Editorial: Strengthening care of the newborn

Tamil Nadu has come to realise in a most tragic manner the high mortality risk faced by preterm babies (those born before 37 completed weeks of gestation), and its unfinished task of saving these lives. Of the 13 neonates who died recently in district hospitals in Dharmapuri and Salem, five were preterm. Both preterm and low birth weight babies have died of the usual causes, such as respiratory distress syndrome, intrauterine growth restriction, birth asphyxia and sepsis. Incidentally, with 27.3 deaths per 1,000 live births, the State has achieved the WHO’s Millennium Development Goal 4 of reducing the number of deaths in children younger than five years, well before the December 2015 deadline. It can further reduce the number of under-five deaths by adopting a two-pronged approach of bringing down the number of babies born preterm and providing crucial care to such babies during the most critical phase. There is a compulsion to adopt both measures simultaneously as birth complications in preterm babies are among the leading causes of neonatal (0-27 days) deaths. Of the estimated 15 million babies born preterm annually across the world, over 3.6 million are in India; of them, over 3,00,000 die each year. Globally, one million preterm babies die every year. According to an October 2014 study published in The Lancet, during 2013, for the first time, preterm birth complications became the leading cause of death in children under five, across the world.

Though there are several reasons for preterm delivery, the common, preventable causes are early induction of labour, teenage pregnancy, multiple pregnancies, diabetes and high blood pressure. In a commendable move in July 2013, the Ministry of Health and Family Welfare authorised auxiliary nurse midwives to administer a pre-referral dose of antenatal corticosteroids to women and injectable antibiotics to babies for suspected sepsis. Since immaturity of the lungs is one of the main reasons for preterm baby deaths, the steroid administered before delivery can vastly improve lung maturity. Similarly, the Ministry’s focus on the well-proven and cost-effective kangaroo mother care in health facilities and at home after discharge can greatly improve survival rates of preterm and low birth weight babies. These measures can potentially save many preterm babies (32 to less than 37 weeks of gestation) even in the absence of expensive incubators and ventilators. There is no reason why Tamil Nadu cannot set these as standard health practices at all its public health centres and hospitals. The lives of at least some of the 13 babies could probably have been saved had the State already adopted them. These deaths should prompt the government to act swiftly.

Published in The Hindu on November 24, 2014

Tamil Nadu has come to realise in a most tr