Times of India
23, February 2010
By Malathi Iyer

Premature Births May Be On The Rise, But Better Technology & Medicines Give Neonates A Second Lease On Life
Surviving The Early Months
According to doctors, while tertiary centres that specialise in high–risk deliveries would see almost 30% premature deliveries, most other centres, too, would have roughly 10–12% premature deliveries in a city like Mumbai Ten years ago, over 70 to 80% neonates would not have a fighting chance and the remaining would have to live with blindness, deafness or mental retardation.

She is barely 24 hours old, but in the centre of a debate. Her parents Rajesh Khake, a peon with a legal firm, and wife Rupali feel she was born 22 weeks of pregnancy, but doctors are not so sure. “The baby seems 24 to 28 weeks old,” says Dr Pallavi Saple, who heads the paediatrics department of the state–run Cama Hospital.

What is not open to debate is, however, the fact that the 750–gram premature baby has a much better chance to survive now than, say, a decade back. “As a referral centre for mother and children, we get premature babies all the time. While those born before 24 weeks have a very slim chance, we do now have the knowledge to save many of our premature babies,” says Dr Saple.

According to the World Health Organisation, premature deliveries account for less than 10% of all deliveries. But as neonatologist Dr Preetha Joshi of Kokilaben Ambani Hospital in Andheri says, “Premature deliveries are on the rise for whatever reasons beginning from stress.” She makes a classification here: while tertiary centres that specialise in highrisk deliveries would see almost 30% premature deliveries, most other centres would see roughly 10–12% such deliveries in a city like Mumbai.

Until a decade back, most premature babies would linger around for a few hours or even months with ventilator support with poor prognosis. “The morbidity and mortality attached to premature babies was indeed very high until a decade back. Over 70 to 80% would not have a chance and the remaining would have to live with blindness, deafness or mental retardation,” said Dr Bhupinder Avasti, paediatrician and neonatologist at Lilavati Hospital in Bandra.

The change, say doctors, is due to the emergence of better technology and availability of medicines, especially their generic versions in the Indian market. A senior doctor recalls how the old ventilators would in 50% of the cases cause permanent lung damage. Now, there are high–frequency ventilators and warmers that almost mimic the mother’s womb, he said.

The Ambani Hospital recently acquired a high–frequency ventilator that can deliver nitric oxide gas to dilate stressed–out blood vessels.

Dr Avasti lists out the mega–wonders that have made a world of difference in the NICUs (neonatal intensive care units). “A drug comprising the molecule surfactant is now available easily in India. Earlier, we had to depend on the grey market to provide this drug. The drug helps prevent neonates from developing Hyaline Membrane Disease (HMD), which is the most common side–effect of premature births,” he said. Because of the deficiency of surfactant, the outermost wall of the lung gets lined with dead cells, causing the lungs to collapse.

Secondly, there are better machines—be it warmers or ventilators—that are flexible and don’t cause physiological damage to the neonates. “Third, we have new–generation antibiotics that can ward off infections or sepsis,” said Dr Avasti.

Nowadays, nutrition in intravenous doses for neonates is also easily available. From glucose to fat to proteins, all nutrients are available in IV form, making it easier for doctors to keep the neonates healthier.

But with new technology and antibiotics, a neonate’s survival rates have increased

• High–frequency ventilators and warmers that almost mimic the mother’s womb. There are ventilators that can deliver nitric oxide gas to dilate stressed–out blood vessels
• New–generation antibiotics and drugs that can ward off infections or sepsis
• Easy availability of drugs comprising the molecule surfactant, which prevents neonates from developing Hyaline Membrane Disease (HMD). Because of the deficiency of surfactant in premature infants, the outermost wall of the lung gets lined with dead cells, causing the organ to collapse.