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:
- MARCUS DAM. Four more crib deaths in Kolkata hospital, 12 in Bardhaman hospital. The Hindu. October 29, 2011
- Infant deaths in B C Roy hospital again. The Telegraph. 26th October, 2011.
- Roy, RabindraNath. (2008) Mortality pattern of hospitalized children in a tertiary care hospital of Kolkata. Indian Journal of Community Medicine, 33(3), 187
- 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.
- Anderson-Berry AL. Neonatal Sepsis. Medscape Reference.
- 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.
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