Dubai, UAE: Between nature and nurture lie the dreams and aspirations of all parents-to-be as they look forward to creating a family unit. The birth of a baby is one of the most joyous moments for a couple but it can, in some instances, also lead to unforeseen complications and financial stress if the child is born with a medical condition.
One kind of a post-natal problem is when the baby is born prematurely. Called ‘preemies’, they need extra attention and care and are required to be placed in an incubator, a device that helps maintain stable environmental conditions suitable for a newborn baby. It is used in pre-term births or, in some cases, even for full-term babies with medical issues.
An incubator not only keeps the premature baby isolated but it also offers it a sterile environment. It can provide it phototherapy, and helps it breathe through a machine placed outside the incubator.
The availability of an incubator, therefore, is at the core of the preemies issue and Dubai is experiencing an increase in the number of premature babies being born each year. This is placing an enormous strain on the system as, many times, there is a shortage of incubators in hospitals in Dubai.
What is causing this spike in preemies?
The reasons are many, say doctors, the most significant being an increase in daily life stressors for pregnant women due to the fast-paced modern lifestyles they lead. Another factor pushing up the number of preemies is the rising numbers of couples who are choosing fertility treatments.
Fertility treatments that women undergo can result in multiple births and early delivery due to a host of reasons, such as the use of fertility drugs, high doses of hormones being given to the woman, etc. Another reason for preemies is late marriages and the more advanced age of the expectant mother due to it.
Some couples also put off the birth of a child due to career reasons or other factors and this also delays the maternity timetable of the woman, according to doctors.
Stress is a big cause for a woman delivering a premature baby and the stressors can be the everyday demands of life in our competitive modern times.
"The parents are young, both the mother and the father have to work and the [daily life stressors] affect the birth," says Dr Khalil Ur Rehman, consultant neonatologist and paediatrician at Mediclinic Welcare Hospital, Dubai.
When is a baby termed premature?
A baby is said to be premature if born before 37 weeks of gestation. There are no statistics to show how many babies are born prematurely in the UAE, but paediatricians guess that the figure is between 12 and 15 per cent every year.
This is pushing up the need for the use of incubators as babies born with high degree of vulnerabilities such as being unable to feed, breathe properly or not able to keep body temperature normal need intervention.
"The biggest threat for a premature baby is infection as their immunity levels are compromised and many need antibiotics and a full support system," says Dr Khalil.
"A premature baby also puts more stress on the parents," he says.
The shortage of incubators
Government hospital doctors said there was a huge demand for incubators and the private sector facilities have limited facilities to deal with the growing number of premature babies. The number of premature babies being born is only expected to increase as the population grows.
The Dubai Health Authority (DHA) estimates in a planning and strategy report of 2010, that by next year (2015), the need for incubators will jump by 48 per cent. The report states that there are presently no figures as to admissions to NICUs in public and private hospitals in Dubai. The report has taken the international benchmark and has estimated there is a 64-bed (or incubator) shortage at present in Dubai.
The report also states that the shortage could be higher and reach 100 beds or more to meet the growing demand.
For example, in Dubai Hospital alone, at least 400 babies every year need to be kept in the neonatal intensive care unit (NICU) after birth for observation and treatment. Many cannot breathe on their own and are placed in a safe environment in an incubator and need special pumps attached to help them breathe. The birth statistics at Dubai Hospital is 4,000 babies per year.
At Latifa Hospital, for instance, on an average per year, 6,700 to 7,800 deliveries take place.
Out of these number of births, about 10 to 12 per cent of the babies delivered are admitted into NICUs.
Latifa Hospital has a 48-bed NICU unit and Dubai Hospital has a 32-bed unit. The hospitals admit babies with lowest gestational age and birth weight, which is 24 weeks onwards and 500 grams onwards.
Some cardiac interventions are done in Dubai Hospital by the cardiac surgery team and other neonatal surgical interventions are offered by the paediatric surgery team in Latifa Hospital and the two hospitals share these services.
DHA does not easily give licences (Level 3 licence) to a hospital or a clinic to run such a unit on their premises without all the elements in place to provide support to the premature infants.
"When I first came here in 2006, the Welcare Hospital [as it was called then] had only one ICU bed for babies," said Jennifer Eastaugh, nurse manager at Mediclinic Welcare Hospital.
It soon started getting a number of referrals from smaller private facilities and it was apparent there was a shortage of such units for premature babies and a shortage of incubators to put them in that special environment.
Today, it has 16 beds and two isolation beds where mothers can come and visit and touch the babies. The smallest baby born at this hospital is 570 gms, said the nurse manager.
Still, the hospital has its limitations and does not have a cardiac surgeon and, sometimes, babies are transferred to larger facilities in Abu Dhabi.
Why incubators are expensive
An incubator is not just a crib that controls temperature and humidity but is an advanced piece of equipment that costs between Dh10,000 for a basic unit to Dh45,000 that has oxygen control, skin temperature monitor, power failure warning, and other audio and visual alarms.
A specialist neonatologist and trained nurse staff are in charge of these special beds for premature babies in the NICUs, and that further drives up the cost of treatment and care of the baby. (Neonatology is a sub-speciality of paediatrics and covers the medical care of premature newborn infants. These infants require care as they generally have a low birth weight or birth defects).
Many top private hospitals and government hospitals in Dubai have NICU units. Zulekha and American hospitals have 10 incubators each; International Modern has three; Cedars in Jebel Ali has three and NMC has eight. Many smaller hospitals cannot afford the high costs of these units and refer cases to the larger hospitals.
For the high level of care given to a baby in its first weeks of life, it costs anything between Dh3,000 to Dh6,000 a day and many new parents who do not have insurance coverage are unable to pay the huge sums.
The daily charge for the incubator goes up if there is lab support required, blood tests to be done, and medicines administered intravenously.
A mother, who did not wish to be named, said she went through a bad time in Dubai five years ago when she went into premature labour. She claims that many hospitals refused to admit her because they lacked facilities for preterm babies.
She was forced to go from hospital to hospital to find a facility that would admit her. She has heard, she says, of mothers giving birth in their car because of this problem.
Dr Laila Al Muhairi, head of paediatrics at Dubai Hospital, said because of the increase in population and the shortage of Level 3 NICU units in the private sector and in the northern emirates, the admission rate is high in the hospital’s neonatal unit.
"Expansion of NICUs is a logical process," she said, adding that Dubai Hospital has completed the expansion of its neonatal unit and has added 12 new beds. "Currently, the manpower recruitment process is under way,’ she said.
Dr Mahmoud Saleh Al Halik, head of paediatrics at Latifa Hospital, says that its unit also has a high volume of admissions as it receives many neonatal surgical cases, in addition to many other nonsurgical neonatal cases from the northern emirates.
Both hospitals have services to deal with high-risk pregnancies, adding more admissions to the neonatal units.
Dr Al Halik said the hospital is thankful to Majid Al Futtaim Charity Foundation that is sponsoring the cost of expansion of NICUs in Latifa Hospital.
The Dh24 million project will add 16 new Level 3 neonatal intensive beds that are expected to be functional in the fourth quarter of this year.
© Gulf NewsMay 2014