Kangaroo Care for pre-terms helps

Dr Dinesh K Chirla, senior neonatologist and director at Rainbow Hospitals talks about effective pre-term care and the need to pay attention in the first 1000 days of life.

Q1 What are the reasons for pre-mature babies in India? Which age-group of women are delivering pre-term babies?

Premature babies is defined as babies born alive before 37 weeks of pregnancy are completed. The duration of normal pregnancy is 40 weeks. There are sub-categories of preterm birth, based on gestational age:

 Extremely preterm (28 weeks)

 Very preterm (28 to 32 weeks)

 Moderate to late preterm (32 to 37 weeks).

Pregnant women have increased risk of preterm delivery if they are younger than 17 years or older than 35 years.

The commonest causes of preterm delivery are:

 previous preterm birth, poor nutrition of mother

 weak cervix or abnormal uterus

 pre-existing diseases in mother like diseases of heart, kidney, lung and liver.

 Mothers who are hypertensive or have diabetes have increased risk of preterm delivery.

 Infection including urinary tract infection during pregnancy increases risk of preterm delivery.

 Premature rupture of membrane , multiple pregnancy are other common causes of prematurity.

Q2. What is kangaroo mother care for pre-term babies? Does it help to improve the outcomes?

Kangaroo Mother Care is a form of developmental Care especially in Neonatal Intensive Care Unit. It is care provided to newborns especially preterm babies by providing skin to skin contact with mother. Fathers can also provide Kangaroo care. KMC also promotes supporting parents and encourages breast feeding. It has immense benefits to both mother and baby. It not only regulates heart rate, breathing and temperature of baby but also promotes better weight gain and growth of head circumference. The baby’s experience less pain and crying and sleep well. The incidence of infections is less in these neonates. Mother also gets more milk and so neonates get benefitted with improved nutrition. The stay in hospital is reduced and the neonates can be discharged early.

Q3. There are lots of formula products also which are being given now to supplement and make the child strong does that help in improving the life span of the child?

Mother’s milk is the best for babies including preterm neonates. Breast milk of preterm babies have extra proteins and sodium which helps in growth. Feed tolerance is better and the risk of infection of intestine is less.

However sometimes mother’s milk is not sufficient. It is that time formula feeds exclusively designed for preterm babies is given. They are rich in proteins, have more calcium and phosphorus needed for growth and have extra iron to prevent anemia. It helps the preterm baby grow when mother’s milk is insufficient. There is no added advantage.

Q4. Most of the preterm babies die before 5 years of age? How can this be controlled?

Globally, prematurity is the leading cause of death in children under the age of 5. The incidence of premature delivery is around 5 to 12%.

In India, with better neonatal care and availability of NICU the outcome of babies have improvedsignificantly. Even babies born as early as 24 weeks of gestation and 500 grams can survive. The survival rates of babies born more than 1. 5 kg and 32 weeks has improved significantly in our country. However there is stark difference in outcome of babies born in rural area versus urban and also theer is wide difference in survival rates on neonates in different states of India.

Death in preterm babies is because of lack of feasible, cost effective care such as warmth, breast feeding support and care to prevent infection and treat breathing difficulty. Majority of neonates born after 32 weeks can be saved with simple interventions and support. All such babies survive in developed countries.

Q5. How is the set-up at the government hospitals? Is it improving in terms of pre-term care?

Government has made significant investment in improving neonatal care. The India Newborn Action Plan (INAP) is India’s committed response to the Global Every Newborn Action Plan (ENAP). INAP lays out a vision and a plan for India to end preventable newborn deaths, accelerate progress, and scale up high- impact yet cost effective interventions. It includes six pillars of intervention packages across various stages with specific actions to impact stillbirths and newborn health.

It has established Newborn Stabilizing unit (NBSU) at block level and SNCU (Special Newborn Care Unit) at district hospitals to provide better neonatal care. It is upgrading neonatal units in medical colleges and institutions by upgrading ventilation facility, surfactant use for breathing difficulty and preventing infection. It aggressively promotes Kangaroo mother care at facility and provides full supportive care at block and district level. q6. What are the measures that still need to be taken in terms of mother care during pregnancy to improve the health of the fetus and ensure that the child is born healthy?

For a healthy baby the care should start from very early before pregnancy. Delaying age of marriage and first pregnancy is important to prevent complications of pregnancy. Adolescent pregnancies have a higher risk of adverse birth outcomes, with a 50% increased risk of stillbirths and neonatal deaths. Maternal under nutrition is risk factors for having small babies. Balanced protein and energy supplements to adolescent girls is very important.

Good nutrition of mother and supplementing them especially iron, calcium, folic acid is very important. Regular antenatal visit, screening of pregnant mother for anemia, hypertension, diabetes and preventing infection is necessary for better outcome.

In cases of preterm delivery before 34 weeks of gestation, Mother should be given steroids. Antenatal Steroids have shown to reduce the incidence of breathing problems in preterm neonates after birth and improved survival. Magnesium sulphate to prevent future neurologic impairment in child should be given to mother in case of preterm delivery.

Promoting hospital delivery and good care at time of labour and child birth will improve outcomes. Keeping cord clean and dry, vaccination and exclusive breast milk will improve outcome of neonates. Maintenance of temperature, treating respiratory distress, kangaroo mother care, safe oxygen use, prevention of infection and good nutrition will help in saving many preterm babies.

For appointments : Dr Dinesh K Chirla, senior neonatologist and director at Rainbow Hospitals