In a shocking incident in one of Delhi's
major hospitals in November 2017, a premature
newborn baby boy born at 23 weeks (5 months) of gestation was declared dead
after unsuccessful resuscitative measures.
Incidentally his twin sister was
‘Incident underscores the need to follow established guidelines in management of preterm infants as well as being cautious in declaring death in hypothermia patients.’
After trying unsuccessfully to
resuscitate him, doctors declared the
boy dead and handed over both bodies in polythene bags
to the grieving
family members. As the family was preparing for the last rites of the babies,
one of the family members felt a wriggling movement within one of the bags and
found the boy to be moving and breathing.
The family rushed the baby boy named
"Champ" to a nursing home where he sadly succumbed after fighting for his life
for nearly five days.
Negligence Or Genuine Mistake?
This incident in a major hospital in
India's capital has sparked serious public outrage against the medical
fraternity in general and in
the hospital in particular.
Both the hospital and the Indian Medical
Association (IMA) have ordered separate inquiries into this incident.
KK Aggarwal, the head of the IMA, said
the episode was a tragic mistake. "The difference between a mistake and negligence is
deliberate action. I don't think any doctor will do it willfully," he said.
Problems of the Preterm
Any baby born before completing 37 weeks
of gestation is considered preterm.
Babies born less than 32 weeks are
considered very preterm.
The earlier the babies are born, the less
ready they are to face the challenges of the outside world and they need specialized care to
overcome these. With a
greater degree of prematurity,
the chances of complications and mortality are also higher
Some of the complications associated with
prematurity include the following:
- Respiratory distress due to immature
- Increased susceptibility to
infections due to immature immune system
- Risk of hypothermia due to immature temperature regulatory
- Hypoglycemia (low
blood sugar) resulting in convulsions and longterm brain damage
- Severe neonatal
jaundice and risk of brain damage
- Increased incidence of intraventricular
hemorrhage with serious longterm complications
Although the survival of babies born
between 22-25 weeks gestation has improved, it remains a huge challenge for
both parents and health care professionals with increased risk of mortality and
morbidity and other longterm complications.
the Royal College of Obstetricians and Gynaecologists (RCOG) has published new guidelines stating that resuscitation in babies of birth weight
less than 500 gms must be performed
only after careful consideration
How to Prevent
Hypothermia in Premature Infants?
Premature infants are at an increased risk of hypothermia. They
should be protected against hypothermia by the following measures:
- Maintaining an appropriately warm
environmental temperature in the labor room and newborn care area
- Drying the newborn immediately after
- Swaddling full-term neonates or
placing premature infants in a polyethylene bag
Norms and Protocols in Preterm Births
has established certain protocols
to ensure optimal outcome in preterm
births and these must be strictly adhered to by all health care professionals
and establishments. This will be one of the angles of inquiry that the investigating committee will look into in this case.
According to Dr Agarwal, IMA head, the inquiry committee
set up has been asked to investigate if
- If the attending doctor was
- If the baby was really premature and
what his weight was
- Was the baby in hypothermia
- Did he have a cardiac arrest?
- Was the counseling given to the
- What were his chances of revival?
- Were the World Health Organisation
(WHO) guidelines followed
- Did the relations sign for the
In fact Dr Agarwal has issued an advisory
to doctors and hospitals across the country not to declare a person dead in the presence of hypothermia
it is possible to revive the person even after a few hours.
Hypothermia - Double
Hypothermia is not always undesirable or
bad. It has
also been shown to have potential benefits in clinical practice.
- For decades, it has been shown that therapeutic hypothermia can
improve the chances of survival in cardiac patients. It is believed
that the cold reduces the body's (especially the brain cells) need for
oxygen and reduces the buildup of toxic chemicals that would otherwise
occur when the heart is beating and oxygen is utilized. The cooling
decreases the amount of oxygen utilized, and slows down the heart rate and
basal metabolic rate.
- When the temperature is
appropriately controlled, it could help keep a person alive while doctors
try to resuscitate the heart. The body is then rewarmed gradually over
- This procedure is also employed for full term babies who have
hypoxic-ischemic encephalopathy, a condition in which they suffer a
lack of oxygen and blood supply to the brain. However it is not recommended in preterm
hypothermia is a double edged sword - if
uncontrolled or used inappropriately, it can kill, as it is thought to
disrupt the body's enzyme systems and clotting mechanisms.
There are many controversies regarding the safety and efficacy of this procedure
with many scientists questioning its use in practice.
In conclusion, incidents such as these
will hopefully serve as eye openers both to health professionals and clinical
establishments to ensure that prescribed norms and guidelines are being
followed in neonatal units, to
employ skilled personnel well versed in neonatal care and to educate the public on the health issues and
challenges surrounding preterm births and the increased risk of mortality and