#NEONATAL_AMBULANCE_FOR_ALL

India, with more than 25 million live births per year, has witnessed a slow decline in neonatal mortality rate (NMR) (from 52/1000 in 1990 to 29/1000 in 2013) in last few years. With this sluggish advancement, the country has not been able to achieve its millennium development goal (MDG) of NMR (17/1000 live birth). One area that has been a neglected subject of attention of our policymakers, government and industry at large is the neonatal transport, in other words providing transport services and right medical care to pre-term babies who are not getting the required clinical treatment they deserve at the time of their birth due to lack of quality NICU infrastructure. This is particularly evident in the context of developing countries like India.

Evidence suggests that mortality in transported new-born is much higher than inborn babies, but there are lack of robust data on neonatal deaths that could be ascribed to transport. In our country, a vast majority of the babies are born in places where the appropriate resources, who can look after the babies, is not available, and therefore would need to be transferred to a care setting.

We should aim to bring the NICU to the patient, so that, as they arrive, we may spend a considerable amount of time at the bedside with the baby and stabilize the baby prior to loading them for transport.

Neonatal transport in India is still in its infancy. With the absence of any dedicated transport system for referred new-borns, a major chunk of critical new-borns unfortunately succumb to death soon after reaching tertiary canters. As a result, close to 40 per cent of neonatal deaths occur within first 24 hours of admission.

Transporting a sick new-born to an equipped health facility is a challenge in India due to scarce and inequitably distributed health facilities and underdeveloped transport network. Though in-utero transport of the new-born and delivery at an adequately equipped canter are ideal, a pre-term delivery and all the subsequent perinatal problems cannot always be anticipated. This results in an increased need to transfer such babies after birth. Stabilization of new-born during and before transportation has been shown to improve the condition of new-born in terms of temperature, blood glucose, oxygenation, and blood pressure, thereby improving the outcome of such critically sick neonate.

In the developed countries, the networking and regionalization of neonatal emergency transport has evolved from the 1990s onwards and is well-developed. Survival rates have improved over the last few years although in-utero transfers carry a better prognosis than ex-utero transfers.

The babies who require further intensive care are then referred out to either teaching hospitals where the intensive care facilities are available or to private hospitals. As there are no dedicated neonatal transport teams, parents are forced to arrange for transport themselves or use the inadequately resourced available transport facilities.

A prospective study done by Jajoo et al showed that in over 75 per cent of instances, parents brought in the new-born in private vehicles with only about 23 per cent, who were brought in an ambulance. Amongst the babies who were transported in ambulances, less than half of them were adequately equipped in terms of resources to provide them warmth and oxygen. It is no wonder then majority of the babies who were transferred in had hypothermia (low admission temperature) or hypoglycaemia (low blood sugar) or had hypoxia (low oxygen levels in the blood). In this study, the mortality rate was about 10.5 per cent.

With little research being conducted to know the process of transport and the outcome of referred neonates, it is sad to learn that far less documentation further adds to the deterioration in neonatal condition during transport. As we are evaluating the progress of our SDGs and its accomplishment, we are still in the phase of implementing diverse policies in different states and yet to ensure referrals for all the new-borns that are in need, with sole responsibility being left to the discretion of parents/guardians on many places. There is an urgent need to have a NETS facility at a national level to provide adequate clinical support that is required for precious deliveries done in any of the hospitals which themselves may not have sufficient neonatology infrastructure to handle extreme pre-term deliveries or high-risk deliveries.

#NEO_NATAL_AMBULANCE_FOR_ALL

1)            We need to set up dedicated department & research centre at National and State government level for studying neo-natal issues that include transport facilities or others.

2)            We need to set up a neo-natal ambulance for every District and Taluka level or needful rural area and a communication system.

3)            We need to increase special trained and educated manpower in this area, here more and more Ayush doctors and Healthcare workers through NSDC can be trained and employed.

I am confident that if Neonatal Ambulance For All is signed by hundreds and thousands of citizens, our collective voice will be heard by the PM OF INDIA and CM OF MAHARASHTRA.

Let’s speak up so that they remember #NEONATAL_AMBULANCE_FOR_ALL.