What is the care protocol for babies in India?

Why in the News?

Recently, a former British nurse Lucy Letby was sentenced to life in prison after being held guilty in the worst child serial killer case in the history of the U.K.

• Letby was convicted of murdering 7 babies and trying to kill 6 others between June 2015 and June 2016.
• The infants were killed by injecting them with air, force-fed milk or poisoned with insulin.

What are patient safety provisions in India?

1. As per the Union Health Ministry, Patient safety is defined as “the freedom for a patient from unnecessary harm or potential harm associated with provision of healthcare” and its forms a fundamental element of public healthcare.
2. Patients in India are protected under multiple layers of law but they are largely fragmented. 
   1. Idea of patient safety is enshrined in the Hippocratic Oath of medical professionals.
   2. The Consumer Protection Act deals with medical negligence and deficiency of services.
   3. Clinical Establishment Act deals with the legal rights of the patients.
   4. National Pharmaceutical Pricing Authority and Drugs Controller General of India à drafts mechanisms to ensure protection of patients’ rights in terms of medication, devices and hospitalisation charges.

How is neonatal safety maintained in India?

1. India registers 2.6 crore child births annually.
2. There are no exclusive rules for neonatal care and safety, or protection against external harm in hospitals in India.
3. Provisions and checks are in place to handle issues like inadvertent mix-up of babies at birth and abduction in the hospital set-up.
4. A comprehensive framework with provisions for the safety and wellbeing of neonates are in place to minimise potential risks., which includes,
   1. Trained healthcare staff to counsel parents and provide emotional support to ensure the safety and development of neonates.
   2. Adequate staffing to closely monitor each baby’s condition and respond swiftly to any concerns. 
   3. Availability of proper equipment for respiratory support, temperature regulation and monitoring vital signs.
   4. Regular training and continuing medical education for healthcare staff to maintain high-quality neonatal care and uphold safety standards.

Issues faced by the Neonates:

1. WHO reports that children face the greatest risk of death in their first 28 days of birth.
   1.  47% of all under-five deaths occurred in the newborn period with about 1/3^rd dying on the day of birth and close to 3/4^th dying within the first week of life, in 2019.
   2. Infants who die within the first 28 days of birth suffer from conditions and diseases associated with
      1. Lack of quality care at birth
      2. Lack of skilled care and treatment immediately after birth and in the first days of life.
      3. Pre-term birth
      4. Intrapartum-related complications (birth asphyxia or lack of breathing at birth),
      5. Infections
      6. Birth defects
2. The Infant Mortality Rate (IMR) in India is 26.6 deaths per 1,000 live births in 2023 which is a 3.89% decline from 2022.

What has to be done to minimise neonatal deaths in India?

1. Midwife-led continuity of care (MLCC) has to be provided to women from the start of pregnancy to post-delivery phase.
   • Women who receive MLCC through professional midwives, educated, and regulated to internationals standards, are 16% less likely to lose their baby and 24% less likely to experience pre-term birth.
2. Seeking prompt medical care by families
   • In the cases of danger signs like feeding problems, or reduced activity of newborns, difficult breathing, a fever, fits or convulsions, jaundice in the first 24 hours after birth, yellow palms and soles at any age, or if the baby feels coldà medical attention has to be sought immediately.
3. Registration of the births of newborns and timely vaccination of the child according to national schedules.
4. Newborns has to provided with additional attention and care during hospitalisation and at home to minimise their health risks.