Mumbai: The premature baby born to the 13-year-old rape victim died within 48 hours on September 10 due to acute respiratory distress syndrome and septicaemia, the post mortem report said. The pregnancy was ‘terminated’ in its 32nd week on September 8 following a Supreme Court order, and the baby was delivered by C-section.
On August 9, Mumbai Police had registered an FIR for rape after the 13-year-old girl was found to be the 27th week of pregnancy. The accused was arrested a day later, and the girl was sent for medical examination at the State-run JJ Hospital. Given that Indian law allows termination of pregnancy only up to 20 weeks, the girl’s family approached the SC to terminate the pregnancy. By the time the petition was filed, the girl was in her 31st week. On September 6, the SC allowed termination of pregnancy in the 32nd week.
While babies weighing merely 500 grams and born as prematurely as 23 weeks have survived, the death of this boy, who weighed 1.8 kg at birth, has raised questions on the quality of care at JJ Hospital’s Neonatal Intensive Care Unit (NICU).
On Sunday, the girl’s family performed the baby’s last rites. “We have not informed her [the mother] about the baby’s death till nowso far. It was a sad end to the story,” a relative said. She said the girl had fever for a short while but was doing fine on Sunday. The case, probably the first instance of the apex court granting permission to terminate a pregnancy in its 32nd week, has been debated nationally.
Medical experts say sepsis in preterm babies can be defined as ‘early onset neonatal sepsis’ that occurs within four days of birth, or ‘late onset neonatal sepsis’ that occurs within seven days or more. While early-onset sepsis is often linked to infections acquired from the mother, who may have had fever or a urinary tract infection (UTI), for example, late-onset sepsis is linked to hospital-acquired infection.
Dr. Ashok Anand, who delivered the baby on September 8, said, “The girl was fine when we took her in for surgery. She did not have fever or UTI. There is no chance of her passing on the infection to the baby as we had evaluated her well.” A senior doctor said JJ Hospital’s NICU should conduct a microbiological examination to check for bugs. Dr Nita Sutay, who heads the NICU at JJ Hospital, was unavailable for comment despite repeated attempts.
Thorough study a must
Dr. Rahul Verma, neonatologist at the HN Reliance Foundation Hospital , said JJ Hospital will have to conduct a thorough study to track the infection’s source. “How did they come to the conclusion about septicaemia? It’s surprising a baby born in the 32nd week couldn’t be saved.”
The city has seen tiny babies battling it out in the NICU and succeeding the long battle. In 2015, baby girl born in the 23rd week and weighing merely 460 grams was saved at a city hospital after spending more than three months in the NICU. More recently, the premature twins of filmmaker Karan Johar, weighing nearly 1.5 kg each, went home after spending a few weeks in the NICU at Surya Hospital. Doctors at the hospital are currently treating a baby delivered at 22 weeks.
Babies born before the 28th week are termed ‘extremely preterm’; those born between 28 to 32 weeks are called ‘very preterm’ and births in the 32nd to the 37th weeks are called ‘moderate-to-late preterm’. According to the World Health Organisation, in low-income settings, half the babies born in or before 32 weeks (tw0 months early) 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, almost all these babies survive.
Dr Sunit Singhi, who heads the Paediatric ICU at Medanta Hospital in Gurugram, said, “Over the past decade, NICU care facilities in India have developed well, but we definitely need to do more. The babies’ health depends a lot on the kind of infection and the salvaging efforts made.” For example, he added, the mother can be administered a steroid drug 48 hours before delivery to improve the baby’s lung maturation. In this case, the medication could not administered as doctors did not have the 48-hour window due to the court’s order to terminate the pregnancy on September 8. This left the baby to battle with lung immaturity and infection.
