It’s time for India to build a neonatal emergency transport network

The infant deaths in JK Lon Hospital in Kota (Rajasthan) and in the civil hospital in Rajkot (Gujarat) have led to public outrage. In 2019, the Kota hospital registered 963 such deaths, while 1,235 new-borns died at the Rajkot hospital.

In 2017, the Gorakhpur tragedy saw over 1,300 infants dying primarily due to the lack of essential resources — the shortage of oxygen cylinders, for example. The disturbing fact is, India has the most child deaths in the world. In 2017, UNICEF estimated that 8,02,000 babies had died in India.

But could this have been addressed by having “neonatal transport”, a solution much neglected by our policymakers and industry? Put simply, neonatal transport involves providing transport and delivering of critical care services to newborn and extreme pre-term babies by a multidisciplinary team of experts using the most advanced technology in order to provide the highest standard of care to the baby. Such babies need clinical treatment at birth at hospitals that have access to Neonatal Intensive Care Unit infrastructure.

While there is general acceptance of the need to regionalise newborn care, with accent on specialised transport, we are far away from implementing a uniform strategy in India. Even in developed regions such as the UK, before the establishment of neonatal networks they used to arrange neonatal transport with an ad hoc team either from the referring centre or from a neonatal unit who had the team to prepare and perform transport. In our country, babies are born sometimes in places where the resources to look after them are not available and therefore, they would need to be transferred to a care setting. We, as doctors, should aim to bring the neonatal intensive care unit to the patient, so that before they arrive at the hospital they are stabilised for transport, with medications.

A Neonatal Emergency Transport Service (NETS) is integral to the delivery of high-quality neonatal service. But neonatal transport in India is still at its infancy. Some States have activated specialised transport services. The gradual expansion of road transport across the country and availability of free transport for all neonates opens up the pathway for similar opportunities to reach all pre-term babies to the nearest equipped hospital at the earliest. With the absence of a dedicated transport system for newborns who need further treatment, a large number of critical newborns unfortunately succumb to death soon after reaching tertiary-care centres. As a result, close to 40 per cent of neonatal deaths occur within the first 24 hours of admission.

There is an urgent need to have a NETS facility at a national level to provide adequate clinical support to infants born in locations without the required facilities. This could take the country a step closer to achieving the Sustainable Development Goals by bringing down infant mortality.

The writer is a Senior Consultant, Neonatologist and Paediatrician at Cloudnine Group of Hospitals. Views are personal