How tech-aided childcare saves lives, but more would be better

Dr Christine Manyasi, a Neonatologist, at Mbagathi Hospital take care of newborns at NICU. [Gloria Milimu, Standard] At the neonatal Intensive Care Unit (NICU) of Mbagathi Hospital in Nairobi, a baby weighing just 670 grams is received as an emergency. Doctors quickly wrap and rush her to an incubator. Too fragile and tiny, the baby was born prematurely and abandoned in a hospital in Tassia, Embakasi. Here, Baby Hope* is fully supported for survival. "This baby is very small and has a long journey ahead," says Dr Christine Manyasi, a neonatologist at the hospital who admits her at the NICU. Doctors provide round-the-clock interventions ranging from breathing support to special feeding. She is fed on small quantities of donated milk through tubes inserted into her stomach. At such a tiny age, her stomach is not fully developed, and she does not know how to suck and feed at the same time. Such babies often stop breathing so that they can feed, which is why doctors have to use tubes. "They also have a challenge feeding, their stomach is not developed, they do not know how to suck and feed at the same time. So they stop breathing, so that they can feed, and we have to feed them through tubes," explains Manyasi. She adds, "Tubes are placed in their stomach, and we put milk in small quantities that are increased slowly until they are able to take more. They need breastmilk, because they have a challenge digesting formula milk." The facility gets donor breast milk from Pumwani Maternity Hospital, until a baby is big enough to feed on formula. At the unit, temperature and humidity are carefully controlled, mimicking a mother's womb. "Premature babies have underdeveloped organs. Their lungs collapse, they struggle to breathe, they cannot feed on their own, and they are prone to infections. Without proper care, they die," explains the specialised doctor. Hope was born at 25 weeks, against the expected 37 to 40 weeks of gestation. She is the tiniest baby. Dr Manyasi estimates about three to four months of hospital stay, until her organs-including lungs, brain and kidneys fully develop before she can be discharged. "Premature babies like her face multiple challenges. They struggle to breathe because their lungs are not mature, they cannot feed on their own, their skin is very thin, and they are prone to infections. We do everything possible to support them until they can survive independently," she says. Just next door, frantic efforts are also underway to keep the next tiny patient alive. Doctors are forced to ventilate Baby Isaiah, who has difficulty in breathing. Though he has been at the unit for three weeks, his response to treatment is slow. Isaiah was admitted with infections acquired from his mother, and has fluid in the brain. He was born preterm. Globally, preterm birth is the leading cause of death among children under five. In Kenya, at least 134,000 babies are born prematurely every year, and many of them require intensive care. Yet, facilities that can offer life-saving interventions remain scarce. Mbagathi Hospital, a Level Five facility, is one of only two public hospitals in Nairobi that run a Neonatal ICU, the other being Kenyatta National Hospital. The unit handles between 200 and 250 newborns every month, most from Nairobi's informal settlements and nearby counties including Machakos, Kiambu, Murang'a and Nakuru. "We receive babies from all over. On some days, we attend to more than 100 cases, yet our ICU has only four beds and two ventilator machines," Dr Manyasi explains. The unit takes care of a wide range of newborn complications. Some babies require ventilation after failing to cry or breathe at birth, whereas others develop severe jaundice, a condition that forces them to undergo exchange transfusion to prevent brain damage. A growing number of babies at the unit are also developing kidney failure. To save the babies, the hospital has established peritoneal dialysis for newborns, a delicate procedure where a catheter is surgically inserted into the abdomen, allowing fluids to wash out toxins from the body. The peritoneal dialysis unit, according to Dr Manyasi, has been a lifesaver. At least two babies are admitted every week requiring the procedure. In the past, only Kenyatta National Hospital could perform it. "Small babies can't tolerate dialysis machines designed for adults. Their blood volume is too small," she explains. Triggers of kidney failure include infections, dehydration, and poor breastfeeding. Fortunately, if detected early, the condition is treatable, unlike in adults who often require lifelong dialysis or a kidney transplant. At the unit, eight-day-old baby Isaack* is undergoing peritoneal dialysis. He was admitted at just five days old. For such infants, dialysis is not done using the big machines that filter and recycle blood, as their blood volume is too little to withstand the process. Instead, a paediatric surgeon inserts a special catheter into the abdomen. "A baby's abdomen has a very good surface for washing out. We place a tube surgically, then allow fluid to flow in and out, gradually washing out toxins from the body. Within a few days, the kidneys usually recover," explains Dr Manyasi. The procedure is repeated after every one hour, continuous, until the bay recovers. A doctor will be able to determine recovery if the baby starts to pass urine, if she or he was not, laboratory numbers are going down, and if a baby who was swollen is not swollen, whereas those who used to cry are calm. "Kidney failure in babies present with poor feeding, unable to pass urine for two to three days, and if examined, the baby are found to be too much dehydrated," explains Manyasi. She notes that at times, babies cry too much. However, a doctor conducts blood test to diagnose kidney failure. For every miracle baby who survives, another does not make it. Every single day, Kenya loses 92 newborns every day cases, figures experts say are alarming. The deaths are linked to birth related complications including infections and prematurity. At least one our of 10 babies reported in hospitals require an ICU for survival. Though Mbagathi has a total of 4 ICU beds for babies, it requires about 10 to serve high flow of babies in need of specialists care. Unfortunately, adult ICU cannot be used to save lives of newborn. All "Without access to facilities like this, a lot of babies die unnecessarily. Most of the deaths reported can be saved if neonatal intensive care was widely available," observes the doctor. But for every miracle baby, there's one who doesn't survive. Survival rates for extremely premature babies in Kenya remain at about 60 per cent, compared to 95 per cent in developed countries. Experts say with investment in newborn care, training, and access to oxygen, incubators, and dialysis, more babies could be saved. The facility receives at least 10 requests for newborn referral for ICU from various counties, but they are limited with its capacity.Sadly, some of babies in need of specialised care die while on their way to the facility. Mbagathi is the only Level 5 facility in Nairobi that has an ICU, in addition to KNH. Apart from Nairobi, Moi Teaching and Referral Hospital (MTRH) is another facility with installed ICU that mostly serves patients from the Rift Valley and Western of the country. "There are sometimes we do allow babies to be brought in from neighbouring counties like Nakuru, but while on the way, they die. Babies are so delicate, and even if they are refereed, many will die on the way," she regrets. Mbagathi Chief Executive Officer (CEO) Dr Alex Irungu notes before establishment of the unit in 2023, it was a hustle managing preterm and babies born with complications. "We used to refer newborns to KNH, but at times we could not get space because of high volume of booking. Though we are not serving more babies as expected, it provides a relief," says Irungu. Plans are underway to expand the facility. A few years ago, extremely premature babies survived for just a few hours, however, majority born prematurely now have a 50 50 chance of survival, thanks to the ICU specifically designed to attend to their needs. Adult ICU however cannot serve newborns- everything is special for newborns, for example the amount of oxygen used is in small quantities. Sadly, the specialist observes though the number of newborns dying is high, with less emphasis put to invest in newborns. "Ironically, when a baby dies at birth, the society takes it easy, saying- atazaa tuu (she will give birth to another child), normalising deaths, instead of getting solutions," regrets Dr Manyasi. Newborn ICU remains unique to babies. An adult ICU cannot serve newborns- everything is special for newborns, for example the amount of oxygen used is in small quantities. The hospital not only stabilises fragile babies, but also prepares families to care for them at home. Of all the admissions at the unit, at least 50 percent are of preterm babies who need support for survival. Pre-term birth complications are the leading cause of death among children under five. However, experts say with enhanced interventions like care of complications, preterm babies in Kenya can be saved. Data by World Health Organisation (WHO) shows that Kenya's neonatal mortality rate is 21 deaths per 1,000 live births, with prematurity as a leading cause of death. The country is four years shy to meeting global targets of reducing the deaths to 12 per 1,000 live births by 2030. At the facility, mothers are taught how to feed and monitor their babies until they are strong enough for discharge. Feeding of babies at the unit including preterm are feed with a cup, as bottle are discouraged, as they trigger infections. For better outcome of preterms, WHO recommends Kangaroo Mother Care (KMC) immediately after birth, early initiation of breastfeeding, use of Continuous positive airway pressure (CPAP) and medicines such as caffeine citrate for breathing problems can substantially reduce mortality in preterm and low birthweight babies.

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