Neonatal mortality rates in India have decreased substantially in the past decade. As reported by UN IGME, the neonatal mortality rates have decreased from 28 to 17 per 1,000 live births from 2015 to 2023. Improvements in maternal care services, institutional deliveries, neonatal infrastructure, and clinical skill sets have contributed to decreasing neonatal mortality rates. But this improvement is not the same for all states. Some states, for example, Kerala, have been performing better owing to their education, awareness, and access to healthcare facilities. There are some states where higher neonatal mortalities rates are found, for example, UP, Bihar, Chhattisgarh, Odisha, and parts of NE region.
The last two to three decades have seen substantial improvements in neonatal care in India. The private health care sector has contributed to the development of NICU technology and processes. The better management of high-risk pregnancies and NICU infrastructure and therapies have helped in the survival rates of premature and low birth weight infants. Trained neonatologists and globally oriented doctors have added to neonatology. Training of nurses and NICU teams has improved, though skilled neonatal nursing remains a gap.
The government has also taken initiatives to further improve the neonatal mortality rates in India with the SUMAN Roadmap 2030. The roadmap adopts a life-cycle approach by integrating interventions across the continuum of care, covering pre-pregnancy care, antenatal care, intrapartum care and postnatal care. It further promotes convergence with child health, adolescent health, family planning and nutrition under the RMNCHA+N framework to ensure integrated service delivery.
Pregnancy that poses risks is also becoming increasingly common in urban India because of the changes in lifestyle and family planning choices. There is an increased tendency for women to conceive in older age and thereby make it prone to complications during pregnancy. There are other diseases such as obesity, diabetes, hypertension, PCOS, and thyroid disease which cause pregnancy risks as well. There is also an increased need for specialised newborns' intensive care due to pregnancy risks.
{{/usCountry}}Pregnancy that poses risks is also becoming increasingly common in urban India because of the changes in lifestyle and family planning choices. There is an increased tendency for women to conceive in older age and thereby make it prone to complications during pregnancy. There are other diseases such as obesity, diabetes, hypertension, PCOS, and thyroid disease which cause pregnancy risks as well. There is also an increased need for specialised newborns' intensive care due to pregnancy risks.
{{/usCountry}}However, in rural areas and underdeveloped areas, there is a challenge in accessing antenatal care and identifying the complications late, lack of health consciousness and delay in transferring patients to better hospitals. Malnutrition of mothers is another important factor responsible for poor pregnancy outcomes and leading to low birth weight and intrauterine growth restrictions. The SUMAN Roadmap 2030 aims to improve these conditions with a comprehensive SUMAN Package for Pregnant Women to promote timely registration, complete antenatal care, quality clinical assessment and adequate post-partum institutional stay.
With better neonatal care, more premature, low-birthweight, and critically ill babies are surviving. This has created a growing population of NICU graduates. These infants might come out of the NICU but will be vulnerable even after being discharged from it. The risks that could face them include development problems, hearing loss, sight defects, problems with feeding, learning disabilities, and cerebral palsy. These infants need ongoing evaluation of their growth, neurodevelopment, respiration, and nutrition in order to achieve significant improvement in their health and developmental results.
The truth is that being born at the NICU is not all about caring for these babies. After being discharged, there is nothing that parents can follow up on. The follow-up care for babies who were born at the NICU must become as important as vaccinations. Follow-up care must become an integral part of neonatal care instead of being considered an add-on. The true success of neonatal care now lies in the development and growth of these children.
NICU care is cost-intensive and often financially unexpected for families. Most families plan for delivery expenses, but very few plan for prolonged NICU stay or follow-up care. Insurance too largely focus on acute hospitalisation. There can be a significant neglect of developmental care, screening, rehabilitation, and therapeutic support in the long term. Such a cost may result in delays of interventions and place a heavy burden emotionally and financially on families struggling with raising a newborn who requires medical attention. Insurance plans covering the NICU admission and follow-up care, developmental screening, and rehabilitation are necessary to allow families receive such care, reducing health care costs in the long run as well as economic burdens.
Neonatal care should be perceived as a process rather than just a hospital procedure. Collaboration is required between hospitals, physicians, insurance companies, policymakers, and families. Attention should be paid to thriving, not survival, of newborns. Follow-up systems, neonatal teams, technology-driven solutions, and insurance are required in India. Raising awareness, follow-up protocol, rehabilitative care, community resources, and investment in neonatal care infrastructure will be equally crucial to guarantee proper care to all newborns at risk regardless of their location and socioeconomic status.
(The views expressed are personal)
This article is authored by Vijayarathna Venkatraman, Chief Executive Officer, Motherhood Hospitals.