Samphel Bishwa made an early arrival at only 26 weeks weighing 700 grams. He was born preterm on June 29.

Twenty-one-year-old mother, Tshering Dema, said that she was worried her son might not survive.

Samphel spent about three months at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu due to feeding and breathing issues.

A few days after birth, Samphel got an infection and his weight dropped to 500 grams. Being born a preterm, he was always cold, Tshering Dema said.

“Despite doing whatever the health staff at the Kangaroo Mother Care (KMC) unit at the hospital told us to do, my son’s weight decreased and I started to lose hope,” Tshering Dema said.

KMC refers to the practice of providing continuous skin-to-skin contact between mother and baby and exclusive breastfeeding.

The doctors and the other health staff at the unit encouraged her to keep going. “Both me and my husband worked hard and continued the KMC method with assistance from the health staff,” she said. “I have learned so much about newborn care including infection prevention and benefitted from it. After practicing KMC, I was able to keep him warm and his breathing improved.”

Samphel is now healthy and weighs 3.40 grams.

“The staff at the unit were amazing. I am thankful to the hospital, particularly to the KMC unit and the staff there. It is because of them that he is a healthy boy today,” Tshering Dema said.

A gynaecologist with JDWNRH, Dr Pema Choden, said in the last two years it was in trying to understand the unspoken words of the newborn and through the EENC (early essential newborn care) and KMC coaching and culture that she personally changed her practice to improve the quality of care for the newborns. “As a care provider, it was a beautiful and emotional experience for me.”

To establish breathing, keeping the babies warm, clean cord care, nutrition and infection prevention are the five important component of the care given to the newborn, both preterm and full-term babies.

For the preterm, Dr Pema Choden said, the hospital also had interventions such as giving a steroid injection to promote fetal lung maturity.

Some of the positive change and practice the caregivers in the hospitals use today are, immediately drying the baby and stimulating breathing, a change of culture of separation after delivery to non-separation through EENC and KMC.

“We also practice delayed cord clamping, clean cord care and initiating breastfeeding within an hour,” she said. “To improve the infection, we have strengthened our hand hygiene and infection control interventions.”

Health secretary, Dr Ugen Dophu, said that as Bhutan observes the World Prematurity Day with the rest of the world, it presents a unique opportunity to understand the burden of premature births and how we can work together to prevent and intensify efforts for better care of newborns who are born too soon.

“Premature births are often accompanied by complex challenges for both the parents and the child,” Dr Ugen Dophu said. “At the same time, it demands skilled health professionals and infrastructures to manage them effectively.”

Like any country in the world, he said that premature births are the number one killers of babies in Bhutan.

About 56 percent of under-five deaths in the country are contributed by neonatal deaths. The annual neonatal audit review shows that around 40 percent of neonatal deaths are contributed by conditions associated with prematurity.

Department of Public Health’s director, Dr Karma Lhazeen, said that although the cause of preterm births was yet to be fully understood, evidence around high-risk factors for preventing preterm births were established. “This means that the preterm births are in part preventable nature.”

Substance abuse including alcohol and tobacco, adolescent pregnancies, and hypertensive disorders among others are some of the risk factors of preterm births.

“Therefore, investment in prevention efforts such as advocacy programmes are necessary to create awareness among the general public,” Dr Karma Lhazeen said.

She said that the reduction of newborn mortality was one of the priorities of the health ministry in the 12th Plan. “It is evident that better outcomes of preterm care are realised when both the parents and care providers work together in the spirit of partnership.”

“We would like to pledge to work together in coordinated efforts to provide optimal care to the preterms, while at the same time focusing on prevention efforts at the institutional and community levels,” she said.

Dr Ugen Dophu said that further efforts were necessary to strengthen and sustain this important programme. “In realizing this, continued support and cooperation of development partners and stakeholder is instrumental.”

Dechen Tshomo