Paediatrician weighs in on neonatal deaths

Over the past few weeks, Trinidad and Tobago has been rocked by reports of multiple deaths at the neonatal intensive care unit (NICU) of the Port of Spain General Hospital. As the nation grapples with this tragedy, several other families have come forward sharing their own stories of grief, with 16 families speaking out so far.

To help shed light on the situation, Altos spoke with well-known paediatrician and newspaper columnist Dr David Bratt. He provided sobering global context on just how vulnerable neonates are. Neonates are under 28 days old.

Delicate and dependent

“If you have children who die, all the children who die, three-quarters of them die before their five years of age,” Dr Bratt stated. “Of those three-quarters who die before five years of age, half of those who die before one year of age, die in the first 28 days of life.” Neonates, especially preterm babies, have incredibly fragile bodies and underdeveloped organs that are not ready for life outside the womb.

“Their organs are totally immature. They can’t breathe for themselves…They have no immune system that really functions. So, they have to be kept in almost a sterile environment,” Dr Bratt explained. Their lack of a functioning immune system leaves them wide open to infections, which can be fatal.

Even routine bodily functions like eating are extremely challenging for these tiny babies. “They can’t eat for themselves, so you have to feed them. And that means either putting a tube down through their nose into their stomach or putting a drip up and feeding them intravenously,” said Dr Bratt.

He stressed that neonatal intensive care requires meticulous protocols to minimise risks. “Strict infection control, if we’re talking about newborn babies, premature babies in a NICU means that you have to isolate that baby and you have to isolate the nurse who is taking care of that baby. So, it should be a one-to-one situation.”

Strides and shortfalls in specialised care 

With such vulnerability on multiple fronts, it’s clear why neonates have an extreme need for advanced care in specialised facilities. While Trinidad has made some positive strides in neonatal care, Dr Bratt indicated more specialised staff is still needed.

“What has happened is that we now have trained neonatologists who are paediatricians who trained in the care of taking care of newborns,” he said. “And we also have some neonatal nurses who have trained in the care of newborns.”

However, the numbers are lacking, especially for nurses. “We don’t have enough, especially as far as the nurses are concerned. We have about eight or nine neonatologists who are these specialists trained in the country.”

Dr Bratt credited the arrival of Trinidad’s first few neonatologists with dramatically improving survival rates for neonates. “When the first two came back, we saw a dramatic drop in the number of children who were dying before they were 28 days of age.”

He believed more must be done to properly staff NICUs with adequate numbers of doctors and nurses specialising in neonatal intensive care. Having more skilled personnel is crucial, coupled with investing in new, state-of-the-art NICU facilities tailored for neonates’ fragile conditions.

He hoped the investigative team from the Pan American Health Organization (PAHO) will recommend building new, tailor-made NICU units with adequate staffing ratios.

“One nurse taking care of three premature babies, one to four in some. That is not what is called a Level 3, which is what we’re looking for.”

Addressing concerns from expectant parents doubting the public health system, Dr Bratt urged them not to lose faith entirely, noting the private sector cannot handle complex paediatric cases. “The private sector cannot take care of premature babies. They can’t…I want the baby at the Port of Spain Hospital or San Fernando or at Mount Hope.”

Psychological toll

The immense grief of losing a baby has undeniably taken a psychological toll, not just on parents, but also the medical staff involved. Dr Bratt empathised with the traumatic impact it has had on them as well.

“I feel sorry for the neonatologists, too, because it’s heartbreaking. And I was speaking to one of them last week, and she was just torn up about what is happening,” he said. “But then the nurses…The nurses are grieving. These are nurses that work hard in situations that are not the best, and they do their best most of the time.”

He added, “And yet now they seem to be being blamed for what is happening, and I don’t think that is the right… The nurses are feeling this, and it must be terrible for them to have to come to work and know what people are saying.”

Dr Bratt emphasised that just as bereaved parents need psychological support, so do the healthcare workers who have experienced such tragedy. “They need psychological support, just as the parents do, just as the doctors do, too.”