What can you fit in your palms? Some dates. A handful of seeds.
On April 1, Jeremy Tubula was born at 400g and he fit in the palms of Dr Miriam Karanja, a neonatologist at Kenyatta National Hospital (KNH). He was so tiny that his parents, Catherine Nkune and James Narikae, were afraid to look at him.
He was born at 24 weeks — four months too soon — before all his organs were formed. A baby is considered full term from 38 weeks. “I screamed when I saw him, but the doctor told me the baby will survive,” Ms Nkune recalls.
His birth, classified as extremely preterm, as he was born less than 28 weeks, meant he required round-the-clock quality care. An all too familiar experience at KNH as Jeremy is the second such baby born at that weight. The other is Baby Hope Obonyo, who is eight years old now. According to Prof Rachel Musoke, a paediatrician, on a global scale some babies have been born much smaller and much earlier than Jeremy or Hope, and survived.
As a preemie, Jeremy’s days and nights were spent enclosed in an incubator — a clear hard-plastic electric-run enclosure — that had the necessary environmental conditions he needed to thrive. This was his home for close to five months. His paper-thin skin, with visible veins, was covered with different sized tubes, a mesh of wires and monitor pads. He fed on his mother’s breast milk through a tiny tube.
Ms Nkune told HealthyNation: “Seeing him all small, frail, hooked to machines and covered with wires was scary. But, the nurses assured me that the equipment was all there to help Jeremy get well.”
Everything on and in his body was monitored. His heart rate was monitored for speed and rhythm; his respiration to check his breathing rate and pattern (such small babies forget to breath as their brains are not fully developed); and pulse oximeters wrapped around his foot to monitor the amount of oxygen in his blood. Each beep a reminder of the vitals under watch.
The incubator regulated the temperature based on his body warmth or lack of it and the functioning of his small lungs. This is because preemies lack body fat, thus cannot regulate their temperature. It also acted as a barrier against infection, excessive noise or light levels that could cause his gradually growing body harm.
On standby, were specialised healthcare professionals such as a neonatologist (a doctor who specialises in the diagnosis and treatment of disorders that affect newborns), a nutritionist, a paediatrician and specialised nurses.
His physical contact with this team of specialists and parents was through holes on the sides of the incubator. His mother looked forward to these moments as it was only then that she would be allowed to hold his hand, stroke his little feet and sing to him.
PUT ON BEDREST
Saving Jeremy’s life began two weeks before he was born, at 22 weeks. On March 22, his mother, while at home, began bleeding. Sensing danger, she asked her two other sons — Kyle and Sane — to call their neighbour who helped her dial her gynaecologist, Dr Barbara Magoha. Ms Nkune was asked to head to the hospital immediately. Once admitted, she was put on bedrest. The bleeding, the first scan showed, was from the placenta, which seemed to be separating from the womb. Jeremy’s life was literary hanging by a thread.
By this time, his organs were what Dr Magoha termed rudimentary to mean they were not fully developed. Ms Nkune, was, therefore, given a steroid injection to speed up the development of Jeremy’s lungs.
“His survival was a 50-50 chance. The doctors said we had to try and get to 24 weeks as that gives the child a better fighting chance,” she tells HealthyNation at their home on Juja Road in Nairobi.
But, the bleeding was incessant. Another scan later, her doctor told her the remaining amniotic fluid was too little as her waters had broken a week after admission. Time was running out and there was need for an emergency caesarean section.
As his mother was being wheeled to theatre, a few minutes to 4pm, Jeremy slid out of the womb and made an entry into the world, albeit too soon and too small.
Ms Nkune and her husband describe the five months in the hospital as an emotional time fraught with anxiety. “We kept asking ourselves, ‘will he be all right? Will he have enough milk?’. We could not find the words to tell the news to our sons when they asked us about their little brother or even explain it to some of our friends. Our hope was in God,” says Mr Narikae.
To their relief, in September, baby Jeremy was ready to go home and was discharged weighing 3.5kg.
Now at home, his parents have improvised ways to ensure he has the right temperature by placing a heater close to some water, so that he does not dehydrate through his skin. However, they worry they may not give him all his needs as their accounts have run dry.
Ms Nkune, cuddling a fussy Jeremy who now weighs slightly close to 5kg, chips in: “We are lucky that our son got a chance to survive. The Newborn Intensive Care Unit at KNH took care of him and gave us a big and healthy baby. While it was costly, as we have a bill of over Sh2 million which we are struggling to pay, it could have been worse had it happened anywhere else.”
Globally, an estimated 15 million babies are born too early every year. Of these, approximately one million children die each year due to complications of preterm birth, shows Unicef. More than 60 per cent of preterm births occur in Africa and South Asia. Within countries, poorer families are at a higher risk.
“In some countries, babies of 22-23 weeks gestation have survived, but on the whole for this group, survival is much less than 50 per cent,” says Prof Musoke from the University of Nairobi’s Paediatric Department.
Preterm birth can be spontaneous or due to early induction of labour or caesarean birth, whether for medical or non-medical reasons.
Common causes include multiple pregnancies, infections and chronic conditions such as diabetes and high blood pressure. However, often, no cause is identified, explains Dr Magoha.
For some of those who survive, they face a lifetime of learning disabilities and visual and hearing problems.
In Kenya, at least 200,000 babies are born before their term. Not all of them are as lucky as Jeremy to get the care, specialists or resources they need. The situation is worse in far-flung rural areas. This reflects the inequalities in survival rates around the world where odds are stacked against babies born in low-income households.
According to World Health Organisation, half of the babies born at or below 32 weeks die due to lack of feasible, cost-effective care, such as warmth, breastfeeding support and basic care for infections and breathing difficulties. In high-income countries, the report shows, almost all of these babies survive.
Beyond Nairobi, counties and hospitals have put in place measures to allow preemies to be born safely and get timely care. “Our major problem is the number of babies who require this type of care versus the availability of hospitals equipped for such care,” adds Prof Musoke.
Her words are personified in most of the counties, where equipment such as incubators are not always available as they are costly to buy, maintain and require reliable power to run. Therefore, simple life-saving cuddles — Kangaroo mother care — fill this gap. Kangaroo mother care works by maximising skin-to-skin contact between a baby who weighs less than 2kg and the mother or father. Much like mother kangaroos do with their babies until they’re fully grown. Kangaroo mother care was piloted for the first time in Kenya in 2013 at the Bungoma Sub-county Referral Hospital by the Health ministry and Save the Children, a NGO.
In Samburu, USAid has funded Afya Timiza, a project implemented by Amref, and introduced the Kangaroo Mother Care Unit at the Samburu County Referral Hospital that bought equipment such as newborn resuscitators and incubators.
Previously, any preemie born at the hospital was referred, six hours by road, to Nakuru County Referral Hospital, making it hard for the baby during the transfer and was, to an extent, a death sentence. Kangaroo mother care, in particular, is a lifeline for mothers and their children, given the rising cases of babies born prematurely and underweight, explains Anthony Lotukoi, the Maternal and Child Health Project Officer at Afya Timiza.
“Kangaroo mother care is free of charge under the Linda Mama package,” he tells HealthyNation.
By July 2019, the neonatal unit had supported more than 170 babies. Of these, 72 were preterm.
HUMAN MILK BANK
While Kangaroo mother care doesn’t need expensive equipment or drugs, it requires a qualified nurse or midwife for constant supervision of the mothers, the right bed and space. To address this, women at the hospital’s newborn unit carry out intermittent Kangaroo care. “We also encourage hospital delivery, so that we can provide timely care. We also train health workers to better handle these cases,” he adds.
Dr Philip Kirwa, director in charge of Reproductive Health Services at Moi Teaching and Referral Hospital, says to save children’s lives requires taking care of their mothers first. “We make sure that when women come in with complications that could likely lead to a preterm birth, we offer prenatal care that, among others, checks the complication and how to manage it. We ensure they are under observation and the delivery is under a skilled birth attendant. We also provide antenatal steroid injections to the pregnant women at risk of preterm labour to strengthen the baby’s lungs,” says Dr Kirwa.
A mother also gets antibiotics when her amniotic fluid breaks before the onset of labour and is offered magnesium sulphate to prevent future neurological impairment of the child.
His sentiments echo the WHO recommendations that, to address premature births, key interventions should be in place to help women enjoy good health before and throughout pregnancy. This includes counselling on healthy diet and optimal nutrition as well as preventing tobacco and substance use. WHO recommends that women make at least eight visits to healthcare professionals throughout pregnancy.
Other initiatives that prevent deaths of premature babies include use of chlorhexidine for cord care in such babies to prevent infections, early initiation of breastfeeding and exclusive breastfeeding for six months. The Human Milk Bank launched in Pumwani in March is an intervention to improve nutrition especially for premature babies without access to their mother’s milk.
On Sunday, the world marked World Prematurity Day to create awareness on the interventions in place to give preemies a fighting chance despite their otherwise rocky start.