being premature in Africa

Something we are getting very good at in the UK is keeping increasingly premature babies alive. When I work at home, being asked to go to a delivery of babies more than 30 weeks gestation ( ie 10 weeks early) hardly gets the adrenaline going at all. After all, we now expect the majority of these infants to survive, hopefully with either no or only minor disability, and I know I have the skills and support to provide the necessary treatment to make this happen.  We have NICUs full of incubators, monitors, ventilators, phototherapy units.... the list is endless.

How different things are here.

At the end of last week, I went into the neonatal unit to find a 24 hour old premature infant who weighs 900g. She was born after 7 completed months of pregnancy and clinically 32-33 weeks looks about the right gestation, but she is tiny even so. We don’t have an incubator here, so she was hypothermic (33.5) with a very slow heart rate (44) but responsive and with reasonable respiratory effort. I put her skin to skin with her Mum which is really the only way of warming up a baby here and crossed my fingers. She was on iv fluids initially as she is too immature to suck, and iv antibiotics as infection is a common reason for preterm delivery and can be rapidly fatal if not treated.  But this is about as much as I can do for her. If she has significant ventilatory problems there is none of the equipment that I am used to – not even a mask small enough for her tiny face. If she becomes jaundiced there is no phototherapy – we use a normal light bulb, but if we expose a tiny baby like this she will become hypothermic again.

Our neonatal unit is basically a room full of cots with a heater on the floor and an oxygen cylinder in the middle. Nothing more.  We did have an incubator but it is broken and no one knows how to fix it. We keep suggesting to VSO that hospital technicians would be a really useful addition to the health team. Someone who can fix these instruments and teach local staff how to maintain and fix them would be worth their weight in gold. Just giving equipment without training staff is a common fault of international aid and really doesn’t help at all.

Sometimes though I think it is just as well we don’t have more facilities, because Ethiopia is really no place for a child with disability. At least this way only the very strongest babies survive.

Our preterm baby is now 6 days old and doing remarkably well all things considered. She is tolerating expressed breast milk and really only had a minor amount of respiratory distress all things considered, with no oxygen requirement (well she’s not obviously cyanosed- we don’t have a saturation monitor). Here heart appears to be normal on examination and so far she is behaving as I would expect from a neurological point of view. She has even put on 50g! She is certainly not out of the woods but she does appear to be a little fighter – and since we have no facilities to put central lines in her chance of secondary infection should hopefully be less!