While the number of sick neonates admitted to the 36 Special Newborn Care Units (SNCUs) across the state has increased since last year, a revision in protocol that focuses on infection control and Kangaroo mothercare has helped bring down the mortality rate to 7.6 per cent, officials said. Of the 55,000 neonates admitted to the 36 SNCUs from April 2017 to March this year, the state health authorities have registered a total of 4,175 deaths.
In the previous year, between April 2016 and March 2017, around 50,000 admissions were registered. Of them, 4,104 babies had died — most of them succumbing to respiratory distress, sepsis, birth asphyxia, low birth weight and prematurity. From April to June this year, the state health authorities registered 13,549 admissions of neonates and out of them, 780 babies have died.
While the revised protocol has been implemented for a year now, Dr Archana Patil, the additional director of health (State Family Welfare Bureau), said it will take a lot more effort to bring down the mortality rate. “However, we have been able to bring down the death rate from 15 per cent in 2011 to 7 per cent this year,” she said.
The revised protocol that was prepared by experts also included a state-level training workshop for staff members at the 36 SNCUs. Online software training sessions were also conducted for 14 medical colleges with Neonatal Intensive Care Units (NICUs) to further clarify the status of the sick newborns. The new protocol includes use of caffeine citrate drug (used to treat lack of breathing in premature babies), antenatal corticosteroids (medications given to pregnant women expecting preterm deliveries) and rolling out Kangaroo mother care (a method that involves infants being carried usually by the mother with skin to skin contact).
Health officials said eight SNCUs in the state are problematic and see a high mortality rate. Among these are the SNCUs at Nandurbar, Chandrapur, Nashik and Gondia. However, in some places, there has been definite improvement with increased number of survivors. For instance, at Jawahar, a tribal area in rural Thane that has reported severe cases of malnutrition, the sub-district hospital saw 1,901 admissions of neonates at the 12-bed SNCU from April 2017 to March 2018.
During this period, they registered 66 deaths. In 2016-17, the number of admissions were 1,440 but there were 92 deaths,” Dr Ramdas Marad, the medical superintendent at the 100-bed hospital at Jawahar, said. The hospital gets referrals from the tribal pockets of Dahanu, Mokada, Vada and Vikramgad tehsils in Palghar district. “We are strictly following the revised guidelines — especially the handwashing hygienic practices and the new antibiotic policy. Weekly videoconferencing with officials have also helped,” Dr Marad added.
There are 36 SNCUs in 20 district/civil hospitals, 10 women hospitals and six sub-district hospitals in the state. These units have a minimum of 12 to 16 beds and include specialised equipment, like phototherapy unit, oxygen hoods, infusion pumps and radiant warmer. While an estimated 22 lakh deliveries take place annually in the state, an average of 50,000 sick babies are admitted to these SNCUs. “Most babies are referral cases and already in critical condition by the time they are admitted to the units,” Patil said.
However, to intensify efforts in reducing mortality rates, the state is planning to set up neonatal intensive care units at Nashik and Amravati. It is apart from setting up more SNCUs at remote pockets like Aheri tehsil in Gadchiroli and Achalpur in Amravati.