President, Nigerian Society of Neonatal Medicine (NISONM), Professor Chinyere Ezeaka, examines the plight of newborns in Nigeria, and says it is worrisome, in this interview with Sade Oguntola.
What is the current situation of newborns in Nigeria and why is your society interested in such an issue?
Nigeria has the highest number of newborn deaths in the whole of Africa and the second highest in the world, coming second after India. Nigeria looses about 264,000 newborns every year, which comes to about 70,000 newborn deaths every day and about 30 newborns die per hour. This is totally unacceptable, given the fact that 90 per cent of these deaths in newborns are preventable.
The major causes of these deaths are prematurity, birth asphyxia (when babies fail to breathe immediately at birth), infection and neonatal jaundice.
You know after delivery, everybody is waiting for these new babies to cry, but due to many antecedent problems, these babies do not cry, and so that is a big problem.
The society has been playing a crucial role to help reduce these major causes of deaths in newborns. Our strategic objective is hinged on advocacy and partnerships with other relevant stakeholders to solve the problem of newborn deaths. We are also building capacity to every partner that is working on newborn health to reduce these deaths.
And in addition to neonatal deaths, we also have a lot of still births. So all these amount to a lot of wastages; deaths of these newborn babies who end up not achieve their potentials.
How are these preventable?
When babies are born premature, you must make them to breathe and to sustain breathing. Respiratory support is very critical to maintain the respiration and continual breathing.
Early and exclusive breastfeeding still remains core to the first immunisation for the newborn to withhold all the infections that abound.
Breast milk gives the child the early best start in life to achieve his life goals, without all the numerous complications that they have when the mother does not breastfeed.
Also, hand washing and the use of chloxidene gel for the umbilical cord care helps to prevent infections.
For modality of transport, kangaroo mother care should be embraced and then as a standard of care, the baby should be kept warm in the kangaroo position.
In science, evidence has shown that when a preterm baby is put skin to skin, that generates warmth, keeps the baby closest to the breast and that it can be used as a modality of transport for a newborn.
It is being used globally for the past 37 years and it is still just catching on very slowly in Nigeria. Incubators are not enough for the Nigeria’s teeming population of preterm babies; we do not have electricity to sustain the incubators and you also need to maintain those incubators.
What about birth asphyxia?
Every delivery centre, even traditional birth attendants (TBA) need to be trained on how to use the ampule bag to initiate breathing in the golden minute. So, instead of turning a baby, beating the baby, turning the child upside down and slapping the baby, this equipment will be put on the baby’s nose and squeezed to expand the lungs of the baby. This is applied within one minute of delivery to ensure air goes in and you see this baby cry.
Unfortunately, many delivery centres do not have this ampule bag which cost about N5,000 despite its importance to initiate breathing. If you do not give oxygen to a baby’s brain within five minutes, that brain is damaged. Such a baby ends up with mental retardation.
So, we are saying that a lot of attention has to be put in the area of newborn health.
A lot of these had to do with ignorance and poverty. Many pregnant women, in fact, are not even registered for antenatal care, so they do not go to clinics to deliver.
No matter how ignorant they are and how poor they may be, they do not want their babies to die. So they need information and we want the government to come to their aid and give some insurance. There should be some free medical insurance or welfare system for these mothers.
Also, a mother who is 28 weeks gestation and is going into labour should be referred to a centre where the baby and the mother will be looked after in appropriate condition after delivery. This is the standard of care. But that is not the scenario that happens and reason many premature babies are dying.
These are babies you have to put in a drip to be able to give them glucose. Due to immaturity, they cannot suck or swallow. These are the problems.
How safe is methylated spirit for umbilical cord care in newborns?
Mothers should not use methylated spirit, chloxidene gel which is an antiseptic gel is superior. The use of this gel should start immediately at delivery, after the cord had been cut off. It means that the gel should be available in the delivery rooms, too.
Also, exposure to naphthalene balls or camphor should be avoided in cord care. It should also not be used to store their cloths. If it is absorbed through their skin, it breaks down there red bloods cells, forming bilirubin. The same is also the case with methylated robs and powders.
Danger signs that new mothers should note?
The most worrisome of these danger signs that mothers and health workers miss is newborn jaundice. Within three to five days, after birth, mothers should get to the health centres so that their babies can be checked for jaundice.
Jaundice is a killer. Within a week, if the baby is not brought to the tertiary centre, the brain undergoes an irreversible brain damage due to a high level of bilirubin.
But if it is detected early when the baby is brought to the hospital , the baby is put under a special light. Sometimes, we exchange the blood to remove the bilirubin and reduce damage to the brain.
Some experts are saying babies need not be bathe in the first 24 hours after delivery and that it is protective. What is your view?
Cleaning babies is very good, but we allow them to delay the first bath to at least after the first 24 hours to keep the baby warm. It is the best way of keeping the baby warm.
Also, when you bathe them as soon as they are born, you are removing God’s own bacterial protection on their skin against infection, and you are creating more problems.
If you notice many babies in our community in the first month of life or first two weeks of life come down with a lot of rashes. It is an infection, and it can even can kill.