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Context: Worst child serial killer case in the history of the U.K.

Why is it in the News?

• Former British nurse Lucy Letby was sentenced to life in prison earlier this week after being found guilty in the worst child serial killer case in the history of the U.K.
• Letby was convicted of murdering seven babies and trying to kill six others while working at the Countess of Chester Hospital between June 2015 and June 2016.
• Letby killed infants by injecting them with air, others were force-fed milk and two were poisoned with insulin, court documents said as per news reports.

Care protocol for babies in India

There are no specific child care protocols in India but following are some provisions that indirectly point towards it.

• National Patient Safety Implementation Framework (2018-2025):
  • It prevents any kind of harm to the patients while providing the medical service.
  • This framework emphasizes that patient safety is the ultimate goal of the healthcare system.
• Hippocratic Oath:
  • In the oath, the physician pledges to prescribe only beneficial treatments, according to his abilities and judgment; to refrain from causing harm or hurt; and to live an exemplary personal and professional life.
• Consumer Protection Act, 2019:
  • Penalizes medical negligence and deficiency of services in various forms by both private and government healthcare providers.
• The Clinical Establishments (Registration and Regulation) Act, 2010:
  • It has been enacted by the Central Government to provide for the registration and regulation of all clinical establishments to ensure a minimum basic standard of service to be provided in health care facilities.
  • Healthcare providers will be liable for any deficiency in the standards of healthcare to be provided to the patients.
• National Pharmaceutical Pricing Authority and Drugs Controller General of India:
  • These bodies ensure the right to medicine to be ensured to all patients.

NEONATAL CARE ENVIRONMENT AS RECOMMENDED BY UNESCO

Sound environment

• Avoid loud noise.

Light environment

• Use dimmed night light. This will help in starting a day/night sleep schedule and support diurnal variations in hormone and temperature levels.

Positioning

• Nesting is one of the key factors in maintaining the beneficial position of a neonate and should be practised routinely. It enhances muscle strength and body control.

Handling

• Minimize handling of the neonate to avoid physiological and behavioural stress.

Touch

• KMC facilitates intimate touching of the baby by the mother and should be encouraged. Beyond KMC, for preterm neonates <30 weeks GA, touch may be stressful rather than soothing. For older preterm neonates, gentle touching can be helpful.

Issues of neonates

• The first 28 days of life (the neonatal period) is the most vulnerable time for a child’s survival. Globally about 6 million children die in the first month of life, with approximately 7,000 newborns dying every day, most of which occur within the first week of life.
• Neonatal mortality contributes significantly to under-five deaths (WHO, 2016). Each of these deaths is a tragedy particularly because many of these deaths are preventable.
• According to the Sample Registration System Statistical Report 2020, the country's female Infant Mortality Rate (IMR) dropped to the same level as males. The data highlighted a decline in Infant Mortality Rate (IMR) from 30 per 1000 live births in 2019 to 28 per 1000 live births in 2020.
  • However, in 16 states, IMR remained higher for female babies than males but the gap has reduced since 2011.
• The United Nations (UN) has recently released a report, titled Improving Maternal and Newborn Health and Survival and Reducing Stillbirth, shows that despite over 4.5 million women and babies dying every year during pregnancy, childbirth or the first weeks after birth, global progress on mitigating this has halted since 2015.

Steps need to be taken

Increasing access

• Increasing access to quality health care for women and children, especially in rural and remote areas, through strengthening primary health care systems, improving referral networks, expanding the health workforce and ensuring the availability of essential medicines and equipment.

Adequate Financial support

• Enhancing political commitment and financial investment for maternal and newborn health, through mobilizing domestic resources, allocating adequate budget, implementing effective policies and strategies, and engaging with civil society and private sector partners.
• India needs to address the gaps in coverage, quality and equity of health services for mothers and babies. It needs to invest more in human resources, infrastructure, equipment and supplies for maternal and newborn health.

Enhance monitoring

• Improving data collection and monitoring for maternal and newborn health, through strengthening civil registration and vital statistics systems, conducting regular surveys and audits, using digital technologies and platforms, and generating disaggregated data for equity analysis.
• India needs to improve the registration and reporting of births and deaths. It needs to engage with communities and families to raise awareness and demand for maternal and newborn health services.

Awareness

• Promoting community awareness and empowerment for maternal and newborn health, through increasing health literacy, addressing social norms and barriers, involving men and families in decision-making, and supporting women's rights and choices.
• India needs to ensure that every woman has access to skilled birth attendance and emergency obstetric care when needed. It needs to promote early initiation of breastfeeding and exclusive breastfeeding for six months.

Conclusion

• Governments should commit to working tirelessly to reduce neonatal mortality rates by putting in place all necessary health interventions, ensuring that we meet the global SDG target of less than 10 deaths per 1,000 live births by 2030 and putting an end to preventable neonatal deaths.

PRACTICE QUESTION Q. Despite the Sample Registration System Statistical Report 2020’s finding on the decline in female Infant Mortality Rate (IMR) in India, the Care protocol for babies in India seems inadequate in India. Discuss in the present context of neonatal care in India.(250 words)

https://www.thehindu.com/sci-tech/health/explained-what-is-the-care-protocol-for-babies-in-india/article67239285.ece#:~:text=Neonates%20are%20typically%20kept%20in,prevent%20the%20spread%20of%20 infections