Dr Amitava Sengupta, Director: Mother & Child Unit, Head: Department of Neonatology & Pediatrics, Paras Hospitals, Gurgaon (NCR), India; Chief Advisor: 49th Annual National Conference of IAP (Pedicon 2012); National Faculty: NNF-IAP Advanced NRP; delves into the detail of Neonatal care in India. He shares his thoughts with Sharmila Das, ENN

Do you think Neonatology services in our country stand at par with the advanced countries of the world?

Neonatology is the specialty that deals with babies from birth to 28 days of life and this field has seen vast advancements in the last three decades globally. By now, our country also has advanced to a tertiary level of care. Comparing a premier tertiary care neonatal unit of the West with large units in metropolitan cities of India, we can see, comparable, high end care and facilities. The care and survival of pre-term, extremely low birth weight (ELBW) babies with a birth weight of <1000 grams was uncertain about four decades back. Now, with a highly developed level of care being available along with major advances in neonatal intensive care the intact survival of the micro preemies has become a distinct possibility.

Altogether, it has been a big leap for us and the advances are evident in metropolitan cities and second tier cities too. However, considering the enormous size of our country, it is difficult to spread the advancement equally to all regions and corners. To achieve this goal, we have to work dedicatedly to spread the message of new-born care and disperse knowledge to the neonatal care givers across the nation and aim to significantly reduce the Neonatal Mortality Rate (NMR) in the various states.

“The care and survival of pre-term, extremely low birth weight (ELBW) babies with a birth weight of 1000 grams was uncertain about three decades back. Now, with a highly developed level of care being available along with major advances in neonatal intensive care the intact survival of the micro preemies has become a distinct possibility”

Don’t you think the government run hospitals should also give due emphasis on this specialty? what is your take on this?
Neonatal Mortality Rate (NMR) is the number of deaths occurring in infants during the first 28 days of life, per thousand live births. It is gratifying to know that the lowest NMR recorded was 7 in Kerala as per 2010 statistics. In my belief, government hospitals like AIIMS and Safdarjung have given due attention to neonatology services. Keeping in view the huge load, we should appreciate that the delivery of care in such institutions is bridged with the game of enormous numbers. AIIMS New Delhi has one of the country’s premier Neonatal Tertiary Care Units. In the NCR and other states, there are many government hospitals that also provide good infant care and are moving forward to deliver better care and facilities. Kalawati Children’s Hospital, New Delhi is an example of a government institution with a large and efficient neonatal care unit. However, looking at the large volumes, giving the same level of care and facilities to all may not always be possible.

“A peripherally inserted central catheter (PICC Or PIC Line) is a form of central venous access that can be used for a prolonged period of time (E.G. for extended antibiotic therapy, or total parenteral nutrition). The catheter is placed in a major blood vessel leading to the heart”

The care and management of premature babies is an integral part of neonatal intensive care. In this regard, what are the modern devices and neonatal programmes paras has brought to its neonatal intensive care unit?

The Mother and Child (M & C) Unit at Paras Hospitals boasts of highly efficient Neonatal and Pediatric units. This M & C unit is one of its kind where the department of “Neonatology and Pediatrics” is housed under one roof along with the department of “Obstetrics and Gynecology”.

The Neonatal division has a level IIIB tertiary care unit with 15 beds. We have “state of art” facilities which include computerised digital servo controlled warmer beds and advanced digital monitors, which display heart rate, oxygen saturation, non-invasive blood pressure and many other parameters. Our special monitoring equipment can measure intra-arterial blood pressure, which is used for continuously monitoring critically ill neonates. In our unit, each neonatal bed is equipped with an advanced monitor,ensuring a one to one patient monitor ratio. Computerised digital syringe pumps are used to deliver intravenous fluids, electrolytes, nutrition (e. g amino acids, intra-lipids), blood components and other products.

The unit has high end, ‘state of art’ ventilators and other respiratory support devices for micro preemies and critically ill neonates. High-Frequency Oscillatory Ventilation (HFOV) and Non-invasive Positive Pressure Ventilation (NIPPV) are newer modes for ventilating newborns, which are also a part of our NICU protocols and practices.

Our highly skilled neonatologists are often placing PIC lines for long term therapy. “A peripherally inserted central catheter (PICC or PIC line) is a special form of central venous access that can be used for a prolonged period of time (e.g. for extended antibiotic therapy, or total parenteral nutrition). In this mode, the catheter is placed in a major blood vessel leading to the heart.”

We have an ongoing “Developmental Supportive Care” (DSC) programme in our unit since last 10 years. This involves a broad category of interventions designed to minimise the stress of the NICU environment These interventions include elements such as control of external stimuli (auditory, visual, tactile, vestibular), clustering of nursing care activities to avoid disrupting sleep, positioning or swaddling of the preterm infant and calming techniques.

Our focus is on practice of evidence based "Neuroprotection Strategies" in NICU and passionately pursue a path towards achieving the "Gold standard" of INTACT SURVIVAL in Micropeemies and/or Critically ill newborns.