We read with great interest the Perspective "Challenges in
Scaling up of Special Care Newborn Units- Lessons from
India" by Neogi, et al. in December issue of Indian
Pediatrics. As neonatologist working in one of the SCNUs, we
would like to make the following comments.
1. The reason for persistence of deaths
due to asphyxia has not been mentioned. We have observed
that the mothers arrive in hospital late, when the fetus is
compromised already and a severely asphyxiated baby is born.
Early referral of mothers will definitely help. Also, in
many hospitals there is lack of dedicated anesthesiologist
for Caesarean section OT, resulting in a delay of 2 or even
more hours, that can be detrimental for an asphyxiated
newborn. Further, all deliveries are not attended by a
health personnel trained in neonatal resuscitation.
2. It is not clear whether, while
calculating neonatal mortality rate only SCNU deaths are
included or deaths in the labour room, and post-natal ward
are also included. Also, the denominator i.e. the
live births would be different for inborn and out born
babies. We feel that an appropriate calculation would be to
calculate percentage of death amongst admitted patients,
rather than calculating NMR.
3. Although a good sum of money has been
allotted each year for maintenance of SCNU by the
government, in our experience, we found that to get the fund
released locally and utilise this finally for maintenance of
SCNU, it took nearly nine months due to lengthy official
formalities needed to be maintained by the NRHM officials.
4. Simply reducing neonatal mortality in
SCNUs probably will not help in long run unless the babies
discharged from these SCNUs are provided follow up and
parents are further provided help regarding feeding and
nutrition, immunization, hygiene etc. Hence personnel in
each SCNU who can be trained to counsel parents during their
hospital stay and follow up them at home probably will help
a lot in addressing this problem, reducing NMR, IMR and
achieving MDG. This facility for home follow up is not
available at present in the SCNUs.
Reeta Bora,
Associate Professor of Neonatology,
Department of Pediatrics,
Assam Medical College, Dibrugarh.
Email: [email protected]
Reference
1. Neogi SB, Malhotra S, Zodpey S, Mohan
P. Challenges in scaling up of special care newborn units –
Lessons from India. Indian Pediatr. 2011;48:931-5.