Premature babies and the fight to stay alive

BABIES are celebrated when they are delivered, but when they are born prematurely, it becomes distressing for the entire family.

A premature baby (or preemie), is born before the 37th week of pregnancy. Because they are born too early, preemies weigh much less than full-term babies. They may have health problems because their organs did not have enough time to develop and need special medical care in a Neonatal Intensive Care Unit (NICU), where they stay until their organ systems can work on their own.

Premature births can be tied to many factors such as young age of pregnant mothers, inadequate feeding of pregnant women, lack of antenatal care, child bearing among teenage mothers who are under-age and whose bodies are not yet fully matured for child-bearing.

Nevertheless, the question that has often been asked whenever there are challenges over the management of pre-term babies is: Are there well stocked hospitals with adequate equipment to manage such babies?

Two of out three triplets who were delivered in Kalallawa Village of Tarmuwa Local Government Area of Yobe State died at the Maryam Abacha Maternity Hospital in Damaturu last month due to what experts described as lack of care, infection and hunger.

The triplets, who were in the village for three days, were later brought to Damaturu for medical attention but stayed for an additional three days without being attended to.

According to reports, the hospital has no incubator, paediatric nurses or equipment necessary for their upkeep, a development which aggravated their troubles and their 25-year-old mother who is still in comma.

According to a report, Professor Ambe Joseph, a consultant paediatrician at the University of Maiduguri, who was at the hospital when the children died, said the two boys lost the battle to stay alive due to infection, cold and hunger.

According to him, they were supposed to be in an incubator. They were also supposed to be fed every two hours for them to be in stable condition.

The mother of the triplets and the remaining baby girl have been transferred to the Sani Abacha Specialist Hospital, Maiduguri while the Ministry of Religious Affairs, Borno State has donated N25,000 to procure blood for the mother.

“We cannot take them to the University of Maiduguri Teaching Hospital now because the mother is not in stable condition,” Joseph said.

Reacting to this development, A Consultant Haematologist and Oncologist at the Department of Paediatrics, College of Medicine, University of Lagos/Lagos University Teaching Hospital (LUTH), Idi-Araba, Dr Edamisan O. Temiye, told the Nigerian Compass that incubators alone do not make a premature baby to survive.

He explained that the incubator is to keep the baby warm.

“Besides, you need somebody who is an expert in operating the incubator and who knows how to manage premature babies to handle them,” he added.

Temiye, who is also the chairman, Nigerian Medical Association (NMA), Lagos State branch said: “You may also need other equipment alongside the incubators, like a special respirator we use for the premature babies when they cannot breathe because many premature babies just stop breathing after a very long time and thereafter, they die.”

A Consultant Paediatrician at the Lagos University Teaching Hospital (LUTH) and lecturer at the College of Medicine, University of Lagos, Idi-Araba, Lagos, Dr Chinyere Ezeaka, said premature babies were the major cause of mortality of newborn in Nigeria. Prematurity and its complications account for up to 25 per cent of deaths in newborns following asphyxia (inability to cry after birth) and infection.

Referring to a current data issued by the United Nations Children's Fund (NICEF), Dr Ezeaka disclosed that about 700 newborns die in Nigeria everyday.

According to her, death in newborns is one of Nigeria’s most neglected health problems because “we have many programmes instituted for under-five mortality, older children - malaria treatment, immunisation, etc but not much has been done for newborns.

Following the current Millennium Development Goals (MDGs) and the high rate of deaths in newborns, Dr Ezeaka says it has been shown that if Nigeria does not reduce newborn mortality, “we will not be able to achieve MDG 4, which is the reduction of child mortality in this country and if Nigeria does not achieve MDG 4, it is very unlikely that the rest of Africa will achieve MDG 4.”“According to her, Nigeria plays a pivotal role in newborn deaths because it records the highest in Africa and this follows very high maternal mortality.

She explained that the mother and the newborn are inextricably linked such that anything that affects the mother also affects the newborn.

“When these newborns die, 75 per cent of them die on the first day of delivery, showing that whatever is killing them has to do with birth and the circumstances of delivery,” the consultant said.

However, in managing premature babies, Temiye said, “you need an equipment to keep them breathing. You need monitors to keep them breathing before the doctors come and attend to the baby.”

He also noted that there are people trained for handling such cases and they are called paediatricians and neunotologists, that is, newborn specialists.

According to him, the problem is that, many hospitals in Nigeria do not have incubators.

“They do not have trained personnel who are specialised in handling the premature cases and that is a big challenge in our country.

“Incubators costs a lot of money and to keep the premature babies alive costs a lot of money if they are kept for long. It is very expensive and many families cannot afford it. Of course, it is only a few private hospitals that have incubators because many cannot afford it.”

Similarly, Temiye highlighted the Kangaroo Mother Care (KMC) method, as another method that may be resorted to in caring for premature babies in the absence of modern equipment such as incubators, monitors, among others.

The KMC method is a practice of providing care for all newborns, especially premature babies in Kano, where the KMC is currently being operated in pilot stage. This practice integrates skin-to-skin Contact-Kangaroo Position between mother and baby, early initiation of exclusive breastfeeding, strict observance of hygiene, among others.

Temiye noted that though the KMC helps to keep the babies when they are warm, it is not the optimum for a baby who is born premature.

Therefore, he noted, that the best way to preserve premature babies is to leave them in the womb until the baby is old enough to be born.

Temiye disclosed that premature birth is caused by various factors which include if nature cannot keep the baby any longer in the womb.

Similarly, if it is a multiple-baby pregnancy, it most likely that the baby will be born so quickly unlike when you have one baby in the womb because the space there will not be able to keep them for too long before bringing them out.

According to him, sometimes, when the neck of the baby is weak, the mother may have premature delivery. Also, when the mother is involved in an accident, have malaria or the mother and the baby are anemic, the mother could give birth to a premature baby.

More so, Temiye noted that when a woman is prone to deliver a baby prematurely, it should be managed by a gynaecologist, thereby keeping it alive. He added that if the baby cannot stay in the womb anymore or when it is not safe for the mother and the child, the baby should be referred inside the mother before the mother delivers to where incubator care is available.

Temiye says it is wrong to deliver a baby who is premature in one hospital and then transfer the baby over long distance to another hospital where incubators are available. This practice may expose the baby to cold, which may injure it before it gets to another hospital.

He said: “The best way is ensuring that the baby is given birth to in a hospital where they have incubators and not taking it to where there are no incubators.”

The NMA chairman in Lagos added: “A lot of doctors know that they do not have incubators in their hospitals, yet they deliver premature babies in their hospitals and they will just wrap these babies and tell the parents to take the babies to LUTH or Lagos State University Teaching Hospital (LASUTH), Ikeja, prompting the parents to travel over a long traffic that will waste the baby's life.”

He noted that the NMA has been reminding the government about its responsibilities to the citizens.

“We need the support of the populace to put pressure on our government to put enough money in the health sector and provide more infrastructure for us. What is happening is that in this country, the government does not see health as an important sector. They refer it to be a social responsibility,” Temiye said.

According to him, the government says the health sector does not contribute to the economy.

“However, they do not know that a healthy population grows the economy but they expect to generate money in return when they invest in the sector. The hospital is meant to keep people alive and it helps people to live a healthy life that is unquantifiable compared to the money the government wants them to return,” he said.

The consultant advised mothers that as soon as they get pregnant, they should meet a gynaecologist and they should ask questions because some patients do not ask questions.

“For instance, mothers should confirm if the hospital has an incubator or not, and if they do not have, such mother should demand for a transfer to a hospital that has an incubator where they can deliver. This will also help in reducing the amount of premature baby lost in the country,” Temiye said.
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