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India has progressed a lot in neonatal care in the last decade

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On World Prematurity Day, Dr Tejo Pratap, Head of the Department, Neonatology, Fernandez Hospital in an interaction with Express Healthcare talks about premature birth in India

Recent studies have shown that immediate skin-to-skin contact with the mother or even the mother’s voice can provide benefits to a premature baby and help reduce pain. What are your views on that?

Immediate skin-to-skin contact in stable neonates has shown numerous benefits. Recent studies on initiation of immediate Kangaroo Mother Care (iKMC study published in NEJM) has shown to decrease mortality and improve breastfeeding rates along with other benefits.

We as an organisation advocate “Zero separation policy”. Involvement of mother in baby care can improve maternal confidence, reduce her anxiety, and prosper developmentally supportive care for the baby. Both have long-lasting effects on growing brains of premature babies.

Family centered/ participative care and KMC improve clinical outcomes and reduce the cost of care. Mother’s voice and touch which the baby can recognize easily comforts the little one while being surrounded by so many machines in the NICU.

These practices enable better growth of the baby, reduce infections & duration of hospital stay, and result in better bonding between the mother and the infant.

Do preterm birth drugs have any side effects? Should they be administered during pregnancy to avoid premature births?

Drugs used to prevent onset and acceleration of labor (tocolytics), promote maturing of fetal organs (steroids) and antibiotics for prevention of infections are proven to be safe.

However, the dose and duration depend on the clinical condition of the mother and fetus. They must be given under supervision of expert clinicians.

What kind of evidence and care is available in the country right now for preterm babies?

India has progressed a lot in neonatal care in the last decade. In September 2014, India adopted the “Indian newborn action plan’. This plan has helped us to focus on neonatal care in many policy matters. Currently, India has more than 600 Special Care Newborn Units (SCNU) which can provide Level II neonatal care apart from facilities in private and NGO setups. Other programs like JSSK, JSY and other universal health insurance coverages also help in providing good care to neonates.

However, the inequalities in providing Level III care exist due to unavailability of expertise and facilities. Currently, government is helping to improve the availability of trained healthcare personnel by educating them about facility based newborn care. National Health Mission is also helping state governments to improve neonatal care.

According to WHO, more than one in 10 of all babies are born premature, globally. Given the high cost of treatment that goes into taking care of such babies, what do you think is the solution to make it more affordable?

Adopting low-cost interventions like universal coverage of antenatal steroids, adapting early kangaroo mother care, good antenatal care, milk banking facility for promoting mother’s own milk and human milk usage, training more nurse for providing care to sick newborns, optimization of care during golden hour (immediately after birth) and family participation in neonatal care will go a long way in reducing hospital cost.

Industry should also help in developing low-cost monitoring, diagnostic and supportive devices indigenously to reduce the cost of set-up.

In most cases, the cause of premature birth is unknown. Could you shed some light on this from your experience?

  • Cause for premature birth is multi-factorial. Health status of women in reproductive age group, demographics, socio-economic status, nature of work and stress during pregnancy, complications during pregnancy and genetic composition are known to influence the incidence of prematurity in society.
  • Hypertension during pregnancy (Pre-eclampsia) and fetal growth restriction are the major contributing factors for having premature birth in the population, according to our experience
  • Proper screening and management of women with risk factors will help to prolong the pregnancy

 

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