On the death of Infants

The recent controversy and allegations over the infant death in the BC Roy Post-Graduate Institute of Paediatric Sciences demands that we examine the issue critically. Every death is lamentable but we should also recognize that every death is not preventable unless action is taken in a timely manner. Only by examining what went wrong we can begin to rectify them.

Image Courtesy : Rana2030

Various reports from the media state that initially 12 infants died within a period of 48 hours and later 3 more deaths occurred in the third day taking the toll to 17 infants in 3 days (1, 2).

The role of the media here calls for criticism. What the media is trying to report is the rate of infant death but it is meaningless unless we know how many infants were admitted in the hospital in these days. The media failed to mention the prevailing infant mortality rate in the hospital. Was the death rate in these 3 days significantly higher than the prevailing death rate? Without this crucial information any reporting of the incident only helps in polarizing and sensationalizing the issue and is of no real help.

Let us look at some data. I couldn’t find data specifically for the hospital in question but data was available for another hospital in the city (3). Although it is not ideal, we can use it as a proxy for the absent data from the hospital in question. A total of 1216 infants were admitted to a tertiary care hospital in a year. 286 died, making the infant mortality rate 23.52%/year which is pretty high. Consider this, if 20 infants were admitted everyday for 3 days, we can expect that a total of 14 would have died. This example of course has several limitations. For starters we don’t know how many infants were actually admitted to the hospital in question. We don’t know the prevailing infant mortality in the hospital. It may so happen babies who were very sick and couldn’t be managed elsewhere were referred to the BC Roy hospital as it is a specialized hospital. What I want to say with this example is that we can’t draw any meaningful conclusion from what the media reported though it is a sensitive issue on which we should have an informed opinion.

The knee-jerk response of the government is also unfortunate. The solution that the government proposes is opening of more Sick Newborn Care Units all across the state. This is commendable but we should realize that this constitutes what the public health doctors term as secondary prevention, meaning taking early action after the disease/event has already occurred. A better way is primary prevention which aims at preventing the disease/event from happening at the first place. Primary prevention demands long term commitment from the all the parties involved. Let us look at the common causes of hospitalized infant deaths in the city – septicemia, birth asphyxia, prematurity, acute respiratory tract infections, meningitis, congenital anomalies, congenital heart defects etc (3).

If we examine the risk factors for the causes of infant death, we can see that many of them are preventable. For example higher paternal education significantly decreases the risk of birth asphyxia. Low birth weight is an established risk factor for birth asphyxia and chronic mater malnutrition is one of the major causes of low birth and prematurity. Poor prenatal care, low socioeconomic status, low birth weight and birth asphyxia itself are causes of septicemia in infants (4, 5, 6).

There are few factors which if controlled will lead to a decreased incidence of the diseases affecting neonates and by extension a reduction in the infant deaths. Maternal nutrition, proper antenatal checkups, improvement in the socioeconomic and living standards of the mothers, proper education of the parents are some of the areas where improvement will lead to a better outcome. This, in conjunction with improved secondary prevention strategies will hopefully prevent further occurrences of such incidences in future.

Conflict of interest – I had attended few lectures of Dr. DK Paul, Superintendent of BC Roy Post-Graduate Institute of Paediatric Sciences when he was posted at my college.

References:

1. MARCUS DAM. Four more crib deaths in Kolkata hospital, 12 in Bardhaman hospital. The Hindu. October 29, 2011
2. Infant deaths in B C Roy hospital again. The Telegraph. 26th October, 2011.
3. Roy, RabindraNath. (2008) Mortality pattern of hospitalized children in a tertiary care hospital of Kolkata. Indian Journal of Community Medicine, 33(3), 187
4. Lee, A. CC. (2008-05-01) Risk Factors for Neonatal Mortality Due to Birth Asphyxia in Southern Nepal: A Prospective, Community-Based Cohort Study. PEDIATRICS, 121(5), e1381-e1390.
5. Anderson-Berry AL. Neonatal Sepsis. Medscape Reference.
6. Paul VK, Singh M, Sundaram KR, & Deorari AK. (1997) Correlates of mortality among hospital-born neonates with birth asphyxia. The National medical journal of India, 10(2), 54-7.