Globally each year, 15 million babies are born too early and more than one million die shortly after birth. Ninety-nine percent of these deaths occur in middle and low income countries. An estimated three-quarters of these babies can survive if a few proven and inexpensive treatment and prevention options are translated into action. In India, where more babies die from complications of prematurity than any other country, saving premature babies is a daunting task for healthcare professionals. In fact, most newborn deaths in India (90 percent) occur in those who are premature or who weigh less than 2.5 kg at birth (low birth weight).
To offer premature babies the best chance of survival, we must look to evidence-based practices to provide optimal care during pregnancy and childbirth in the early postnatal period. These practices include the use of antenatal corticosteroids, given to the mother before birth, which help premature babies’ lungs mature more quickly, providing a hygienic environment to avoid infections, feeding with mothers’ milk, and kangaroo mother care (skin-to-skin contact).
Such interventions are not only highly cost-effective, but can also be readily implemented whether care is provided at home, by a community health worker or at a health facility.
However, a significant proportion of preterm babies need more specialized care like help with breath at birth and in the early days of life, keeping their blood volume and composition balanced, and screening for morbidities like eye damage (e.g., retinopathy of prematurity) which is a particular risk for preterm babies on oxygen.
Very small babies (who weigh less than 1000 g) need referral to specialized health facilities and management by a dedicated team of healthcare professionals led by a trained neonatologist. During pregnancy, referral of high-risk mothers to centers where babies can be cared for is necessary. Without a functional referral and transport system it would be hard to save these preterm babies needing specialized care.
How do we improve preterm birth care in India?
There are five ways, looking forward, to dramatically improve care for some of the most vulnerable newborns in India:
- Empower the states to run maternal health programs. Despite health being a state subject in India, most of the maternal, newborn and child survival programs have been conceived and run through the federal government. There is need to decentralize powers to the states for improving health of mothers and babies. Role of federal government should be policy setting, technical supervision, stewardship, and resource mobilisation.
- Ensure there are best practices for providing care for premature birth. Each state needs to take proactive steps to address best practices for premature babies, ensuring equity of care.
- Encourage innovative solutions to providing care. There is a need to create health facilities for birthing and caring for sick newborns. This involves strengthening services at medical colleges, creating special care neonatal units at district and sub-district health facilities and improving linkages. This is a huge task and needs innovative private-public partnership (PPP) models. PPP can also help in designing innovative solutions for ensuring cost-effectiveness and quality care.
- Skilled providers around the clock. Round-the-clock availability of skilled staff should be mandatory in facilities caring for preterm or sick neonates. A large number of health professionals will need to have updated evidence-based knowledge and skills. This can be facilitated by use of e-learning distance education programs run by state resource centers. Use of computer and information technology can be linked with m-health by health workers for ensuring accountability and data retrievals.
- Accreditation of healthcare facilities. This can help in ensuring adequate infrastructure and trained manpower on an ongoing basis.
The new paradigm for the care of premature babies should be directed towards affordable quality of care with intact survival.