Newborn mortality rate (per 1000 live births) – 25
Annual reduction in newborn mortality rate 3.6% (2000-2016)
Preterm birthrate (per 100 live births) – 13
Maternal mortality ratio (per 100,000 live births ) 174
Source Healthy Newborn Network ; 2015 statistics

Joyful Motherhood – Part II

Welcome back to the second part of my blog Joyful Motherhood.
While I was practicing clinical obstetrics I used to counsel the husbands and parents on the pregnancy outcome such that all are well prepared.
Let us have a look at the frequently asked questions,

On exercise
The first three months can be a very physically tiring time for a pregnant woman due to the energy expended with changes occurring in her body and the development of a baby. There is need to listen to one`s own body and rest when one can. A brisk walk once or twice a week may be all that is needed. In the second trimester, many women tend to feel great. These women may well be able to change the exercise program during this period, and adjust to a rhythm that is comfortable for their bodies.
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During the last three months called the third trimester, women may feel more fatigued with the weight of their growing baby. This is the time for gentle walks, stretching and catching up on some rest. A pregnant woman can manage all house hold activities including scrubbing the floor during the first six months.This will give more laxity to pelvic bones and facilitate normal delivery.

On Ante natal care
This can be done by any basic doctor or a well trained midwife. Ante natal care is planned to have an idea about the health of the woman and anything that can affect the baby. Each visit should be a question answer session to build up the confidence of the patient on the doctor and vice versa. Urine and blood pressure and weight gain is checked. Weight gain should be on average 9-13 kg during the pregnancy period. An abdominal examination is also done to ascertain the position of the baby and the size of the uterus carrying the baby to rule out any small or big baby or twins. A scan is done in the second month to confirm whether the baby is inside the uterus, another in the third month to confirm singleton or multiple pregnancy. A scanning is done at fifth month to rule out neural tube defects and at 7-8th month to confirm the position of placenta.All other sophisticated tests are not required as a routine. These may be done at the instance of the Obstetrician if indicated as a special case. A blood test is done to rule out anaemia, and blood grouping in the event of the requirement of blood transfusion. Screening for Hepatitis, Rubella anti body and HIV screening are all optional.

For screening for foetal anomaly-A detailed ultrasound scan (anomaly scan) at 20 weeks. This looks for major physical abnormalities. There are however, limitations to the accuracy of the scan.

On the diet

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There is no need for any extra food in pregnancy. It is a common myth that you should eat for two. In fact most women do not need extra calories for the first 6 months of pregnancy and only require approximately 200 extra calories per day during the last 3 months.

However, because the blood sugar levels fluctuate more due to the extra demands on the body, it is important to eat regularly, including snacks between meals. Most women gain between 9 – 13 kg during pregnancy, although this can vary from woman to woman. You should never try to diet during this period as you could be depriving the baby of vital nutrients.
The best thing to do throughout pregnancy is to eat a variety of healthy foods. They should contain certain key components necessary for growth and development. These include foods containing iron (e.g. green leafy vegetables, red meat, beans and pulses although additional iron supplements may also be given to you by your doctor); calcium (e.g. dairy produce, fish with edible bones like sardines and bread) and folate (e.g. green beans, oranges, spinach, kale or broccoli).

On Vitamin, Calcium and Iron

Image result for pregnancy On Vitamin, Calcium and Iron
Folate is a B vitamin crucial in the development of baby’s nervous system. It has been shown to reduce the chance of having a baby with a neural tube defect (a disability affecting the nervous system). Folate is easily destroyed during cooking and large servings are necessary for adequate intake. The simplest way is to take a folate supplement (one 5 mg tablet daily) for the first 12 weeks of pregnancy. Folate is particularly important if one suffer from epilepsy, thalassaemia or have a family history of having relatives with a neural tube defect. One Calcium and Iron tablet each can also be consumed daily. Have enough fluids and one should also reduce the intake of tea, coffee and cola as the caffeine content of these drinks will affect the vitamins in the food, particularly Vitamin C and also Iron. Develop a habit of taking a fruit juice instead of Coffee /Tea.

On Sex
There is no reason why pregnant women cannot have a fulfilling sex life. In fact, the pregnancy hormones may make you feel more responsive. As the woman get bigger, she may want to experiment with different positions to find one that is comfortable. If she has suffered from any early bleeding, premature labour or have a low-lying placenta, it is wise to consult the doctor who may suggest a period of abstinence.

On Drugs
Avoid intake of any drugs from any system of medicine from 28th day of conception to sixtieth day unless and until they are absolutely indicated.The date of conception will normally be between 10th to 15th day of last menstrual period. This period is very crucial as organogenesis occurs during this period. A ball like fertilized egg called Zygote turns into a foetus during this period. Unnecessary drug intake can result in the defect in the organ that is likely to develop during the dates when the drugs are taken.

The Warning Symptoms Of Adverse Events In Pregnancy
In early pregnancy light spotting or bleeding is due to implantation which occurs when the embryo is attached to the womb. This is a normal phenomenon. However continued bleeding requires clinical examination. Similarly light bleeding with blood-stained mucus in the month before the baby is due could be a ‘show’ — a sign that the woman may go into labour within the next few days or week. However painless heavy bleeding and any amount of bleeding with severe pain also warrants clinical examination. Another warning symptom is feeling dizzy with , nausea and vomiting, blurred or double vision which often herald hypertensive disorders from pregnancy. This requires continued monitoring of blood pressure and albumin in the urine and swelling over the legs.

Babies are most active when the woman is at rest. This is because she is now more aware of their movements. Hence she will notice frequent movements in the evening or at bedtime. There should be at least 10 “kicks” over a 12-hour period. Conversely an active baby is reassuring and excessive movements are not cause for worry. If the kicks become lesser a scanning may be required.

Normally the water-bag where the baby floats in t he uterus is ruptured (either spontaneously or by the obstetrician) when labour begins. Rupture of the water-bag before the onset of labour is associated with increased risk to the baby. Complications include infection or prolapsed of the umbilical cord through the cervix. If she feel a sudden gush or continuous flow of clear fluid from the vagina, an obstetrician should be consulted.
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I am sure if the woman is under the care of a trained doctor/midwife they can easily pick out these problems and initiate required management processes.

Remember always that 60% of pregnancies can occur without any help, only 40% require some assistance and only 15% require surgical interventions. This doesn’t mean that 60% need not have any help. The main issue is that only after the delivery will one know in which group they belonged?

Labour -the process of child birth begins with regular, painful uterine contractions or tightening of the abdomen, ‘bloody show’ (blood-stained mucus) or ‘breaking of her waters’ (rupture of your membranes). This usually occurs at term, after 37 weeks of pregnancy. Preterm labour occurs when these signs are present before 37 weeks.

The idea behind this article is awareness generation on Safe delivery and for avoiding undue tension and stress during pregnancy. I have included only some of the danger signs in Pregnancy and Child birth. My intension is not to load one with lot of materials that may not be much relevance .

Be under the care of a well trained midwife who is very patient or a well trained family doctor. Forget all the tension and stress. Pregnancy problem are always individualistic and not much attention need be given to what the print and visual media churns out. Remember that media are more interested in circulation and number of viewers their product can attract.
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The estimated date of delivery is often calculated by adding 9 months and 7 days to the first day of the last menstrual period. These dates are all calculated assuming that you have a standard 28 day cycle and the number of weeks also includes the first 2 weeks of your menstrual cycle, when you are technically not pregnant. If your cycle varies from this and you know when you ovulated (mid period with signs like lower abdominal pain and increased discharge of thick vaginal mucus), just work back 2 weeks from this date to find your last menstrual cycle date (LMP). Knowing when you are due can help you plan your important appointments for your antenatal care and lots more. Just remember, it’s not mandatory that the woman will be delivering on the estimated day. Baby will come  when it is ready. The majority of babies are born within 2 weeks either side of their EDD.

Have a safe and Joyful pregnancy

An alumnus of Trivandrum Medical College (1965-70) Dr N S Iyer is a senior Obstetrician and Gynecologist and retired Deputy Director of Kerala Government Health Services. Post retirement he became the Project officer in UNICEF, Chennai office, in charge of the Maternal and Child Health Programme in Tamil Nadu and Kerala.

If you have any pregnancy related queries for Dr.Iyer  write to us at marketing@pmsind.com

Joyful Motherhood – Part 1

A retired Gynaecologist in a senior citizen meeting milieu serves as the catalyst for the discussion to veer toward problems faced by women during pregnancy and how doctors prefer to do Caesarean Section (C-Section) . Having served as an Obstetrician in Kerala Government Health services for three decades, I argue with them sharing my own clinical experience and opine that C-section rates need not be more than 15% and that only 40% of pregnant women face some problem during final stages of pregnancy. More important, pregnancy should be considered a joyful process.

But melodramatic movies that depict a shrieking mother-to-be writhing in pain as well as all other women’s tales of pain makes the situation worse. As a result more women request doctors for a C-Section, not realizing that regardless of the procedure adopted, the child feels some pain in the process. Since now I am now involved the field Of Social Obstetrics, focusing on quality of care in Obstetric services, I thought it might be worthwhile to share my opinion about the concept of preparation for a child birth.

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Pregnancy is a normal physiological process and if any complications arise, these are usually due to some unresolved issues. The point to note is that pregnancy is not a disease.“An occasion so momentous and a marvel so beautiful has however always been shrouded in myths , old wives’ tales and also pain for all those who don’t know. What is ironic to note is that even advancements in science and increasing education levels haven’t done much to alleviate the doubts and fallacies surrounding child birth. 

You would be amazed that even with such high levels of education and exposure, young girls have gross misconceptions about child birth” says Dr Sushma Neharai the world record holder for delivering a 5.7 Kg baby through normal delivery.

Baby pic 1024x511 - Joyful Motherhood – Part 1For a normal pregnancy and delivery, a regular check up is all that is required to ensure that everything is well. This can be done by an ordinary doctor or a well trained midwife. However, pregnancy complications are always unpredictable but curable if detected on time. Further, the instances of complicated pregnancies can be saved by timely referral to institutions with all required facilities.

On an average 28-30 million deliveries take place annually in India. This is nearly 75000 a day across India.

What is required for a routine checkup is a well trained and caring midwife doing the ante natal check and labour being arranged in a facility where 24 hour obstetric care services by a qualified well trained doctor is available. Availability of a trained doctor /midwife having patience, masterly inactivity and watchful expectancy are the requirement of a normal delivery and not star studded hospitals with intensive care units and obstetricians of repute and those with the so called kai rasi.(Kai punniyam).

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The misconception that all pregnancies end in C section is an offshoot of “my daughter/my wife should not experience pain during labour” syndrome. In cases where the parents /husbands do not have confidence in the doctor and if the confidence level of doctor is sub optimal, there may be instances of unnecessary C-Sections

Whenever I start my lecture on Maternal Health, I always state complications in a pregnancy can arise anytime. This in spite of the reputation of the obstetrician involved, having daily check ups with all required tests etc. Even if a mother-to-be is found to be normal until the time of delivery, a complication can still occur depending on various conditions. The higher the reputation of an obstetrician ,more will be the number of pregnancies she may be forced to manage and it will be impossible to get personal attention. Sometimes, the doctor may not be available at the time of delivery and the poor woman may be seeing strangers when she requires affectionate, patient observation and masterly management at the time of child birth.

Having said that, pregnancy is still a normal physiological process, and as two lives are involved there are certain common facts every pregnant woman, husbands and parents ought to be aware of . While I was practicing clinical obstetrics I used to counsel the husbands and parents on the pregnancy outcome such that all are well prepared.

Stay tuned for my next post on common facts for every pregnant woman, husbands and parents.
An alumnus of Trivandrum Medical College (1965-70)

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Dr N S Iyer is a senior Obstetrician and Gynecologist and retired Deputy Director of Kerala Government Health Services.
Post retirement he became the Project officer in UNICEF, Chennai office, in charge of the Maternal and Child Health Programme in Tamil Nadu and Kerala.

Breastfeeding for preemies

Baby’s stay in NICU can be stressful and emotionally taxing. Mother’s often miss the initial bonding and feeding. It is really important to feed term or pre-term babies with breast milk after they are born. If mother’s can’t breastfeed directly to ill or preterm babies then mother’s have choice to express their milk instead of feeding formula milk.

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What makes breast milk so special?

Breast-milk is a unique fluid containing essential nutrients – anti-infective factors, hormones, enzymes, specialized growth factors, anti-inflammatory mediators, specific nutrients. There are various studies stating importance of breast milk for term as well as preterm babies. Recognizing the importance, Unicef and WHO in 1990 came up with Innocenti declaration stating infants should be fed breast milk up to 4 to 6 months. This provided ideal nutrition transfer – helped in reduction of neonatal morbidity.

 

Breast milk for premature babies

Premature babies spend comparatively lesser time in womb, depriving of basic nutrients required for growth. They are easily susceptible to illness and stunned growth. For first few weeks- mother’s of premature babies secrete milk with higher fat, proteins, minerals and antibody ( immunoglobulin G) required for their growth.

Premature babies face issues of improper digestion. Antibody and enzyme also help in intestinal digestion making preemies less susceptible to intestinal infections.

Prof. Peter Hartmann founder of Human lactation research group in Australia says,”Every drop counts”. A premature baby is likely to recover faster from illness and sepsis when fed with breast-milk.

 

Facts on Breast-milk:

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  • Breast milk is the first choice in neonates, whether term or preterm.
  • There are significant clinical benefits to providing breast milk in the preterm infant.
  • Expressed breast milk can be frozen for later use.
  • Human milk fortification should be considered in babies with a birth weight of < 2000 g.

 

Skin – to -skin contact

Once your baby is ready to be held, gradually shift from tubes to breast feeding. Caring for and learning to breastfeed a premature or ill newborn is emotionally taxing for any new mother. Ask for help from nicu nurses to first initiate. It usually takes sometime for baby to latch. Gradually as they develop and get stronger, they will be able to breastfeed directly. During breastfeed, skin to skin contact promotes warmth and bonding between mother and baby.

 

Benefits of breast-feeding moms

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Lot of mothers who breastfeed feel fulfillment and joy with physical and emotional bonding. Hormones like prolactin and oxytocin are secreted releasing strong sense of nurturing and bonding between mother and baby. There are recent studies stating breastfeeding reduces risks of breast and ovarian cancer.

At home

Once baby is home from hospital, breastfeeding can be continued till 4-6 months. Later stages, mothers can express breast milk and store, especially when baby grows and need increases. Additionally, emotional and practical support from loved ones goes extra mile to support new moms.

 

Ref:

http://humanlactationresearchgroup.com

https://www.unicef.org/programme/breastfeeding/innocenti.htm

Neobreathe—Treat Asphyxia with Ease

Neobreathe—Treat Asphyxia with Ease

 Millions of neonatal deaths arise due to asphyxia. There are different reasons why newborn babies just cannot start breathing by themselves. Some babies are born with the lungs insufficiently developed. Others have fluid in the windpipe, having swallowed meconium in the womb. And there are babies who simply need an initial gasp of air to start breathing. These newborns can be saved using a simple life-saving procedure called resuscitation. Across the world, people are provided the basic equipment (essentially a bag and mask that pumps air) that is required for resuscitation, and they are trained to use this equipment. Unfortunately, there is still a lack of skilled people and of resuscitation devices, and so it is difficult to save babies in a lot of places.

Basic resuscitation care

A general resuscitation procedure is carried out immediately after the birth of a baby. Indeed, this must be done during the first 60 seconds after the birth of the infant, this period being referred to as the golden minute.

During resuscitation, first any fluid that may be present in the windpipe is removed, by suction. Then artificial breaths are given using the bag–mask. Cardiac massage is performed if necessary. Typically, two staff members are involved in carrying out resuscitation. One performs the actual resuscitation. It is important to note that this staff member must use both hands. He or she uses one hand to generate pressure with the bag; the other hand holds the mask to the baby’s face, preventing air from leaking where the mask touches the face. The other care-giver applies suction and gives the cardiac massage.

Neobreathe

Phoenix has come up with a cost-effective, innovative resuscitation product called Neobreathe. Phoenix designed the device along with Stanford Biodesign and commercialize Neobreathe.

Neobreathe is designed such that the operator needs to use only one hand—to hold the mask to the face. To generate the pressure, the operator uses his or her foot—Neobreathe is the world’s first foot-operated newborn resuscitation system. Neobreathe also has an integrated suction unit.

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Neobreathe’s single-handed operation feature permits one hand of the user free for chest compression or CPR. This feature is most useful in places where there is a shortage of skilled labour. The device also gives the user the liberty to use both hands to seal the mask effectively. A study conducted by the inventor Dr. Avijit Bansal shows that face mask leakage can be reduced to a good extent when the mask is sealed well.

Neobreathe is a user-friendly device requiring minimal training compared with the traditional bag and mask. It is fitted with a manometer that displays the pressure delivered so that the clinician can monitor it while he or she observes the chest rise. Neobreathe is also provided with a pressure safety valve.

Actually Neobreathe has several other features. For instance, the oxygen level in the air delivered by the device can be regulated over a broad range. Another feature is a PEEP valve. This valve permits the peak end expiratory pressure (PEEP) to be maintained at a set value so that the lungs of babies with difficulties do not collapse.

Neobreathe fits conveniently into labour rooms, NICUs, paediatric centres and public health care centres. Its cost-effectiveness and innovative features make it very suitable and affordable for all users.

To know more about Neobreathe, please visit the product page:

https://www.phoenixmedicalsystems.com/infant-care/respiratory/neobreathe/

Perinatal asphyxia – Brain injury at birth

Perinatal asphyxia – Brain injury at birth 

Perinatal asphyxia, also known as hypoxic-ischemic encephalopathy (HIE), causes acute or subacute brain injury due to asphyxia.
Earlier, no significant treatment was available for HIE. Later with research evidences, they found cooling baby’s brain reduces the metabolic rate of cells, in turn reducing brain damage. This can be achieved if treatment begins within 6 hours of birth.
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Qualification of baby for hypothermia treatment:
Any term baby suffering from perinatal asphyxia with qualified APGAR score are eligible for hypothermia treatment.
Apart from this, various tests and symptoms indicate baby might have HIE.

  • Meconium-stained amniotic fluid
  • Low heart rate
  • Poor muscle tone
  • Weak breathing or no breathing at all
  • Bluish or pale skin color
  • Excessive acid in the blood

Also CT scan, MRI scan, echocardiography, and ultrasound are taken for confirmation. Optional tests may include electrocardiogram (EKG), electroencephalogram (EEG).

 Treatment:
Immediate treatment for infants born with HIE involves cooling the baby for three days. Few degree drop in temperature result in significant less brain injury.
The baby will be placed on a cooling blanket for three days and are closely monitored for any signs of discomfort.

The treatment usually involves head cooling or total body cooling. Initially they started with head cooling, down the line they concluded the deeper parts of brain didn’t receive proper cooling leading to brain damage. Later they discovered, whole body cooling is much effective compared to selective head cooling.

Monitoring during treatment:
While baby is under treatment, baby is constantly monitored.
They check heart rate, breathing pattern, temperature along with monitoring of brain activity with EEG and with cerebral function monitor (CFM).

During the cooling period, it is normal for your baby to have a slower heart rate and breathing rate, and to appear quiet and sleepy. Baby will receive nutrition through intravenous (IV) therapy.

Treatment cycle:
1) Rapid cooling – cool the baby to 33.5 ˚ – 34.5˚ from 37.5˚.
2) Constant temperature phase – maintain the temperature for 72 hours
3) Slow re -warming: Increase baby temperate by 0.1˚ to 0.2˚ per hour till it reaches 37˚.
4) Monitor the baby for next 24 hours for thermal maintainence.

Introducing Brammi..

We are gratified to see how well clinicians are taking efforts to save these precious lives. Contributing to HIE therapy, Phoenix came up with ingenious servo controlled cooling system – “Brammi”. The unit is designed in such a way complete treatment cycle is taken care. The system maintains 33.5˚ for 72 hours and immediately starts rewarming at pace of 0.1˚ to 0.5˚
Brammi’s intuitive feature helps to closely monitor baby with graphical representation of data and comes with safety parameters. The patient data along with name can be ported out through USB. Understanding the treatment has to start within 6 hours of birth, the unit is built light weight (portable) with 3 hour battery back up for easy transportation. Cool the baby, anytime – anywhere.

For more information on Brammi please contact any phoenix representative.
Source : ncbi.

 

All about Neonatal HIE

HIE (Hypoxic Ischemic Encephalopathy ) is one of the leading causes of Neonatal death.
Every year roughly 10 to 60% babies with HIE die in new born period. Atleast 25% of HIE babies receiving delayed treatment suffer neuro developmental issues. 

What is HIE?
HIE stands for Hypoxic Ischemic Encephalopathy
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HIE occurs because the baby lacked oxygen or blood flow around time of birth. Eventually, causing brain injury and can result in cerebral palsy and other cognitive and developmental impairments.
Several scientific studies have proven decreasing the body temperature reduces neuro damage.

HIE therapy :
Hypothermia therapy is usually carried out with a cooling system.Therapy usually begins within 6 hours of birth and lasts for next 72 hours. The therapy phase maintains few degree less than body temperature. This phase slows down the metabolic rate of cells. The baby is monitored in therapy phase until treatment stabilizes brain cells preventing further damage. Finally baby’s normal body temperature is slowly regained in 6-7 hours of span.
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Stay tune for next post on HIE.

All about your Baby’s first cradle – The incubators

A neonatal incubator is a closed medical equipment with regulated temperatures and infant friendly environment. The temperatures are regulated usually between 35.5 o c and 36.6 o c. It helps a newborn to adjust to the normal parameters of the environment such as air, temperature, humidity, etc. The main purpose of it is to take care of those premature babies or other ill affected or disabled ones. It is usually made available in the pediatric hospitals and neonatal intensive care units.

Where It All Began…

The story of Babies’ first medical cradle began in 1903; when Dr. Martin A. Couney, a physician and pioneer in Neonatology worked hard to save his premature daughter by inventing incubator for helping her survive. He wanted to save many more lives who were suffering just like her daughter. Unfortunately, his first attempt was not financed by any banks. But that didn’t discourage him. He took his plan forward by exhibiting his invention before public and made them aware about the importance and functions of incubators. He made sure that the treatment for his pediatric patients was free of cost and none of them died. The exhibition was a massive hit in his career with a daily walk in about 3600 visitors and this lead to the acceptance of the concept “incubators”  and hospitals were in great demand for the same.

What Does It Do?

Favourable conditions for living-

The most conspicuous property of an incubator is to provide favourable conditions of living for the infants during the first few days after their birth. As it is noise proof, it allows the infants to get plenty amount of rest and relaxation. The design of incubators is such a way that it protects the infants from the common flu and related symptoms. The enclosure makes sure that the infants are kept out of all pollutants and allergens etc.

Facilitates oxygenation

Incubators facilitate Oxygenations which facilitate breathing. It is beneficial for treatment for infant respiratory distress syndrome, which is identified as the major cause of death in infants. Following are the oxygenation techniques:

  1. Using nasal cannula- A tube placed right in front of the nostrils that aids in supplying oxygen directly into the nostrils.
  2. Using a plastic hood – it’s placed over the infant’s head, which creates an oxygen supplying environment.
  3. Using continuous positive airway pressure, or CPAP- Its a type of respiratory device (a small mask or nasal prong) that fits in the infant’s nose. It is mainly for the treatment of premature infants

Monitors Health condition-

The health condition of the infant is monitored using the following instruments inbuilt in the incubator such as:

  1. Cardiac monitors
  2. Brain-scan equipment
  3. Blood-monitoring equipment
  4. Thermometers and other instruments

(For observing vital signs)

Body temperature and heart rates of the infants can be accurately measured inside the incubators as it has a closed and a sound proof environment.

Things to Make Sure…

  1. The incubator should be sterile, protecting infants from germs and minimizing the risk of infection.
  2. The monitoring instruments inside the incubator should be thoroughly checked for its proper functioning before the baby is placed in it.
  3. The oxygenation devices should be sterile and should perform the exact function in order to prevent infections and lack of oxygen supply.
  4. Humidity is maintained at 50 to 60 percent. It could be raised high as 85 to 100 percent, depending upon the medical conditions of the newborn.

The yellow killer

 A newborn looks gorgeous and a little yellow!?  Why yellow?

Yellowing of eyes and skin are common symptoms of jaundice. Jaundice is a condition in which there is an excess of a pigment called bilirubin in the blood. Bilirubin is a natural by-product of red blood cells breaking down. It is processed by the liver and discarded through the stools. A mild level of jaundice is normal in a newborn and usually passes when there is a well-functioning liver. But the liver of a premature baby is not sufficiently developed. So bilirubin starts building up in the blood stream of the premature infant. If left untreated, the jaundice can cause brain death, also called kernicterus, or interfere with the development of the brain, leading to cerebral palsy.

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The treatment for jaundice was discovered in 1956. Sister Jean Ward, from the Premature Unit of Rochford General Hospital, in England, believed sunshine and fresh air had restorative properties for babies. She would wheel the babies in her care out on warm summer days. Once Dr. R.H. Dobbs noticed that the uncovered area of a baby was less yellow than the covered area. He questioned Sister Ward about this, and she reluctantly admitted to taking the baby out in the sun. She suggested that the exposure to the sun was the reason for the baby’s colour. Around the same time, the biochemist of the hospital had left a few samples of blood on the windowsill and measured the bilirubin level in them a little later. The level had dropped.

Thus it was found that light affected bilirubin. After intense research, the paediatricians of Rochford General Hospital published their findings in the Lancet in 1958. And the treatment for jaundice, ‘phototherapy’, was discovered. Light became an effective agent in the treatment, reducing the number of exchange transfusions drastically. Eventually, with the growth of technology, light bulbs and fluorescent tubes were used. Today LEDs producing light in the blue spectrum have been found to be the most effective treatment for jaundice.

D-rev has partnered with Phoenix Medical Systems to eliminate the effects of jaundice worldwide by 2022. D-rev is a non-profit organisation whose mission is to design and deliver quality medical equipment at an affordable cost. D-Rev identified Phoenix to be on the same page with them in terms of their mission. D-Rev partnered with Phoenix to manufacture and market the Brilliance Pro phototherapy unit globally. At the time this is being written, 415,900 babies have been treated using Brilliance Pro.

To understand how Phoenix and D-Rev are working on achieving their goal, visit

http://d-rev.org/projects/newborn-health/

Infant resuscitation -Providing support for life at a fast pace

The minute after the birth of a newborn is a period of anxiety for parents and health providers, as the newborn undergoes rapid and significant physiological changes to adjust to the environment outside the mother’s womb.

It is a fact that every year around 38% of all the babies born are asphyxiated at birth. How does this happen?

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Until an infant starts breathing air, he or she depends on the placenta and umbilical cord for oxygen. At birth, the baby’s lungs are filled with fluids. And they are not inflated. After delivery, the baby takes the first breath. In practice this sounds like a gasp. Normal breathing is usually established right away. Once the baby starts breathing, the fluid drains away from the respiratory system.

Unfortunately, not all infants can start breathing air on their own. The normal transition from placenta and cord to lungs can be interrupted, and often it is. If this happens for 50–70 seconds, a hypoxic stage (no-breathing condition) is reached. Considering this, it may be argued that the most stressful period for the infant.

Fortunately, infants can be revived through resuscitation, a process in which the baby’s normal lung functioning is established thorough artificial breaths. Effective performance of resuscitation has reduced the infant mortality rate the world over. Resuscitation, a basic procedure, has saved millions of babies.

Life-saving resuscitation

A baby may get asphyxiated due to reasons such as clogging of the lungs with amniotic fluid, which blocks the passage of air in the lungs. A standard resuscitation protocol is in place for clinicians to ensure the safety of infants. The life of the newborn is supported by a few simple resuscitation steps. The entire sequence of steps is carried out very quickly.

Apart from being small, a newborn baby, particularly a prematurely born baby (a ‘preemie’) is wet. The first step according to the resuscitation protocol is to provide warmth to baby. Wipe the baby dry and wrap him in a dry cloth. Then the fluid in the lungs is removed by suction. Once the airway is cleared of fluid, resuscitation is carried out. The lungs are mechanically aerated in a process known as breaths. A blend of oxygen and air is supplied to the baby through a bag-and-mask unit in this process. This opens up the tiny air sacs of the lungs, known as alveoli, which are essential for gas exchange. The whole process occurs in few minutes from the birth.

Low cost – Innovation in India

India is an ideal place for innovation, with 70% of the population being rural and 30% urban, with many strata of society. Any innovation needs to provide a solution for the majority. Developing country faces a number of issues such as a lack of skilled trainers and the facilities being minimal. While designing products, its important medical equipment provides solutions that address these issues.

Simple, easy to use, low cost and effective equipment addresses for affordable care with minimal training.

Explore the Phoenix website to learn about a range of resuscitation products, including Neobreathe, the world’s first foot-operated resuscitation system and the infant resuscitator, and other neonatal and maternal products.

https://www.phoenixmedicalsystems.com/infant-care/respiratory/