“In most civic body-run hospitals in the city, almost 90% of the admitted neonates go home. Even babies who weighed around 750gm or 800gm at birth do well,” said Dr Jayashree Mondkar, former dean of BMC-run Sion Hospital and head of neonatology. She said the availability of warmers, pulmonary surfactant to treat respiratory distress in preterm babies, and nurses and doctors ensures that preterm babies get a fighting chance.
In private hospitals, which have more sophisticated machinery and round-the-clock nursing and doctor care, even the tiniest born between 23 weeks and 28 weeks of pregnancy – called extremely preterm babies – can survive. Consider Surya Hospital in Santacruz, where 66% of the 25-weekers born between 2012 and 2022 were discharged. “Children born at 23 weeks are extremely fragile, but we have had 30% survivorship in this group, too,” said neonatologist Dr Nandkishor Kabra.
Dr Kabra’s team is among the handful of centres in the country that have handled close to 1,000 extremely preterm babies in the last decade since neonatology emerged as a crucial specialty. “Between 2012 and 2022, we handled 895 preterm deliveries of 23-28 weeks. Around 70% of the children survived,” he said.
A research study published by AIIMS, New Delhi, in the peer-reviewed ‘Journal of Perinatology’ in January 2020, showed that 62% of the children born in the hospital between 2013 and 2018 at 28 weeks of pregnancy weighing 800gm had survived.
Dr Kabra said extremely premature babies survived at Surya Hospital because of a five-point formula that includes treating the pregnant woman who is on the verge of a preterm birth with specific medicines. “We need a trained neonatal team to attend the delivery, then provide breathing apparatus for the newborn immediately after birth,” he said. Care has to be taken to transfer the child to the NICU in the safest and warm manner. “In the NICU, nursing support and doctors should be provided round the clock. Strict infection control practices and use of human milk banking are the other keys,” he said.
The term premature describes babies born within 37 weeks of pregnancy; while those born between 28 weeks and 37 weeks of pregnancy have a good chance of survival, the challenge is in reviving those born between 23 weeks and 28 weeks. “Most of these children need close monitoring. They are born with a premature heart, lungs, kidneys and liver, and can’t breathe normally or handle normal nutrition. They need warmth, fluid intake should be right and infection control to survive,” said a doctor from a state government-run hospital.
Many government hospitals in rural settings such as Nanded, which is 70% rural as per the last Census of 2011, have inadequate medicines and staff. “Moreover, most of those taken in aren’t even neonatology specialists. In most places, paediatricians with some short-term fellowship in neonatology (as against DM neonatology) are employed,” said the doctor. Neonatology ICUs “exist” in many hospitals because it’s a prerequisite for running a medical college as per the National Medical Commission, but adequate care is not taken to equip them well.
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Dr Mondkar, however, refused to take a dim view of things. “In the last 12-15 years, the government has set up SNCUs (special newborn care units) across the country to ensure that premature babies get care,” she said.
According to an article in the latest issue of reputable medical journal The Lancet, almost a fifth of the world’s prematurely born babies are from India. It said over 34 lakh children were born prematurely in India in 2020. As prematurity increases the risk of disability or death, the government has set up SNCUs across the country. In Maharashtra, there were 29 SNCUs-which are a basic form of NICU called level 1 or 2 and can be managed by paediatricians instead of neonatologists. The last government review showed that over 50% of these SNCUs in Maharashtra had adequate nursing and doctor care.
“The need of the hour is more NICU beds,” said Dr Mondkar. The combination of medicines, machines and medical personnel can make all the difference.