Neonatal transport key to save preemies

World over, one in 10 babies is born preterm. Annually, 15 million preterm babies are born of  whom more than one million do not survive. However, we now know that several countries across the world have doubled their survival rates in the last five years alone. In India, the Neonatal Mortality Rate is declining at about 6% annually (current rates close to 29 per 1,000 births).

There is, however, a wide gap between the developed world and low-income countries. Bringing this into sharp focus, the Union government launched the India Newborn Action Plan (INAP) in 2014 through which some of the bottlenecks were dissected and action plans made.

It is ironic that the minute a life begins is the most vulnerable. About 70% of neonatal deaths occur in the first week of life with more than half of that in the first day itself. A foetus nourished in a mother's womb for nine months comes prepared to sustain the stress of being born and surviving the first few days as she learns to feed and stay warm.

However, babies can be born very early (preterm - before 40 weeks of pregnancy), with illnesses like birth defects or with brain deprived of oxygen and blood supply (birth asphyxia) due to events around the time of birth or catch life-threatening infections.

In India, of late certain states and urban pockets are witnessing decreasing trends in the mortality of preterm babies with some advanced centres seeing survival rates comparable to the developed world. The gap between what can be done and what is the current state is ever widening with a few centres showing best practice even as the country deals with challenges of resource limitation and prioritisation in public health.

The INAP aims to reduce this gap as simple interventions (helping babies breathe, keeping them warm and free of infections) can alone save 80% of preterm babies born later than 32 weeks. However, advances both in technology and medical expertise allow  us to look after babies born as preterm as 23 weeks.

The challenge is then twofold: to improve basic care at every setting and to establish a programme for stabilisation and safe transport of sick and very premature babies to advanced centres (50 million births worldwide occur outside of the centres that can provide neonatal care).

Today, in most of the developed countries, neonatal intensive care is provided across geographical regions in a networked manner. If there is no accessibility or opportunity to shift the mother for the delivery, intensive care services transfer the mother and child to a hospital in a specially-equipped ambulance. Under this service, which is funded and run very efficiently, well-trained doctors and nurses operate on standard clinical protocols. This really makes a huge difference in the intact survival of preterm babies.

Golden hour care

Sick and preterm neonates are vulnerable and can suffer from complications en route, as they tend to lose temperature and turn cold. There are babies who need to be on a ventilator and life-saving treatment in the ambulance even before they reach the ICU. Without this, the chances of survival and surviving without major disabilities come down significantly.

Even today, many well-equipped hospitals of the country are not prepared to offer the much-needed care to preterm babies during the golden hour through organised and advanced transport services. Many states are in the process of tailoring their 108 ambulance service to cater to newborn transport and this is a work in progress.

Very few paediatric hospitals in the country have evolved an organised neonatal transport system. We now have data from these centres to show that a well-run road transport with advanced equipment and trained personnel on-board following strict clinical protocols have shown excellent outcomes. We have even demonstrated that long-distance road transports, as far as 300 kms, are feasible if carried out meticulously.

Along with the Union government's efforts through INAP, neonatal transport needs to be prioritised, too. Learning from the best practices that already exist in the India Neonatal Stabilisation and Transport services need to come of age across government and private sectors. This will ensure that not only more preterm babies survive but that they also have a healthy and productive life ahead of them.

(The writer is Lead Consultant Neonatologist at Rainbow Children's Hospital, Marathahalli, Bangalore and heads the Neonatal Transport Committee in the Hospital)