Premature birth a major risk to survival of newborns

Shiv Kumar Sharma

A protocol-based management system is being adhered to, according to the WHO guidelines, for better outcomes with regard to morbidity and mortality of preterm births and the overall survival of newborns in district and sub-district hospitals, all six community health centres and 12 primary health centres in Yamunanagar district from January 15, 2019.

All expectant mothers, where preterm delivery is expected, are given antenatal cards with yellow stickers. All such deliveries are mandatorily conducted at the district or sub-district hospital. Besides, all such deliveries are supervised by newborn care trained medical officers or staff nurses. 

“Referral transport ambulance drivers and technicians have specifically been instructed to directly bring these yellow strip card holders to the district or sub-district hospital without any referral and visit to primary or community health centres,” says Dr Vijay Dahiya, Medical Superintendent and in-charge of Special Newborn Care Unit (SNCU) of Mukand Lal District Civil Hospital, Yamunanagar.

Since the establishment of the SNCU at the district hospital, Yamunanagar, on March 31, 2011, 4,867 newborns have been admitted to this secondary care unit. Out of these, 3,412 were treated and discharged from the hospital while 1,247 newborns were referred to tertiary care centres. As many as 208 newborns died during treatment.

According to Dr Dahiya, it has been observed that one important cause of neonatal mortality and their referral to tertiary care centres was premature or preterm births. Out of 208 newborn deaths, 129 were of preterm babies. Preterm birth, defined as birth before 37 weeks of gestation, is an important cause of neonatal deaths and ultimately a major contributor to the overall infant and child mortality. 

“Premature birth is the single most important cause of adverse infant outcomes in terms of survival and quality of life. Premature infants are vulnerable to complications and poor survival due to impaired respiration, difficulty in feeding, poor body temperature regulation and high risk of infection. So, it is important to address the determinants of poor outcomes related to preterm birth to achieve further reductions in infant and child mortality,” says Dr Dahiya. 

He says that interventions can be directed to all women for primary prevention and reduction of the risk of preterm birth or aimed at minimising risk in women with known risk factors. 

However, the most beneficial set of maternal interventions are those that are aimed at improving outcomes for preterm infants when preterm birth is inevitable. He adds that special care of a preterm newborn to prevent and treat complications of prematurity is also critical for his survival. With improved care and, more importantly, by appropriate policy changes, there can be a remarkable reduction in the mortality rate of infants that are born preterm.

“On a meticulous review of five-year data of the district hospital, Yamunanagar, it was observed that neonatal and subsequent survival of preterm babies was better in case of those newborns where the mother got quality regular antenatal care with single or multiple antenatal steroids and antibiotics in case of premature rupture of membranes,” says Dr Dahiya.

The 24-bedded SNCU has radiant warmers, phototherapy units, separate labs, portable X-ray unit, breast feeding room and an eight Kangaroo Mother Care Units, besides doctors and staff rooms for observation and follow up visits.

Quality antenatal care to mother critical

Premature birth is the single most important cause of adverse infant outcomes in terms of survival and quality of life. Premature infants are vulnerable to complications and poor survival due to impaired respiration, difficulty in feeding, poor body temperature regulation and high risk of infection. It has been observed that neonatal and subsequent survival of preterm babies was better in case of those newborns where the mother got quality regular antenatal care. — Dr Vijay Dahiya, Medical Superintendent, Mukand Lal District Civil Hospital, Yamunanagar