Care makes all the difference

KOCHI: Neonatal fatality (death occurring within 28 days of birth) contributes majorly to the death of infants less than a year old. The three major factors causing neonatal death are infections, prematurity & asphyxia Back in the day, babies born weighing less than 1.5kg, especially extreme preterm deliveries (born 28 weeks premature), either ended up not surviving, or had to cope with perpetual developmental problems and disabilities.

But thanks to advancement in technology and medicine, neonatology has evolved to be one of the most developed branches of modern medicine. Presently, even premature babies have a good shot at leading a normal life.

What caused the advancement?
The main reason for neonatal fatality is the immaturity of all organs of the body, leading to oxygen deprivation, infection and inability to maintain a normal body temperature. Developments in pre-birth, post-birth and during birth care make a major difference. A major turning point was the discovery that steroid injections administered on the mother before an expected pre-term delivery enhance the lung, brain and gut maturity of the baby. Since transporting a newborn to a facility right after birth may be hard due to infrastructural limitations, it is always better to transfer the mother to a hospital with advanced neonatal facilities. In fact, mothers are the best transport incubators in the world.

The availability of a skilled resuscitation team and equipment is also equally important. At the Neonatal intensive care unit, incubators or radiant warmers may be used for temperature maintenance. Surfactant may be used to treat respiratory issues related to immature lungs. CPAP machines and advanced monitors, improvements in cardiac assessment, nutritional management, infection control me a sur e s and developmental supportive care (begins when the baby is in mother’s womb), have contributed towards ensuring the best outcome.

The availability of bedside ultrasound and echo machines to screen the organ structure and functions, regular eye screening (ROP) to identify any visual disorders, thyroid and o the r me t ab o l i c screenings will also help us identify issues i n these babies and help take appropriate intervention measures. The author holds an MD in paediatrics and DM in neonatology, and is a consultant neonatologist at Lourdes Hospital, Kochi