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‘Each baby is precious. We who work in neonatal care speak up for them; we speak loudly’

Some 200,000 babies die each year across South-East Asia, according to official data. Thi Hoang Tran’s research could help reduce that grim statistic.

Interview by Karen Coombs
 

‘My study was done at the neonatal unit in Da Nang Hospital for women and children in central Vietnam, which takes care of newborns at risk in the first four weeks of life. I researched the leading causes of neonatal morbidity (disease) and mortality (death).

The research involved recording all newborn admissions in the neonatal unit for a year. I recorded all information, including the management of the unit, from admission to discharge or the death of a baby. I also gained as much information as possible about the mother’s pregnancy.

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During this time there were 2555 admissions with 220 deaths. Of these deaths, 21 per cent were in the first 24 hours and 57 per cent occurred in the first week. The primary causes were birth defect, infections and prematurity. I found hyperthermia was common on admission of preterm infants and that temperature control within the unit was poor.

We started to use ‘kangaroo mother care’. This means the baby is kept next to the mother’s chest, or any other family member, such as the father or grandparents. The idea is to provide skin-to-skin contact. This is an effective, low-cost way to keep premature babies warm when there are no incubators.

Long term studies have proven ‘kangaroo care’ to have very good outcomes and so we made its implementation a priority. We now have more beds and two new rooms for mothers and babies especially for such care. We hope to add more. I wish we could have done this earlier but we had limited staff at the time, but now the babies are happier and more comfortable.

One baby boy was born at 30 weeks and weighed just 1.4 kilograms. He spent seven days in intensive care on a ventilator. After he became stable, we transferred him to ‘kangaroo care’ where his mum and dad were kept busy taking turns keeping him next to their chests.

‘It is very hard here. There is a lot of suffering for the mother. We don’t have a free universal vaccine program but we believe the government is introducing this in the next year or two.’

We fed him his mother’s milk through a nasal gastric tube until she was able to successfully breastfeed. This can be hard work and take some time because the babies are so small and weak. But we were very pleased to see this little boy nearly double his weight and six weeks later he went home with his happy new parents.

‘Kangaroo mother care’ is also good for increasing the breast feeding rate which was very low. Breast milk is very important for premature newborns but this can be difficult when they are in intensive care or if the mother can’t stay at the hospital.

We now encourage them to express their milk every three hours and deliver the milk to the unit at any time so we can store it in a refrigerator. Before this, the unit wasn’t open to take the milk at night but now we have breast milk arriving at all times of the day and night, wrapped in ice and delivered on motorbikes.

However, infections are another problem. We found powerful antibiotics were overused and that limited the baby’s ability to develop resistance to bacteria. We now have much stricter guidelines when using antibiotics. This will reduce and control the infectious diseases and bacteria that have a lot of resistance to many antibiotics.

I also found birth defects were caused by the mother being exposed to rubella in the early stage of pregnancy. Rubella has been eradicated from most parts of the world but in Vietnam pregnant women are still vulnerable.

‘If we care for the mother and for the health of her newborn, the better it is for our country.’

Fifty babies had congenital rubella syndrome — which means the foetus became infected in the womb — during the year of our research. Many babies were born with brain and eye defects and heart disease. For the few that survived, their lives will be very difficult.

It is very hard here. There is a lot of suffering for the mother. We don’t have a free universal vaccine program but we believe the government is introducing this in the next year or two.

Change requires time and hard work. It takes a lot of effort to get people involved to try and help us. When our neonatal unit is up and running at a certain level, we will help other hospitals.

Traditionally in South East Asia, a baby was not given a name for the first 29 days in case it died. But each baby is precious. We who work in neonatal care speak up for them; we speak loudly. If we care for the mother and for the health of her newborn, the better it is for our country.’

Thi Hoang Tran’s thesis was titled: Neonatal mortality and morbidity in Da Nang, Vietnam.  Her study is the first of its kind to focus on Vietnam and it provides information that can lead to low-cost interventions to reduce newborn deaths in similar resource-limited settings.* My PhD is an irregular series in which The Citizen speaks with recent Melbourne University PhD graduates. 

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