Mother Sumona Akhtar Juthie, 21, holds her 47-day-old baby daughter Muskan at the Special Care Newborn Units (SCANU) of the Institute of Child and Mother Health in Dhaka, Bangladesh, Saturday 17 February 2018.
Muskan (ÒsmileÓ in Bengali), girl, 47 days old, born premature at 6.5 months of pregnancy on 2 January 2018. Her weight at birth was 700 kg, her current weight is 1.2 kg. About 14 per cent of babies are born prematurely in Bangladesh. Thanks to the care Muskan received at the Special Care Newborn Unit (SCANU) supported by UNICEF Ð and, more specifically, an incubator and oxygen mask Ð she survived. MuskanÕs mother is Sumona Akhtar Juthie, 21, married for the last 6 years to Mijanur Bepari, Muslim, 28 years old. She lives in Panchashar, a district 22 km from Dhaka. However, she briefly lived in Dhaka after the babyÕs birth because the baby was born prematurely and needed special care. Sumona has two children.
Sumona Akhtar Juthie says:
ÒI slipped and fell during my pregnancy and then went into labour. I delivered Muskan at home; my aunt helped me and cut the cord. My father called an ambulance as soon as we saw that the baby had difficulties breathing. She was born at 6.5 months, and was struggling to get air Ð her chest was going up and down, she was panting. We tried to have her admitted at two other hospitals at first, but were turned away. We were told they were full.
At the hospital, she was given oxygen through a mask and was assigned a bed [an incubator] where she spent 10 days. Had we not come to the hospital, Muskan would have died.
I saw the baby and I thought she was very tiny. ÔHow am I supposed to hold her?Õ I thought. But, at the hospital, I was told that so many others [mothers] have babies like this Ð the doctors told me, ÔKeep praying, your baby will be fine.Õ The doctors gave me hope.
I have great hopes for her Ð sheÕs going to be a doctor when she grows up. Just because I couldnÕt study doesnÕt have to mean that my children canÕt.
I felt good, because when I came here I was afraid, but then the nurses told me, ÔYou have to learn all these techniques because we canÕt visit you at home.Õ They also told me to be hopeful and confident, because I could take care of my baby myself. And they were right.
The nurse taught me how to take care of the baby at home Ð she said I should remain in a separate room, just me and someone else, with, if possible, no other people entering, to limit infections. They also taught me how to breastfeed and weigh Muskan. So, I bought a scale that I use for her. The weight increase that it registers tells me she is doing well.Ó
In 2016 in Bangladesh, the neonatal mortality rate is 20 per 1,000 live births. Most newborns die from prematurity (31 per cent), perinatal asphyxia (22 per cent) and sepsis (19 per cent). About 14 per cent of babies are born prematurely. Reduction in neonatal mortality has been slower than reducing under-five mortality. Risk factors such as adolescent pregnancies, hypertension, short birth spacing, sexually transmittable infections, obesity, diabetes, domestic violence and pollution are known to cause prematurity.
Of critical concern to premature babies is that they are born with lungs too small to breathe on their own. The lungs are often filled with fluid (23 per cent of newborn deaths are caused by acute asphyxia). To prevent the lungs from collapsing, doctors inject surfactant into them, removing the surface tension, so that they can expand Ð and breathe Ð more easily. Next, medical personnel manually pump air into the babyÕs mouth until it starts breathing and can be transferred to an incubator. Oxygen is administered through a continuous positive airway pressure machine (CPAP), a form of ventilator that keeps the airways open. A baby can stay up to 68 days in an incubator, until a minimum weight is reached. Babies that were born prematurely cannot keep themselves warm. Many die from hypothermia, a condition that arises when their body temperature drops below 36.4 degrees celsius. UNICEF teaches mothers to use their own body warmth to nurture babies less than 2 kg in weight. The technique is called kangaroo mother care (KMC), for the skin-to-skin contact between mother and baby. The mother wears her baby wrapped in a binder against her breast Ð in an upright position, neck extended, head turned to one side to keep the airways open and enable eye-to-eye contact. All limbs should be flexed like a frogÕs. KMC is initiated at the hospital and should be practiced at the motherÕs home for ideally 20 hours per day. Intermittent care is possible, in the absence of a relative who can assist, for example, but not recommended. The baby should be exclusively breastfed every two hours, to be kept warm and protected against infections. Asphyxia and infections are the two leading causes of death in premature babies.
Providing neonatal care through Special Care Newborn Unit (SCANU) is a main UNICEF initiative, implemented in collaboration with the Government of Bangladesh since June 2011. At the UNICEF-supported SCANU at the Institute of Child and Mother Health (ICMH) in Dhaka, thanks to its life-saving equipment and training, newborn mortality is 8 to 10 per 1,000 live births, the lowest of all SCANUs in Bangladesh. Since 2015, it has admitted 2,266 babies and registered about 4,200 newborns in outpatient care. The SCANU counts 40 beds, but, to fully meet demand, staff say they require 100 more. In the past 12 months alone, 612 premature babies have been admitted to the unit. ICMHÕs SCANU is recognized as a centre of excellence and provides training to all other SCANUs Ð 42 in total Ð distributed across 38 districts in all eight divisions of the country. Cost examples in Bangladesh include one radiant warmer at US $4,000; a C-pap machine at US $3,000; and an Ambu Bag (Oxygen mask for newborn baby) at US $70.