Low Cost Level II Newborn Care Service: Experience Of Kathmandu Medical College Teaching Hospital

Abstract

Newborn infants require special care when they become sick. Majority of the newborn require only feeding,
warmth and loving care by the mothers. Nearly 15-20% of newborns become sick requiring care in hospital.
Most of these babies can be managed using low cost locally made equipment which makes newborn care
affordable. This is a prospective study of 201 sick newborns looked after in the Special Care Baby Unit
(SCBU) of Kathmandu Medical College Teaching Hospital (KMCTH) using locally made low cost equipment.
In the period of 28 months from 2nd July, 2001 to 17th Oct. 2003, 882 babies were delivered at Kathmandu
Medical College Teaching Hospital (KMCTH). 859 were live births. Out of 859 live births, 173 (20.1%)
were admitted in the special care baby unit (SCBU). SCBU of this hospital also admitted 28 babies born
outside the hospital. The main causes of admission in SCBU were low birth weight (37.3%), neonatal
jaundice (18.9%), birth asphyxia (6.9%), septicaemia (2.4%) and out of 201 babies admitted in SCBU,
89% were discharged in good condition, 3.9% of the babies left against medical advice, 2 babies (one with
congenital hydronephrosis and another with congenital hypertrophic pyloric stenosis) were transferred to
Kanti Children Hospital for surgery and 11 babies (5.4%) expired. The main causes of neonatal deaths
were extreme prematurity (70%), septicaemia (23%), birth asphyxia (15.3%) and congenital anomalies
(7.6%). The perinatal mortality rate (PMR) and neonatal mortality rate (NMR) during this period were
26.4/1000 births and 15.1/1000 live births respectively. In SCBU, locally made low cost equipment
(Resuscitaire, Warm cot, Phototherapy and Oxygen hood designed by Prof D.S. Manandhar) are being
used in the manangement of sick babies, since the unit was started on 2nd July, 2001. Babies with birth
weight as low as 1020 gms and gestation as low as 28 weeks have survived in this unit. This unit has shown
that Level II care could be provided with simple and low cost equipment and results are quite satisfactory.
Good antenatal care, good care during delivery including use of partogram and care during postnatal
period have helped to make this result good. Expansion of such facilities in district and bigger hospitals in
the country are not only affordable but also will have great impact in saving many lives. This will have a
major impact in reducing the present high IMR and NMR of the country.

Key Words: Care of sick neonates, low cost locally made equipment, common neonatal problems,
special care baby unit, and level II care.