Khyati Agrawal Gupta
Nearly 3.5 million babies are born prematurely in India every year, yet very few parents are prepared. When my son was born at seven months & spent nearly 20 days in Dr. Pandita’s NICU, I witnessed firsthand the expertise required to save premature babies.
Dr. Aakash Pandita is Director, Paediatrics& Neonatology at Medanta Lucknow. An ICMR awardee, a gold-medalist & President of the regional National Neonatology Forum, he has decades of experience in managing extremely premature babies & sick newborns. According to him, the biggest preventable cause is infection- especially dental or urinary tract infection, during late pregnancy. Interpregnancy interval of under 2 years, poor maternal nutrition & smoking rank second.
“But if it cannot be prevented, a mother with threatened preterm labour should be shifted to a Level III NICU with a neonatologist who has experience successfully delivering, managing & discharging premature babies regularly. Next are antenatal steroids. A mother delivering before 34 weeks should receive 4 doses of Dexamethasone to prevent complications of brain bleeds, infection, abdominal swelling & need for ventilation by 30-50%.” Few expecting parents know that these interventions exist. “Magnesium Sulfate, under 32 weeks, is critical to prevent cerebral palsy in the child. Lastly, avoid Amoxiclav antibiotics as they can cause perforation of intestine in the fetus.”
He explains the ‘Golden Hour’. “Management during the first 60 minutes largely determines a preterm baby’s future outcome, including mortality & morbidity. Doctors are racing against time to smoothen the transition from fetal to extrauterine life. Every step is a challenge. Their temperature falls rapidly because their skin is thin & they lack brown fat. Stabilising glucose, circulation or even a single organ can require multiple specialists. For example, achieving regular breathing may require CPAP, intubation, ventilation & surfactant to expand the lungs. For circulation: continuous IV fluids, inotropes, etc. Each second counts.”
When should a preemie be shifted to a higher-level NICU? “Escalating respiratory distress, rising CRP, bleeding, falling platelets, feed intolerance, abdominal distension, any surgical conditions, persistent jaundice or unstable sugars are danger signs requiring early transfer.” Can a Level IV NICU change the outcome? “It’s not about the machines but the expertise. A super-specialist neonatologist, not just a pediatrician, with a dedicated team are available round the clock because preterm care is a constant process. A Level IV NICU also offers adequate nursing, strict asepsis protocols, high-end ventilators, total parenteral nutrition & immediate access to microbiologists & multiple super-specialties.”
Even after discharge, many preterm babies are readmitted. “The commonest reasons are viral infections, especially RSV, now largely preventable with monoclonal antibodies. Others include jaundice, hypothermia, feeding difficulties, choking, vomiting & dehydration, particularly during summer.” Age-old traditions still send newborns back to the hospital. “Giving gutti, gripe water or even water- anything other than milk- in the first six months can injure the kidneys. Kajal can cause lead poisoning & infections. Applying cow dung to the umbilical stump can cause severe fulminant sepsis. Avoiding colostrum, skipping vaccinations & delaying medical care worsen the risks.”
More premature babies are surviving today. What’s changed? “Firstly, the mindset. Parents & neonatologists now believe even a 400–500 g baby born at 24-26 weeks can survive. Today there is better technology, evidence-based medicine, protocols, sophisticated machinery & trained neonatologists. Care is also gentler- from ventilation & feeding to infection prevention.” Lastly, I ask Dr. Pandita: What should hospitals mandate to prepare families for premature births? “Antenatal counselling,” he says promptly. “A pre-delivery consultation with a neonatologist, with handouts or videos explaining likely complications & treatments, hospital stay & costs. Sessions on Kangaroo Mother Care, expressing & storing breast milk can help greatly.”
