High risk mother giving birth to a high-risk newborn
Ambezech Alemayehu (35) gave birth to her second child, a baby boy- Kaleb-, prematurely at eight months at St Paul Teaching and Referral Hospital on 16 September 2021
Ambezech was admitted to the maternity unit as she was diagnosed with pregnancy related severe hypertension (pre-eclampsia) and her baby with Intra Uterine Growth Retardation. Delivery was conducted by emergency caesarean section. Kaleb had trouble breathing after birth and was put on delivery continuous air way pressure therapy (CPAP) before being shifted to Neonatal Intensive Care Unit (NICU). CPAP is a lifesaving therapy for premature and small newborns who have respiratory distress that is relatively low-risk and easy to administer. Once admitted, Kaleb was diagnosed with respiratory distress syndrome having a birth weight of 1110-gram which is considered small for gestational age. His mother Ambezech was very sick from the severe pre-eclampsia and required dialysis and intensive care for 20 days after delivery.
Saving the life of the baby and the mother
Kaleb was kept in the NICU with CPAP support for the respiratory for five days and then changed to supplemental oxygen therapy as he improved. Kaleb was also treated with antibiotics for an infection that he acquired in the hospital in the first few days of his life. Kaleb was then cared for and kept warm on a radiant warmer by the NICU nurses for an additional two weeks.
Kaleb’s mother was supported to express some breastmilk while she was on dialysis. On the 20th day after delivery, Ambezech’s health improved. Kangaroo mother care (KMC) was then initiated. KMC involves caring for small, particularly preterm, babies by positioning them skin-to-skin to the mother ‘s or caregiver‘s chest. KMC also includes a critical component of adequate nutrition - early and exclusive breastfeeding - and aids early recognition and response to newborn infections or other complications. The KMC continued until he was discharged from the hospital on the 28th day. Before discharge, Kaleb had his eyes, brain and heart screened, which were thankfully all normal. At discharge, Kaleb was given iron and vitamin D supplementation and was vaccinated. Ambezech was educated on how to do KMC at home, further supported with breast feeding, and discharged.
Ambezech was grateful for all the nurses, physicians who took good care of her small baby in her absence.
‘’Thank you all so much,’’ she said.
One month later, Kaleb was 1400 gram, breastfeeding, and practicing KMC, and had started sunlight exposure and taking vitamin D and Iron.
In Ethiopia, saving newborn lives is the Government’s priority as reflected in the Health Sector Transformation Plan II and corresponding strategies for reproductive health and child health. The most recent data shows that newborn mortality in the country has stagnated at 33 deaths per 1,000 live births, accounting for 59 per cent of child mortality. To increase access to high impact essential newborn care interventions, the Government and partners has been implementing several facility- and community-based newborn interventions, including establishment of sick newborn units at all public hospitals across the country.
“UNICEF is supporting the Government to scale up quality newborn care at three key levels of the health system: first, through our support of community-based newborn care by health extension workers; second, through supporting ‘Newborn Corners’ and provision of essential newborn care, including managing breathing problems at birth; and third, by equipping and capacity building staff at sick newborn units at hospital level to provide appropriate life-saving care,” says Julia Battle, Health Manager from UNICEF Ethiopia.
Since 2010, NICUs have been established in 196 hospitals to take care of small and sick newborns. Some 920 nurses, 24 health science college teachers, 192 physicians, and health officers have been trained to appropriately manage sick or ill premature newborns with UNICEF support. To ensure that every zone in the country had high-level care for newborn babies, the Ministry of Health in 2017 invested US$24 million in equipping 80 hospitals with level III NICUs. The government and UNICEF have together selected 15 learning hospitals for NICUs across the country that can serve as examples for their regions. With funding from the US Fund for UNICEF, health workers from these 15 NICUs were trained on how to operate and use this life-saving equipment, including— most critically for Kaleb and many other premature babies—CPAP.
