india

Updated: Jan 03, 2020 02:12 IST

The central government on Thursday rushed a multi-disciplinary expert team, including senior paediatricians, which will suggest measures to prevent infant deaths at Kota’s JK Lon Hospital that has seen 103 deaths since December 1.

“The team will carry out joint gap analysis along with the state government in terms of clinical protocols, service delivery, manpower availability and equipment for maternal, newborn and paediatric care services in the Medical College Kota, Rajasthan; and will develop an action plan for providing technical and financial support to Kota Medical College…,” Union health minister Harsh Vardhan said.

The central team included Dr Kuldeep Singh, head, paediatrics, AIIMS Jodhpur; Dr Deepak Saxena, senior regional director, Rajasthan; Dr Arun Singh, professor, neonatology, AIIMS Jodhpur; and Dr Himanshu Bhushan, adviser, National Health Systems Resource Centre.

Harsh Vardhan said he had spoken to chief minister Ashok Gehlot and assured him of all possible support.

On New Year’s Day (January 1) alone, three babies, including two newborns, died in the hospital that is struggling to accommodate the rush of critically sick infants due to inadequate infrastructure and manpower.

An internal note prepared by state health officials highlighted lapses inadequate infrastructure and said out of 533 key equipment, only 213 were available for use. The note, accessed by HT, showed, 14 out of 20 ventilators, 32 out of 38 pulse oximeters and 22 of 28 nebulizers are out of order.

The note also said 81 out of 111 infusion pumps, 14 of 22 BP instruments and all three portable X-ray machines are out of order.

It said, “44 out of 71 warmers are not working. A warmer is used for three children and that’s one of the key reasons for the spread of infection.”

Some other machines were also in shortage as a large number of them were out of order. The note said as against the rule of having 10 staff for 12 beds in neo-natal intensive care unit, the Kota hospital had 12 staff for 24 beds.

Officials said that Lok Sabha Speaker Om Birla, who represents Kota constituency, has already arranged ~50L from different companies through their CSR initiative for the purchase of equipment.

Most of the referred infants suffer from low birth weight (less than 2.5 kg weight), prematurity (born before gestation period of 37 weeks) with mild infection and other ailments, doctors said. Only around 20% are those born at JK Lon Hospital. “Most of the deceased are those who were referred from other districts of Rajasthan and even from the neighbouring state of Madhya Pradesh and were in critical condition,” said hospital superintendent Dr Suresh Chand Dulara.

Hypothermia (extremely low body temperature), hypoglycemia (very low levels of blood sugar) and hypoxia (inadequate oxygen supply) are the primary triggers that aggravate the health problems of such infants.

Among the main causes of infant deaths, paediatrics department head Amrit Lal Bairwa, was shifting babies to the hospital. Moving them in open jeeps or vehicles worsens their condition as they catch a cold which leads to hypothermia. “At least 35 degrees Celsius temperature should be maintained in the body of the infants,” he said.

Another cause of death among premature or low birth infants is hypoxia or the lack of oxygen in the body tissues to sustain bodily functions. Dr Bairwa said, “hypoglycemia is also a reason for fatality of such weak infants as they face shortage of glucose in the body”.

“Infant lives can be saved if they can be guarded against hypoxia, hypoglycemia and hypothermia,” he said. To put a check on such causes, Dr Bairwa said transport incubators should be used while referring the infant from peripheral hospital to keep the baby’s body temperature maintained or Kangaroo mother care procedure can also be adopted.

Kangaroo mother care involves infants being carried with skin-to-skin contact, he said. Hypoglycemia can be tackled by feeding mother’s milk or glucose before transportation of the infant for referral, he said. Doctors recommend arrangement of an oxygen cylinder during transfer of babies from a small hospital to a bigger one.

Infant deaths are higher at JK Lon Hospital because peripheral hospitals refer critically ill infants there. But the facilities at the hospital seem insufficient. The hospital has around 120 beds in each paediatric unit and around 200 beds in the gynaecology unit but need for extension of the hospital is being felt from long time.

At least two infants share a bed at the Kota hospital, with a similar situation in the warmers of the neonatal ICU in the hospital.

A proposal for a 300-bed hospital for paediatrics was proposed in 2017 but it is awaiting an approval. Kota Government Medical College principal Dr Vijay Sardana said the space and the facilities deserve augmentation as they are insufficient to meet the demand.

The infant death toll in 2019 at the Kota Hospital was 963, and hospital authorities claimed it had been the lowest in past six years.

Child mortality is a public health concern in India with about 0.76 million babies dying in the neonatal period, and nearly 3.5 million babies being born premature, shows government data.

In September last year, The Lancet Child & Adolescent Health by the India State-Level Disease Burden Initiative report showed low birth weight prevalence in India in 2017 was as high as 21.4%.

“It is one of the major contributors of death and disability adjusted life years among other malnutrition-related problems. Inadequate maternal nutrition is one of the reasons,” said Lalit Dandona, Indian Council of Medical Research scientist and national chair of population health, during the release of the study.