When Babies Die

A baby is God's opinion that the world should go on.
~ Carl Sandburg

A baby is a blank cheque made payable to the human race.
~ Barbara Christine Seifert

The quotes above speak of the fantastic potential babies have that I think more than becoming eerie, it is always depressing to hear news of babies who were just born die suddenly. This sends unbearable pangs of emotional and mental turmoil to vulnerable parents. The emotional hurt gets worse when the baby happens to be a first-born child, or when we learn that the parents were trying so hard for so many years to have a baby, only to be suffocated with an unexpected outcome like a sudden, unexplained death of what would have been a bundle of joy.

Anybody would have described October 4, 2006 as an ordinary day at the Rizal Medical Center (RMC) in Pasig City, a tertiary government hospital, were it not for the alarming fact that of the 28 babies born on that day, 15 were diagnosed to have neonatal sepsis. Out of the 15, six babies died 2 days later, and another one died again a day after.

Neonatal sepsis has become an "ordinary diagnosis" in RMC. Hardly is there a month when there is no diagnosis of neonatal sepsis and neonatal deaths occuring. As of October 15 this year, a total of 69 neonatal sepsis deaths had been recorded in this hospital, and this is noticeably higher than the 45 deaths recorded during the same period last year.

Naturally, the parents of the dead babies were furious and blamed hospital staff for the tragedy. Allegations of negligence and irresponsibility were hurled. The parents alleged that the delivery rooms were crowded and dirty, and bedsheets were not even replaced with each new delivery. They threatened to file a legal case against the hospital.

Hospital staff interviewed meanwhile, said that the babies concerned had difficulty of breathing, poor suck, seizure and fever within few hours of delivery --- all characteristic signs and symptoms of neonatal sepsis.

A Department of Health (DOH) investigation ensued, but aside from mild reservations from the Health Secretary and four days of inquisition and detective work, the investigating committee had cleared hospital doctors of any responsibility arising from the infant deaths. As if adding insult to injury, they even insinuated that all along, the mothers of these dead babies were the ones who are at fault.

"The newborns [had] difficulty of breathing and fever within 90 hours after delivery. This suggests that mother-to-child transmission has occurred even before the delivery," said a statement.

Health Secretary Francisco Duque III saw things differently, stressing that medical center officials "are not totally off the hook because there is an increasing neonatal sepsis case in that hospital according to our records. All this strongly points to some degree of negligence perhaps."

The joint probe’s finding indicated that there was a "remote" possibility that power outages caused by typhoon Milenyo late last month triggered environmental infections.

"Both the fact-finding committee and National Epidemiologic Center (NEC) were unable to link contaminated hospital equipment to the outbreak. The short power interruption after typhoon Milenyo appears to be unrelated, too," it said.

[SOURCE: Manila Standard Today, 23 Oct 2006 ]

I am flabbergasted by these insensitive statements from our health authorities. Do they know how it is to lose a dear child?

"All this strongly points to some degree of negligence perhaps."

Perhaps? WOW! Isn't negligence written all over the reports already?

Unable to link contaminated hospital equipment to the outbreak? Did they do any bacterial cultures to support this claim?

Other personal comments:

1. What will happen next? - Forgive me, but the first impression I got from the DOH investigating committee results was the cunning good-cop/bad-cop approach. The results brought more questions than answers. And as the PDI editorial asked days ago, is this case now closed or open???



2. Is Sterility and Asepsis a Passing Fad? - there was a time when my classmate doctors and I would spend a good 20-30 minutes scrubbing our hands, arms, and elbows not just with soap and water, but with antiseptic solutions before going inside the delivery room. We complained, of course, because at a rate of more than 20 birth deliveries per night, the skin on our arms looked red and sore already from all the scrubbing. But we did it, anyway. And today, are we glad we did! All our babies and mothers are still alive and kicking. Is scrubbing still practiced with zeal today, or is it just a passing fancy, which becomes necessary only when a health inspector is around? Also, concerned health personnel should always be aware of guidelines for the management of spontaneous preterm labor as many Filipina mothers give birth to preterm babies, and they are usually very vulnerable to neonatal sepsis.



3. Quantify and Qualify the "Abnormal Conditions" - on October 13, the RMC hospital director apologized on national TV to the parents of those babies who died. He said that RMC hospital was in a state of "abnormal conditions" during the time of the said deliveries. He cited electrical power and water source problems. It would be helpful to know if he can elucidate how the said problems could have probably jeopardized sterility in the delivery room. What really happened?



4. Where is the DOH Investigating Committee Full Report? - I didn't see it on the DOH website, and I didn't see it on the NEC website, either. So, where is it? Can't ordinary people like me read it? Or is it confidential?



5. Neonatal Nosocomial Infections Exist - and they must be addressed. It is not bad for a hospital to admit these things happen, because they do happen, even with current advances in neonatal care. What I would like to see --- and I know many of you wouldn't agree --- is transparency on the specific types of bacteria present in hospitals. We can also probably add what is being done to limit nosocomial infections from happening. The best database on neonatal sepsis I've read recently is on last year's issue of Pediatrics journal. It details seventy-five (75) years of neonatal sepsis in Yale's New Haven Hospital.



6. Tulfo Anecdotes - I'm not really a fan of Ramon Tulfo, but confronted with a dearth of data on the RMC catastrophe, reading his anecdotes about the hospital adds to my suspicions of massive hospital negligence.

Should you still be interested after the long read above --- I can hear you yawning, already --- please spend some time reading on the following excellent links:

• Recognition, Prevention and Management of Sepsis - not just for newborns. Sepsis is discussed in simple terms as it affects both adults and children.



• Predictors of Neonatal Sepsis in Developing Countries - abstract on what to look out for in neonatal sepsis; includes the Philippine local setting.

Let's pause and pray for the souls of those babies who died. May they rest in peace.