80
The Newborn Prof Sheila Karan A doyen and pioneer of Neonatology
The Newborn
Prof Sheila Karan
A doyen and pioneer of
Neonatology
Reminiscing Contextual Evidence Based
Transformative Newborn Care Journey
1966-2019
Dr. Santosh K Bhargava
Founder President
National Neonatology Forum
15th December 2019
Hyderabad
Dr Sheila Karan Oration
National Health MissionMinistry of Health and Family Welfare, Government of India
Current Status of key RMNCH+A/RCH Indicators
*SRS 2017
Indicator Current
status
National Health Policy
Target
SDG 2030
Target
Maternal Mortality Ratio
(SRS 2014-2016) 130 100 by 2020 <70
Neonatal Mortality rate* 23 16 by 2025 <12
Infant Mortality Rate* 33 28 by 2019 -
Under 5 Mortality Rate* 37 23 by 2025 ≤25
Total Fertility Rate* 2.2Replacement level
fertility -
0
20
40
60
80
100
120
140 India
National Goals Neonatal Mortality
Current 23
2025 16
2030 <12
Decadal Trends in Neonatal Mortality 1901 - 2018
Newborn Care
Pre-Independence 1900-1947
Highlights
Neonatal Mortality rate 104 (Mortality curve 100-150)
Newborn a mere appendage of mother and cared by those who delivered
The birth or death of a Newborn considered God’s wish
Almost always delivered at home by traditional birth attendant
Birth weight ??
Causes of death ??
Neglect of newborn
Harmful traditional practices
Religion, Faith and beliefs
Religious Faith and Beliefs
Harmful Traditional Resuscitation Practices
Discarding
Colostrum
Potential Causes
of Neonatal
Deaths
1900-1950 &
beyond
Newborn Care
1950-1960
Neonatal Mortality Rate 80
Adoption of Bhore Committee
recommendations by Government
Newborn care in very nascent stage but
beginning to arrive at few hospitals
Primary maternal and newborn care by
mid wife and ANM
Newborn Care
1950-1960
Defining the Newborns
Controversies
Prematurity and Low Birth Weight
Definitions ??
Seminal work of Arvo Ylppö. ―we define as preterm those
neonates born with a birth weight less than 2,500 grams.‖
1909
American Academy of Paediatrics fifth annual meeting in
New York on June 7, 1935. The proceedings highlight the
acceptance and spread of Ylppö’s definition of prematurity
(< 2,500 grams)
In 1948, the World Health Assembly proposed an
international definition of a premature infant as one with a
birth weight of less than 2,500g, a gestational age of less
than 37 completed weeks, or both
A beginning of debate for redefining birth weight cut off point for prematurity in India
LBW problem prevalence 30-60%
Newborn Care
1960-1970Newborn Mortality 80
Ghosh S & Daga S:Standards of
Prematurity in North Indian Babies
Ind J.Child Health1962:11, 210
Ghosh et al; Standards of Prematurity in North Indian Babies
Journal 0f Pediatrics 1962:11,210
International Definition 5 ½ lb (< 2.5 Kg)Evidence
• Distribution by birth
weight
• Mortality
• Asphyxia
• Feeding problems
• Infection rate
Recommended Indian cut off
Weight 4 lb ( 2.0 Kg) and It was adopted and used for all clinical
and research purpose.
But Now we use less than 2.5 kg as definition for international
comparisons but have our own norms for clinical care
The Decade 0f 1960-1970
Newborn Care gets attention• The beginning of my journey with my mentor
Prof Dr Shanti Ghosh in 1966 at Safdarjang Hospital,New Delhi
Safdarjang Hospital, New Delhi Dr Shanti Gosh Dr Santosh K Bhargava
• Prof Bhakoo at PGI ,Chandigarh and Prof Sheila Karan At Nilofur Hospital Hyderabad also
begin their crusade for newborns
PGI Chandigarh
Dr O. N. Bhakoo
Nilofur Hospital, Hyderabad
Dr Sheila Karan
Historical Development of Newborn
Care in The Country Exemplified by
Development of Newborn Care
at Safdarjang Hospital
1966- 2000
Newborn Care
Safdarjang Hospital, New Delhi
1965-1966
Situational Analysis
The beginning
1966
Some Far reaching policy changes
Reorganizing Newborn Care
1966
Safdarjang Hospital,
Obstetric & Newborn Wing
Rooming In
Practice
Delivery of Newborn Care
Warming Newborns with
Electric Bulbs
Discarding hot water bottles
Transporting the Newborns
No transport Incubators
Exchange Blood transfusion
cannula with Liver Biopsy
needle for Innovation
No Triways or catheters
available
Development of indigenous instruments as severe
restriction on foreign exchange
No imports allowed : 1960’es
Scalp Vein Needles
Newborn Care Initiatives
Late 1960’es - 1970’es
Focus on infant mortality
Beginning of awakening of newborn needs
WHO and Government of India Newborn workshop
1969
The First National Workshop by
WHO & Ministry of Health
Government of India
At Safdarjang Hospital, New
Delhi
Dr Beryl Corner from Bristol, UK
as WHO Consultant
Newborn Care
Safdarjang Hospital, New Delhi
1970-1980
Reorganisation
Progressive Changes
Training & Multi
disciplinary
approach
Newborn care
1970’es
Happenings
• Problem identification
Prioritisation, evidence and
solutions
• Hypothermia & Cold Injury
• Low Birth Weight
• Survival & Mortality
• Sepsis
• Pneumonia
Equipment becomes
available overtime
Hypothermia
&
Cold Injury of Newborn
One of our most important contribution in recognising and reporting
hypothermia and primary cold injury as perhaps one of the most important
contributory cause to neonatal morbidity and mortality in the country***
The beginning of warmers
***Ref: Bhargava S.K., Kumari S., Ghosh S., and Sanyal S.K.: Primary cold injury
in the new born., Indian Pediatr. 8:827,1971
Warmth by Electric Bulb Warmer : The most essential
primary equipment at all levels of
Newborn care
Low Birth Weight
Birth Weight
Gestation
Foetal Growth
Foetal Growth Curves
1967,1968
First Published Indian Intra-Uterine Growth:
Pediatrics:1971, 47,826
Monitoring Fetal Growth all trimester specially 3rd
Significant differences western and Indian
population
• Fetal growth deviation from 34
weeks
• Plateau of fetal growth 37 weeks
• Shift of gestation curve to left
• Significantly more births at 36,
37, 38 weeks as against 39 and
40 weeks in western literature
Comparison with Australian &
Indian studies
Classification
by Birth Weight, Gestation, Foetal growth
AGA, SGA, LGA
Appropriate referral for care
Ref: Bhargava S.K., Ghosh S..: Nomenclature of the
newborn, Indian Pediatr 11:443, 1974
Outcome &Sequelae of Birth Weight ,Preterm, IUGR
Survival, Morbidity, Growth, Development
Survival
Bhargava S.K., et al Ghosh S.: Birth weight, gestational age
gestational age and growth pattern in babies with a birth weight
of 2000 gms or less Indian Pediatric. 8:736, 1971
**** Awarded S.T. Achar Gold Medal 1971
Comparison of Morbidity in Preterm and Small for Date Infants
MorbidityPreterm
(1974)
Small for
date (1974)
INFECTIONS 36.3 20.3
PULMONARY HEMORRHAGE 9.04 5.6
INTRA CRANIAL HEMORRHAGE 805 1.9
HYPERBILIRUBINAEMIA 8.3 3.7
ANOXIA 6.9 5.7
PNEUMONIA 5.5 11.3
HYPOGLYCEMIA 4.3 13.2
RESPIRATORY DISTRESS SYNDROME 2.3 0
CONGENIAL MALFORMATIONS 4.2 1.9
Perinatal & Neonatal MortalityCauses –remain almost same and unchanged
1.Ghosh S., Bhargava S.K. Sharma D.B., Bhargava V., Saxena H.M.K.: Perinatal mortality,: A preliminary report on a
hospital based study, Indian Pediatr 8:421,1971
2. Bhargava S.K., Kumar A., Bhargava V., Saxena H.M.K., Sagreiya K., and Ghosh S.: Perinatal mortality: Clinico
pathological causes in 643 autopsies. Indian J.Med. Res.64: 513,1976
Infection, Age at Death & Early Discharge****
Ref: ****Bhargava S.K., Kumari S., Bawa S., Chaudhury P., and Lall U.B.Early discharge
of infants with birth weight of 1800 gm. Or less,
Indian Pediatr.17:425-429,1980
Implication : Accepted as low birth weight early discharge policy
Observed Deaths in Late Neonatal
Period & Infection – Suspected
Nursery infections
Early Discharge Showed to be
beneficial with no effect on later
survival
Early Neonatal Sepsis & Pneumonia
Provisional Diagnosis
by Gastric Aspirate Examination
Lall U.B., Bhargava S.K., Kumari S., Kumar A., and Ghosh S.: Study of gastric smear
examination as an index for detection of early neonatal infection Indian Pediatr
12:673,1975 ****
Bhutani V., Bhargava S.K., and Ghosh S.: Gastric aspirate cytology in neonatal pneumonia, Current Top. In Pediatr, pp. Interprint, Mehta House, 16 A, Naraina II,NewDelhi,1977**** Awarded S.T Achar Gold Medal 1974
Became Side Lab
Tests foe institution of
antibiotics till detailed
reports became
available
National Recognition
Sheila Karan ―Necrotising Enterocolitis
in Newborn‖- Paper Awarded Dr S.T. Achar
Gold Medal IAP Conference 1973
Causes
No. of cases Percentage
Pyrexia- Continuous 28 80.0
- Intermittent 7 20.0
Weight Loss- < 10% 9 25.8
- 10-20% 22 62.8
- > 20% 4 11.4
Gasterointestinal- Abdominal distension 30 85.7
- Regurgitation of feeds 14 40.0
- Diarrhoea 5 14.3
Neurological- Cerebral irritability 18 51.4
- Neck retraction and hypertonia 7 20.0
- Convulsions 1 2.8
Respiratory- Tachypnoea 16 45.7
Bleeding- G.I.T 3 8.5
- Pulmonary 1 2.8
Heat Injury in the NewbornAn unrecognized cause of morbidity & Mortality
Heat Injury In Newborns
• Reported by observing illnesses and deaths in newborns in 1974 in Delhi Heat wave.
Temp above 42.5 degrees Celsius causes onset of
illness of Heat Injury***
Implications
* Started the Air Conditioning of Nurseries
***Ref: Bhargava S.K., Mittal S.K., Kumari S., and Ghosh S.,: Heat injury in the newborn, Ind J.Med.Res 65;688,1977
Government of India :
Initiatives by National Neonatal Workshops
I was fortunate to be asked to lead this initiative
by being the first Indian Neonatologist
Newborn care
Safdarjang Hospital
1980-1990
Newborn care
Safdarjang Hospital
1980-1990
The beginning of
Neonatal Intensive
Care in The
country
Blood
Gas
machine
in
Nursery
Transport
Incubator
• Ventilators
• Transcutaneou
s and intra-
arterial
continuous
Monitors
• Open infant
care Incubators
• Others
National Neonatology Forum
Founded
1981
Safdarjang
Hospital
Founder
President
Prof Santosh K
Bhargava
Government of India , Ministry of Health & Welfare
Department of maternal and Child Health
First Official Publication of
The Govt. Of India on
Newborn
List of Participants
1. Prof. Indra Bhargava Convener
2. Prof. Ajit Mehta
3. Prof. (Mrs.) A. B. Desai
4. Prof. (Mrs.) A. Chakraborty
5. Prof P. Rajaram
6. Dr. D K Guha
7. Ms. Kanta Gupta
8. Prof S K Bhargava Member Secretary
9. Dr. Sudershan Kumari
Special Invitees
1. Dr. B N Haldar
2. Dr. P S Jain
3. Dr. (Mrs) S. Tejuja
4. Mrs. A Pandit
Bhargava I., Bhargava S.K., Mehta A., and Desai A:
Recommendations on Minimum Perinatal Care
A National collaborative study on Identification of High Risk Families,
mothers and outcome of their off springs with particular reference to
the problem of maternal nutrition, low birth weight, perinatal and infant
morbidity and mortality in rural and urban slum communities‖, 1980-83***
First Multi-centric Study of ICMR
Slum,Safdarjang Hospital, New Delhi : S.K.Bhargava, S.K.Das, Man Mohan
Rural, NIN, Hyderabad : Prema Ramachandran
Rural, Institute of Medical Sciences, Varanasi : Vijay Bhargava, Amod Prakash
Slum, Kolkata : S.P.Khatua, N.N. Roy Choudhary
Slum, Chennai : S. Jayam
Rural, Chandigarh : Anil Narang, A.N. Gupta, G.I.Dhall
*** Ref: ICMR Task force National collaborative study on Identification of high risk families
mother and outcome of their off springs and particular reference to the problem of Maternal
nutrition, low birth weight perinatal and infant morbidity and mortality in rural and urban slum
communities Indian Pediatr 1991, 28: 1473-1480
ICMR Multi-centric Study on
Regionalization of Perinatal Care
―A Concept of Rationalization of Perinatal Care‖
1981-83
Multi-centeric Centre
Safdarjang Hospital, New Delhi
JIMPER , Puducherry
Government Medical College, Ahemdabad
Safdarjang Experience
―A Concept of Rationalization of Perinatal
Care‖, 1981-83
Safdarjang Hospital Experience
Regionalization of Newborn Care
TRIAGE
SYSTEM
LEVEL – I
PRIMARY CARE
LEVEL – II
SECONDARY CARE
LEVEL – III
TERTIARY CARE
PRIMARY HEALTH CENTRE
Bharakala Primary Centre
Haryana
DISTRICT HOSPITAL
Civil Hospital, Gurugram
Haryana
REGIONAL NEONATAL CENTRE
Safdarjang Hospital,
New Delhi
Bhorakala Primary Center, Haryana
Gurugram Civil Hospital : Secondary Level IISafdarjang Hospital Tertiary Center Level III
Traditional Birth
AttendantTraining Birth Attendants
The Triage : Primary Centre : Bhoara kala Haryana – Civil
Hospital, Gurugram, Haryana - Safdarjang Hospital, New Delhi
• No
Communication
• No Transport
• Only coloured
referral letter
Regionalization of Perinatal Care
Referred By Level No. No Risk Confirmed
Referred Reached
T.B.A. II 2 1
III 8 6
10 7 7 Yes
A.N.M II 24 2
III 18 3
42 5 5 Yes
P.H.C III 1 1 1
TOTAL 53 13 13 Yes
Ref: Bhargava S.K., Rahman F., Arya H.V.,: Triage system of neonatal care: experience at Safdarjang Hospital, New Delhi Recommendations of education and training in neonatology, published by National Neonatology Forum, New Delhi.1982
Safdarjang Experience: Neonatal Referrals to Higher Level
Mid Arm Circumference
Bhargava S.K., Ramji S., Kimar A., Man Mohan, Marwah J., Sachdev H.P.S: Mid arm chest
circumference measurements at birth as predictors of low birth weight and neonatal
mortality in the community.
Br.Med.J 291:1617-19,1985
Mid Arm Circumference as Surrogate to Birth Weight
In Community. PHC & Home Delivery where weight could
not be recorded
Triage system of Newborn Care
As recommended by
• Government of India, Ministry
of Health and Family Welfare
• NNF accreditation committee
Level I Level II
Level III
Finally Recognition of the Need For Newborn
In The Country
The Government invites me in 1994 to write a National
Programme With following Conditions
1. I will write a programme consistent with national
needs and resources
2. The Government will accept he programme as our
programme – Good , bad, indifferent
3. The Government has funds limitation and I won’t ask
for Funds
4. They will discuss programme on one to one basis and
not in large group or delegation
5. I requested a day to speak to our NNF President Dr S.
Jayam if she would like it to be NNF – Govt Of India
Programme and I can go ahead on their conditions
6. Dr Jayam instantly responded positively and I
proposed the ― Essential Newborn Programme’’
which was accepted in Principle by the Government
Essential Newborn Care
Essential of Newborn Care
Components
Care of Birth
- Warmth- Initiation and Maintenance of adequate
respiratory effort- Prevention of Infection- Referral for appropriate care
Care During Immediate And Early Neonatal Period
- Warmth- Early breast feeding- Prevention of infection- Early diagnosis appropriate care and
referral of a sick newborn
Care Of Late Neonatal Period And Beyond
- Follow up- Intervention
GWALIOR 1994
The Decade of 1990’es & early 2000
1992 Child Survival and Safe Motherhood Programme*
1997 RCH Programme Phase -1 Essential Newborn Care part
of IMNCI (15.10.1997)*
2005 RCH Programme Phase -2 Essential Newborn Care part
of IMNCI (01-04-2005)*
*Essential Newborn Care became part of the
national child health programme and there
was a very active collaboration between the
Government of India and NNF and its state
branches
The Decades of 2001-2019
2005 National Rural Health Mission
2013 National Health Mission
2013 RMNCH+A Strategy
2014 India Newborn Action Plan
Essential Newborn Care
Part of all National MCH Programme from 1994
2005 –RCH Programme Phase‐2 (01‐04‐2005)
2005 –National Rural Health Mission
Facility Based Newborn care
Newborn Corners
Newborn stabilization Unit
Special Newborn Care Unit
2013-National Health Mission
• Provision of Newborn care Corners (NBCC) at all Delivery Points
• NBCC equipped for resuscitation and has trained personnel
• Care provided by ANM, Staff Nurses, Doctors, depending on the level of health facility
Essential newborn care & resuscitation
• Essential newborn care to all newborns by ASHA , those delivered at home or health facility
• 6 visits in first 42 days of life in case of institutional delivery, 7 visits in case of home deliveries
• Incentives to ASHAs @ 4.5 USD per newborn
Home based newborn care
• Sick Newborn Care Units at District Hospitals and tertiary health facilities
• Established at facilities with more than 3,000 deliveries per year
• Aim is to have one SNCU in each district of the country
• Newborn Stabilisation Units at FRUs; 4 bedded units
Facility based care for sick newborn
Provision of newborn care at
various levels of public health system
Sick newborns entitled to free healthcare ( included free emergency & referral
transport, diagnostics, drugs public health facilities), aim is to have ‘nil out of pocket’ expenses
Costed operational guidelines issued by Government of India available for Home Based Newborn Care
and Facility Based Newborn Care used across the States
2013: RMNCH+A
Is a platform for delivering adolescent, maternal, newborn and child
health in an integrated manner using a life cycle approach.
The new initiatives under this strategy that would impact
• Newborn health include • Antenatal corticosteroids in preterm labor
• Delayed clamping of cord at birth
• Skin-to-skin contact at birth and Kangaroo mother care
• Family participatory care
• Lactation management centres and
• Care beyond newborn survival under the Rashtriya Bal Swasthya
Karyakram
• Even though the coverage of many of the existing initiatives has been
been moderately high, there are concerns about the quality of delivery
delivery of these interventions and slow progress in the roll out of
the newer interventions
Pre-conception and Antenatal care
Care during labour and child birth
Immediate newborn care
Care of healthy newborn
Care of small & sick newborn
Care beyond newborn survival
Facility Based Newborn Care
Intervention Packages under INAP
Making Interventions More Effective - 2015
Dakshata
Empowering Providers for Improved MNH Care during Institutional Deliveries. A
Strategic Initiative to Strengthen Quality Of Intra- and Immediate Postpartum
Care. Operational Guidelines. Maternal Health Division, Ministry of Health and
Family Welfare, Government of India, 2015.
LaQshya
Another recent quality care initiative that has been launched by the NHM is
LaQshya in 2017
It is aimed at reducing preventable maternal and newborn mortality and morbidity
when associated with care around birth in labor rooms or maternity OTs.
Ref: 11th Common Review Mission: Report. National Health Mission, Ministry of Health
and Family Welfare, Government of India,2017
India Newborn Action Plan was Formulated in 2014
• Antenatal Steroids in Preterm Labor
• Delayed Cord Clamping
• Skin-to-Skin Care at Birth & Kangaroo Mother Care (KMC)
• Family Participatory Care
• Lactation Management Centers
• Care Beyond Newborn Survival
Beyond Survival
Developmental Disabilities
• 0-6 years 6.8% in Delhi *
• Cerebral Palsy in preterms 1-19% with decreasing gestational age
34-26 weeks**
• Mild Neurodevelopmental Dysfunction Preterm 40.5% (Excluding CP)
• IQ scores and intellectual disabilities significantly lower in preterms as
compared to term
• Language delay in IUGR***
* Indian Pediatrics 2009; 46: 575-578
** Clin Perinatologoy 2011, 38: 441-454
*** Indian Pediatrics Bhargava et al Indian Pediatr 2000
Beyond Survival
• Despite normal IQ low score
than term controls in maths,
reading, writing and spelling
<1000gms with normal
• Intelligence-low (=>1 SD)
test score were observed
in
– Reading=19-54%
– Maths = 24-69%
– Spelling = 34-61%
• School problems were statistically significantly seen even in 32-34 and 34-36 weeks gestation
Saigal S, den Ouden L, Wolke D etal. Pediatrics 2003;112(4):943-50
Gestation
in Weeks
<30 <27 <25-26
Severe
Visual
Impairment
1% 1-2% 9-12%
Severe
Hearing
Impairment
2-6%
.
Clin Perinatol. 2011;38:441-454
Specific Learning DisabilitiesVisual & Sensory Impairment
Improving
Survival : New
Initiatives
Family Participatory Care in India:
Partnering with families to care for small
and
sick new-borns
Mother and Her Newborn-
The Zero separation policy *
Mother & family involved in continuum
of neonatal care
*Dr Harish Chellani and
Colleagues
*Personal Communication
M-NICU: Mother as care provider *
*Personal
Communication Dr Harish Chellani and Colleagues*
Safdarjang Hospital, New Delhi
Impact of
National Newborn Care
Programmes
11th Common Review Mission (CRM)
• 2350 functional Newborn Stabilization Units (NBSUs) at the sub-district level at the first referral unit (FRUs) across the country, reveal
Low adherence to standard treatment protocols,
Indiscriminate use of antibiotics.
and often lack of ownership by the SNCU leadership.
Ref: 11th Common Review Mission: Report. National Health Mission, Ministry of Health and Family Welfare, Government of India,2017
•
Home Based Newborn Care(HBNC)
To be delivered by the Accredited Social Health Activist(ASHAs) was seen as an
intervention to reach the unreached and non-compliant mother-infant dias to address
the twin problems of maternal and neonatal mortality.
ASHA’S Performance
Current monitoring data suggest that 73% newborns receive some visits from an
ASHA and they have detected only 2% sick newborns
ASHAs have followed up only 6.8% of SNCU discharges till 28 d
and 1.4% till 1 y of age
The time spent during home visits by ASHAs is woefully inadequate to complete the tasks
envisaged during the visit, and quality of care is woefully inadequate
The inadequate supportive supervision of ASHAs for implementation of HBNC was
universally observed in all the states reviewed by the 11th Common Review Mission
[
Ref: Home Based Newborn Care. Operational Guidelines (Revised 2014). Ministry of
Health and Family Welfare, Government of India.
Care practices and neonatal survival in 52 neonatal intensive care
units in Telangana and Andhra Pradesh, India: A cross-sectional
studyClaudia Hanson , Samiksha Singh , Karen Zamboni, Mukta Tyagi, Swecha Chamarty, Rajan
Shukla, Joanna Schellenberg
• Cross-sectional study between 30 May and 26 August 2016
• Baseline evaluation in 52 consenting hospitals (26 public secondary hospitals, 5 public medical colleges, 15 private
tertiary hospitals, and 6 private medical colleges) offering neonatal intensive care
• Assessed the availability of staff and services, adherence to evidence-based practices at admission, and case
fatality after admission to the NICU using a range of tools. (including facility assessment, observations of
admission, and abstraction of registers and telephone interviews after discharge).
• In total, the NICUs included just over 3,000 admissions per month. Staffing and infrastructure provision were
largely according to government guidelines, except that only a mean of 1 but not the recommended 4 paediatricians
in public secondary NICUs per 10 beds
• The most common single cause of admission was preterm birth (25%) followed by jaundice (23%). Case-fatality
rates at age 28 days after admission to a NICU were 4% (95% CI 2%–8%), 15% (9%–24%), 4% (2%–8%) and 2% (1%–
5%) (Chi-squared p = 0.001) in public secondary hospitals, public medical colleges, private tertiary hospitals, and
private medical colleges, respectively, according to facility registers
• Case fatality according to postdischarge telephone interviews found rates of 12% (95% CI 7%–18%) for public
secondary hospitals. Roughly 6% of admitted neonates were referred to another facility. Outcome data were
missing for 27% and 8% of admissions to private tertiary hospitals and private medical colleges
• Our study faced the limitation of missing data due to incomplete documentation. Further generalizability was
limited due to the small sample size among private facilities
.
• Conclusions
Care practices and neonatal survival in 52 neonatal intensive care
units in Telangana and Andhra Pradesh, India:
A cross-sectional studyClaudia Hanson , Samiksha Singh , Karen Zamboni, Mukta Tyagi, Swecha
Chamarty, Rajan Shukla, Joanna Schellenberg
• (CONTD)
• Our study faced the limitation of missing data due to incomplete documentation.
• Further generalizability was limited due to the small sample size among private facilities
Conclusions
• These findings suggest differences in quality of neonatal intensive care and 28-day survival between the different types of hospitals, although comparison of outcomes is complicated by differences in the case mix and referral practices between hospitals.
ICMR Research in Newborns1958-1999
ICMR Research Grants Child Health
Community based & Operational Research
• Development & validation of simple criteria for diagnosis of neonatal sepsis
• Home-based management of neonates with sepsis
• Organisms causing neonatal sepsis & their antimicrobial sensitivity
• Surveillance of pathogens causing diarrhoeal diseases in children
• Epidemiology of childhood asthma
• Testing of efficacy of available interventions for asphyxia
• Home-based management of LBW neonates
• Care-seeking behaviour of families for their sick neonates and impediments to
early care-seeking
• Traditional beliefs & practices in newborn care in different communities
• Development of low-cost primary newborn care technologies :
- mouth-to-mask resuscitation & kangaroo mother care
• Impact of bacterial vaginosis & UTI on the incidence of prematurity/LBW
• Association of LBW with maternal energy expenditure, tobacco abuse
nutritional deficiencies, malaria & household smoke; & interventions
(single or in combinations) aimed at reduction of LBW
• Prevalence of genetic disorders & birth defects in different communities
• Status of newborn care services at the secondary level
• Involvement of Panchayat raj institutions (PRIs) in implementation of the
RCH programme
ICMR Research Grants Child Health
Neonatal Research papers 2001-2019
• Neonatal sepsis
• Hemolytic anemia
• Riga Fede Disease
• Longitudinal growth of low birth weight children
• Celebral palsy
• Home based newborn care (intervention)
• Coginitive disorders
• Neonatal jaundice
• Epilepsy
• Management of newborn and child illness,
• Neonatal outcomes for SGA & preterm babies
• Mortality
• Autism
• Neonatal encephalopathy
• Neurodevelopment
• Neonatal meningitis
• Gestational diabetes
ICMR Research Grants Child Health2001-2019
HELIX: Hypothermia for Encephalopathy in Low & Middle Income Countries: a RCT***
• Expected to enroll over 400 neonates with moderate-severe
encephalopathy from Public funded hospitals in India, Bangladesh
and Sri Lanka
• Intervention: Total body cooling versus standard care
• Outcome: Death or moderate-severe neuro-disability at 18-22
months
• Also to see if it reduces brain injury (measured by MRI
spectroscopy)
Ref: ***Hypothermia for encephalopathy in low-income and middle-
income countries: feasibility of whole-body cooling using a low-cost
servo-controlled device. BMJ Paediatr Open. 2018 Mar
23;2(1):e000245
Pregnancy Cohort to Study Multidimensional Correlates of
Preterm Birth in India (Interdisciplinary Group for Advanced
Research on Birth Outcomes-DBT India initiative (GARBH-Ini)***
Objectives
• To identify
clinical, epidemiologic, genomic, epigenomic, proteomic, and
microbial correlates;
• discover molecular-risk markers by using an integrative -omics
approach; and
• Generate a risk-prediction algorithm for preterm birth.
• The study is enrolling women <20 weeks and following through
pregnancy and postpartum
Ref :***Bhatnagar S, Majumder PP, Salunke DM; Interdisciplinary Group for Advanced
Research on Birth Outcomes—DBT India Initiative (GARBH-Ini). A Pregnancy Cohort to Study
Multidimensional Correlates of Preterm Birth in India: Study Design, Implementation, and
Baseline Characteristics of the Participants. Am J Epidemiol. 2019 Apr 1;188(4):621-631
The New Delhi Birth Cohort ***
1968-2019
Established in 1968 it
continues to contribute on
Birth
Weight, Gestation, Foetal
Growth
Founders
Dr Shanti Ghosh
Dr I.M. Moriyama
Dr Santosh Bhargava
INAP – National Targets
Targets Current 2017 2020 2025 2030
Impact targets
NMR (per 1000 live births) 29 24 21 15 <10
SBR (per 1000 live births) 22 19 17 13 <10
Coverage targets
Safe delivery (institutional + home delivery by
SBA (%)76 90 95 95 95
Initiation of breastfeeding within one hour of
birth (%)- 75 90 90 90
Women with preterm labour receiving at least
one dose of antenatal corticosteroids (%)- 75 90 95 95
Babies born in health facilities with birth asphyxia
received resuscitation (%)- 75 90 95 95
Babies received complete schedule of home
visits under HBNC by ASHA (%)- 50 75 95 95
Newborn with sepsis in the community received
Gentamicin by ANM (%)- 50 75 75 75
Newborn discharged from SNCU followed until
age one (%)- 35 50 75 75
Newborn with low birth weight / Prematurity
managed with KMC at facility (%)- 35 50 75 90
Are we likely to achieve goals ?
• Urban Newborn care
• Too frequent addition of new /modified programmes
Suggested Strategies
Urban Newborn Care
• Accreditation of Hospitals , MCH Centres &
Nursing Homes
• MNICU In Centres where significant number of deliveries occur
• Tertiary care Nurseries for referrals
• Telemedicine
Research supported priorities
Family Participatory Care in India:
Partnering with families to care for small
and
sick new-borns
M-NICU: Mother as care provider *
*Personal
Communication Dr Harish Chellaney and Colleagues*
Safdarjang Hospital, New Delhi
Thank You
