DO WE NEED SOPHISTICATED INSTRUMENT AND CARE FOR SURVIVAL OF LBW BABIES IN OUR COUNTRY ?
Dr. Reena Sinha*, Dr. (Mrs.) V. Kapoor**, Dr. Hima Charan***
DCH, MD, DNB, Kurji Holy Family Hospital.*, MD,Kurji Holy Family Hospital.**, Kurji Holy Family Hospital.***
A study of LBW babies mortality in Kurji Holy Family Hospital, Patna from 2004 to 2005 with basic care of type II Nursery.
With this question in mind, we conducted a study on low birth weight babies in our Kurji Holy Family Hospital, Patna from 2004-2005. Our Hospital has a 40 bedded nursery, 25 beds in clean side and 15 beds in septic side attached to the delivery room and delivery O.R., well equipped with basic resuscitation facilities, 24 hours facility for RBSD monitoring, CBC, CRP, Micro bilirubin, Micro ESR, Serum Calcium and Cardiac Monitor, Pulse Oximeter, Phototherapy Unit, facility for echocardiography, and Portable X-rays.

Just after birth, these babies were managed as follows:
  1. Each and every delivery of LBW baby was conducted by senior resident or registrar of OB/Gynae department and attended by Senior Resident/Registrar of Pediatrics department and Senior Consultant being called if needed.
  2. General Assessment of the baby for vital - colour, cry, respiration, H.R. were done and resuscitation done if needed.
  3. Optimal temperature of the baby was maintained in incubator/radiant warmer/heat cradle with bulbs.
  4. Oxygen therapy, if required was given.
  5. Delayed cord clamping was done to improve the iron store of the body.
  6. Routine blood glucose monitoring for 72 hours, Serum Calcium. Serum Bilirubin followed by septic screening was done and treated accordingly.
  7. Early enteral feeding was introduced as soon as the baby was stable.
  8. Babies weighing <1200 gm and sick ones were started on I.V. 10% dextrose water.

Results:
With this management protocol in our level, two nurseries out of total LBW babies born in 2004 to 2005 was 415, deaths of LBW babies was 89 which amounts to 22% of the low birth weight babies born. This data is comparable with that our country where the present low birth weight mortality rate is 26%. In these babies, the predominant cause of mortality was found to be sepsis (30%), birth asphyxia (25%) followed by others (35%). Incidence of RDS was not much in our study (10%) which restricted the need for surfactant and ventilator.

Conclusion:
Thus, we can conclude that safe delivery, aseptic measures, prevention from hypothermia, sepsis, hypoglycemia, timed resuscitation, proper feeding can improve the outcome of mortality in LBW babies. Ventilator and surfactant therapy decreases mortality but at the same time increases morbidity which leads to leads to life long respiratory impairment whose consequences can not be effectively managed in the country like ours.
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Sinha R D, Kapoor V ( D, Charan H D.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=473
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