‘One baby, one cot’ protocol ignored at GMCH: Experts on infant death

Guwahati, Aug 21: The Gauhati Medical College and Hospital (GMCH) authority violated protocol by keeping multiple babies in one cot, which may have led to the tragic death of a newborn in the hospital. The main protocol violation is that one baby should be kept in one cot and multiple babies were kept in one cot.

The second major violation is that one nurse should not be allowed to take care of so many babies in the Neonatal Intensive Care Unit (NICU) at a time and blaming the nurse for the incident is not correct. This is the observation of multiple prominent child specialists.

When contacted by The Assam Tribune to get his views on the incident, child specialist and former Head of the Paediatrics Department of the GMCH, Dr JN Sarma said as per protocol, one baby should be kept in one bed or else the very purpose of keeping babies in NICU would be defeated.

He said that babies with serious infections are kept in the NICUs and the babies infected with jaundice are kept in the phototherapy unit. He said that in a phototherapy unit, lights are put on top and bottom of the cot to expose the baby to the light. Such phototherapy is usually given to babies suffering from jaundice. Only one baby at a time, he said.

Dr Sarma said if two or more babies are kept on one cot, the very purpose of keeping babies in NICU would be defeated, which was the case in the recent tragic incident where more than one baby was kept in a cot. He pointed out that if more than one baby is kept in one cot, the babies would not get the required light in the phototherapy unit or warmth in the radiant warmer they need for treatment and the whole purpose is defeated.

Moreover, if one baby has some other infection, it will be transmitted to the others kept together, which can lead to serious consequences. Because of these reasons, one baby one cot protocol should be strictly followed.

Dr Sarma said that the newborn babies cannot roll and it is difficult to understand how a baby can fall off the cot. Moreover, the cots have boundaries and even if one baby gets pushed by another due to movement of hands and feet, there is very little chance of one baby falling down. Babies can roll only after three months age.

Dr Sarma said that as per protocol, there should be one nurse per baby in the NICU but there is always shortage of nurses in the GMCH. “I do not know what actually happened. But I have seen a nurse commenting in front of TV cameras that there was only one nurse on duty in the room of the NICU, which had around 30 babies. If that was actually the case, it was a total breach of protocol and you cannot blame the nurse only in such a case,” he added.

Dr Sarma further expressed the view that in an ideal situation, specialized doctors and trained nurses should be posted in the NICU. The nurses should monitor the babies in every half to two hours as necessary and call the doctor whenever required. If a baby is not seriously sick, ideally it is kept with the mother, he added.

When contacted, another prominent child specialist, Dr Partha Pratim Bora told The Assam Tribune that one baby one cot is the norm in the warmers used to keep the babies warm. He said that one nurse should not be allowed to take care of more than four babies at one time. He pointed out that unlike adults, babies need constant care and one nurse cannot handle more than four babies at a time.

Dr Bora expressed the view that blaming doctors or nurses for the tragic incident is not correct. He said that the system needs to be changed. The problem in the GMCH is overcrowding and in that case, patients should be sent to other medical college hospitals. Though a number of new hospitals have come up in the State, the new colleges often refer patients to the GMCH, which has become a serious issue. “Even when we were students, overcrowding was a major issue in the GMCH and the system needs to be blamed for the tragedy,” he added.

Dr Bora pointed out that some government hospitals outside the State have a policy of not admitting more patients than the bed strength. Even the AIIMS follow the same policy. He also said that some hospitals outside the State have full buildings dedicated to the NICU and Assam needs to change the system.