There are some patients that keep me up at night — the ones I worry about even when medical care is optimal. Patients with severe acute malnutrition fall into this category.
It’s difficult to predict which child with severe acute malnutrition will survive and which child won’t make it. All too often, I have seen a child on the pediatric ward who seems to be doing well, only to be told the next day at morning report the child had died. …Read More
Kangaroo mother care has been part of neonatology’s toolkit for close to 40 years. Characterized by four components — early and extensive skin-to-skin contact between mother and baby, exclusive breastfeeding, early health facility discharge and close follow-up care at home — this form of care was initially conceived as an alternative to incubator-based care for babies born preterm or with a very low birth weight (LBW), particularly in resource-poor parts of the globe.
While there’s extensive literature on KMC’s benefits — including reduced risk of infant morbidity and mortality — it’s been hard to get a complete picture of what the how well the approach works, and what its disadvantages might be. According to Grace Chan, MD, PhD, a researcher at T.H. Chan Harvard School of Public Health and a staff physician in Boston Children’s Hospital’s Intermediate Care Program, most of the reviews or meta-analyses available have focused on particular populations or specific outcome measures, or have only looked at randomized, controlled clinical trials (as opposed to how KMC works in real-world conditions).
The red dirt road brings me back to these wards, these walls, these children. I’m about half way into my second six months in Rwanda working for Partners In Health/Inshuti Mu Buzima (PIH/IMB) as a district clinical advisor to two district hospitals — which is really just a fancy way of saying that I’m the (only) attending pediatrician on two government hospital wards. I walk into the neonatology unit and the nurses are bustling around, hooking babies up to CPAP, performing the first steps of life saving care for tiny (800-1500g, or 1.8-3.3 lbs.) premature babies who the doctors have not been able to come see yet because they are busy in the other wards with other critically ill patients.
Rwanda is unique in that almost 90 percent of births take place in facilities. But despite that fact, two-thirds of neonatal deaths still occur within the first 7 days of life while babies are still receiving facility-based care. …Read More