Successfully putting new neonatal care training to the test in Preah Vihear Province
Back in November 2019, Navy, a 29-year-old mother-to-be from Srey Sonos Village in Preah Vihear Province, travelled 100km to January 16 Referral Hospital, as she felt she was in premature labour. There, she gave birth to her daughter, Vany. Vany was admitted to the Referral Hospital’s newly installed Neonatal Care Unit (NCU) a day after she was born. Vany had complications from premature birth (30 weeks), including low birth weight. She weighed only one kilogram.
At the time of Vany’s admission, AHC’s Saving Babies Lives (SBL) team had just finished the clinical attachment and had begun the first several months of mentorship sessions with the January 16 Referral Hospital team. The nurses at the NCU checked Vany for congenital abnormalities. They also knew they had to keep Vany warm under a baby warmer, and provide her with Continuous Positive Airway Pressure (CPAP) therapy to support her breathing. Vany also received intravenous antibiotics Ampicillin and Gentamycin, nasogastric feeding, and blood screening.
After two weeks, Navy was able to start breastfeeding Vany and her condition began to improve. Navy wanted to return home as soon as possible, as it is too difficult to be away from home for extensive periods of time. The team reluctantly discharged Vany, as long as Navy agreed to come back for a follow-up in one month.
One week later, the SBL team returned to the referral hospital for a routine mentorship visit, and discovered Vany’s case, and how she was discharged after only two weeks of care in the NCU. They explained to the team that it was too early for Vany to have been discharged and advised them to contact the family to advise them to bring her back to the hospital immediately. When they located the family, Navy said they lived too far to come back again. The team explained to her how important it is for Vany to come back to the hospital for proper care because she was too small.
Eventually, Navy returned to the NCU with Vany. After a few days, Vany was able to gain weight, become active and suck properly on the breast. Navy received education to prepare her to continue caring for her small baby at home, learning about topics such as breastfeeding and the importance of keeping baby warm. SBL mentors supported NCU staff to teach her Kangaroo Mother Care (care method for premature babies involving skin-to-skin contact). AHC’s SBL mentors and the referral hospital staff all felt content. Vany was discharged and had a successful follow-up one month later. This was one of the first cases where the January 16 staff had to put their new neonatal care training to the test and effectively advocate for the proper care, even though it was contrary to the mother’s wishes.
“At that the time, when they told me about this case, I felt like I finally made it because they managed the premature admission by themselves, giving all the treatment including IV fluids, IV antibiotics, CPAP, breastfeeding support. We just needed to add to their missing knowledge and practice. I just needed to add up some points about safe discharge and follow up. Nowadays they can manage all the proper care for premature babies independently. That’s what made me most happy, that the NCU staff can manage without me.”
Dr Say Sopheakneary, AHC’s SBL Referral Hospital Lead
In late 2021, pure delight erupted at January 16 Referral Hospital’s NCU when almost two-year-old Vany returned to the unit to say hello. Navy had brought her to the hospital to treat a small wound on her foot and wanted to come by to visit the team that had helped her baby as an infant. “Vany is my miracle. She was born so small but now she is bigger and growing every day, developing well like other children. I want to say thank you so much to everyone at the NCU for their help in supporting my daughter to be healthy”, shared Navy.
The NCU at the January 16 Referral Hospital has completed three years of training and mentorship and has grown in both knowledge and confidence since then. As one of the first premature babies to successfully receive breathing and feeding support in the unit, Vany’s story is a motivating one for the team at January 16. The biggest learning and success was that the team learnt about the importance of proper care and communication for premature babies, from admission to discharge to follow up.
“It is difficult to express how happy we are to see Vany. We are all just so happy. When she first arrived, I felt like the case was hopeless and that she would not survive. Our NCU had just opened and our knowledge was very limited. SBL mentors from AHC taught us how to care for babies directly by teaching mothers together about Kangaroo Mother Care and how to do it at home. Vany makes me so happy because she is our first case of such a small baby surviving at our hospital.”
Sreylin, NCU Nurse at January 16 Referral Hospital