A 40-day-old baby was brought to the Paediatric Resuscitation and Emergency Medical (PREM) unit at Government Hospital, Tirupattur, with pneumonia, respiratory failure and shock. The critically-ill baby was resuscitated at the unit; he recovered a day later and was handed over to his mother in a stable condition.
Doctors, who are working in paediatric emergency care, say that in this instance and many more, the PREM unit has done what it was supposed to do – provide emergency medical care to babies older than 28 days, thereby helping in reducing the post neonatal mortality, infant mortality rate (IMR) and under-five mortality.
It was with this aim that the Tamil Nadu government proposed the setting up of PREM units in 28 government hospitals – 22 district hospitals and six sub-district hospitals. The Tirupattur GH was one of them.
S. Srinivasan, State coordinator of Neonatal Intensive Care Unit (NICU), said, “We already have a well-established network of NICUs to cater to newborns in the State. But we were losing babies in the post neonatal period. Under-5 mortality is also caused due to pneumonia, diarrhoea and malnutrition. So, for us to reach the millennium goals of single digit IMR, we have to keep children safe in the post neonatal period. With NICU proving to be a successful model, we brought in the concept of PREM units.”
He said the process for setting up full-fledged PREM units was going on in the State, with supply of equipment for some units under way. Recruitment of nurses was also progressing.
“The PREM unit came up at Tirupattur GH, which is a sub-district hospital in Vellore, in July last year. The hospital was selected based on its performance in paediatric care. The unit started to function full-fledged three months ago. In the last three months, we have received 121 patients aged 28 days to 12 years,” said R. Senthilkumaran, senior assistant surgeon, paediatrics, Tirupattur GH.
The Special Newborn Care Unit that has been functioning at Tirupattur GH caters to babies up to 28 days old, and has helped in reducing neonatal mortality rate, he said, adding, “If some of these babies fall ill later, they will have to be taken to a government medical college hospital or private facility for treatment. Now, a 15-bed paediatric intensive care units are available at medical college hospitals but face increasing case load. It is here that the PREM units come in.”
The National Health Mission allotted ₹25.25 lakh to each unit towards equipment.
“We have equipment such as ventilator, non-invasive ventilators, pulse oxymeters and multi channel monitors, besides beds in the unit,” he added.
“We receive cases of accidental poisoning, insect/snake bites, severe asthma, respiratory failure, severe dehydration and convulsion,” he said. After 48 to 72 hours, the child, once stabilised, is shifted from the PREM unit.
Single digit target
“At present, IMR is 17 per 1,000 live births in Tamil Nadu. The aim is to bring down IMR to a single digit in the State,” he said.
