Current status of neonatal intensive care in India

Abstract

Globally, newborn health is now considered as high-level national priority. The current neonatal and infant mortality rate in India is 29 per 1000 live births and 42 per 1000 live births, respectively. The last decade has seen a tremendous growth of neonatal intensive care in India. The proliferation of neonatal intensive care units, as also the infusion of newer technologies with availability of well-trained medical and nursing manpower, has led to good survival and intact outcomes. There is good care available for neonates whose parents can afford the high-end healthcare, but unfortunately, there is a deep divide and the poor rural population is still underserved with lack of even basic newborn care in few areas! There is increasing disparity where the 'well to do' and the 'increasingly affordable middle class' is able to get the most advanced care for their sick neonates. The underserved urban poor and those in rural areas still contribute to the overall high neonatal morbidity and mortality in India. The recent government initiative, the India Newborn Action Plan, is the step in the right direction to bridge this gap. A strong public-private partnership and prioritisation is needed to achieve this goal. This review highlights the current situation of neonatal intensive care in India with a suggested plan for the way forward to achieve better neonatal care.

Care practices and neonatal survival in 52 neonatal intensive care units in Telangana and Andhra Pradesh, India: A cross-sectional study

“…Most mothers (97% in urban and 91% in rural areas) delivered in health facilities, but less than 34% in urban and 39% in rural areas delivered in public health facilities [31,32]. However, because specialised newborn care is more expensive in the private sector, most seek public healthcare for very sick newborns [17]. The neonatal mortality rate was estimated, in 2016, at 11 and 15 per 1,000 live births in urban areas of Andhra Pradesh and Telangana and 27 and 25 per 1,000 livebirths in rural areas of Andhra Pradesh and Telangana [33].…”

“…Neonatal intensive care constitutes Level II care in special newborn care units (SNCUs) at district and subdistrict hospitals providing all types of care to newborns except surgery and Level III NICUs that provide intensive care including ventilation and operative care [14]. These neonatal intensive care facilities are complemented by Level I newborn stabilization units (NBSUs), which provide management of low birth weight (LBW) neonates not requiring intensive care, as well as stabilization of newborns before referral—and newborn care corners (NBCCs), which have been established at all facilities providing childbirth care, providing essential care at birth, including resuscitation [15–17]. The private sector offers a wide range of neonatal services, but there is no mapping of the newborn services in private hospitals.…”

“…The private sector offers a wide range of neonatal services, but there is no mapping of the newborn services in private hospitals. Some private hospitals offer neonatal intensive care at Level II, and a few offer Level III care [17].…”

“…Overall, 51% of the admitted neonates were underweight, and 44% had a gestational age of 36 weeks or less [19]. Very little is known, however, about NICU admissions in the private sector [17]. A study from rural Uttar Pradesh reported that more families of male neonates sought care at private facilities compared with families of female neonates [20].…”

Public health system integration of avoidable blindness screening and management, India

“…Services for sick and preterm infants in India have been rapidly expanded over the last decade. 27 Since 2008, the national government has established 525 district-level special newborn care units, which cover 414 districts. The remaining 208 districts are expected to be covered soon.…”