babies, the nursing staff can promptly detect distress by change in colour, breathing difficulty, and by touching them to check if there is adequate warmth. The staff also monitors the functioning of warmers, incubators and ventilators.
Not without problems
The risk of physical and cognitive underdevelopment, however, cannot be ruled out in such infants. “We counsel parents in all such instances. For example, if babies born at 24 weeks have a 50% survival rate in our hospital, at least half of them may have problems varying from mild to severe,” said neonatologist Nandkishor Kabra.
He said the most common problem is cognition, in which some infants may have an intelligence quotient below 70, some may develop cerebral palsy, while a small number may have hearing and vision problems. Doctors say that when parents do not want to take such chances, they opt to not carry out aggressive treatment. In the private sector, NICU care for extremely pre-term babies can cost from ₹10 to 25 lakh.