NICU: critically ill infants need the safe abode
Although Bangladesh has made a commendable success in reducing child mortality, the rate of neonatal death (death within 28 days of birth) is still quite high and one of the major obstacles in achieving Millennium Development Goal. We are lagging far behind the standard in managing newborns properly. Strengthening and establishing more Neonatal Intensive Care Unit (NICU) could handle thousands of critically ill newborns and give them a second chance to life. Managing premature and low birth weight babies is major challenge in Bangladesh. These babies need special care and ideally, should be managed in NICU for survival and better outcome. NICUs now concentrate on treating very small, premature or congenitally ill babies. Some of these babies are from higher-order multiple births, but most are still single babies born too early. Besides these, common diseases managed in an NICU include severe breathing difficulties, major birth defects, severe infection, neonatal jaundice, bleeding in brain or any fatal condition directed by physicians. Skilled health professionals in managing neonates and NICU setting altogether have greatly increased the survival of very low birth weight and extremely premature infants. In the era before NICUs, infants of birth weight less than 1400 grams were rarely survived. Today, infants of 750 grams have a fair chance of survival. There are three levels of care given in NICU. In level 1, basic neonatal care is provided for those babies who born before 34 weeks and have weight of 1800 grams or more. Level 2 ensures special care to babies who were born at or after 32 weeks with 1500 grams or more in weight. Intensive neonatal care is given at level 3 for all infants with special laboratory tests. As per standard, 30 level 3 NICU beds are required for each one million population. If we consider our population 15 crore, we need about 450 level 3 NICU beds. But in reality, we have hardly 30-50 level 3 NICU beds in whole Bangladesh! Even in most tertiary level government hospitals, we have extreme shortage of level 3 NICU beds. There are some NICUs with level 3 facilities in some private hospitals mostly located in the capital city Dhaka and few others are in certain divisional cities. But most of these are far beyond the reach of general people. Now a days, because of improvement of pregnancy and delivery facility, birth of premature, twin are more in Bangladesh. Unfortunately, we are unable to provide quality management for all of them due to shortage of facilitates. This is the high time to give emphasis to increase the facilities to save many newborns from early grave. The writer is a Paediatrician working at Community Based Medical College (CBMC), Mymensingh. E-mail: mmukkhan@gmail.com
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