Our Special Care Baby Unit admitted 373 babies in the year up to 30th June. The majority are born here but some come from home or sent to us from other hospitals.
Here is a picture I took on my night round showing an incubator with a 960 gram baby born about 12 weeks too early. On the left you see the oxygen concentrator which removes nitrogen from room air leaving (mainly) oxygen which is humidified then administered to the baby with nasal prongs. You can also see a glass bottle on the floor, this takes the expiratory arm of the circuit to provide some back pressure, giving the baby Continuous Positive Airway Pressure. This is beneficial in babies with surfactant-deficient lung disease, a common problem in pre-term babies especially here where we don't have any surfactant to give ( it costs a couple of hundred pounds a dose but of course is freely available in the NHS).
On the right you will see the syringe pump for his intravenous fluids to ensure he doesn't get too much too fast which would be risky. This size of baby may only be on a few mls an hour.
The incubator itself, of course, is keeping his temperature at the right level and also forms an isolation chamber in one sense. Happily our Staff are trained in how to keep such incubators clean as otherwise there is a risk of infection.
Above the incubator is a light giving phototherapy for jaundice. This photo-oxidises the yellow pigment bilirubin and makes it easier for the baby to excrete. No, its not ultra-violet, though many of the medical students still seem to think so! Its just visible blue light. It's important to control jaundice, especially in such tiny infants, as an excessive level may cause deafness or brain damage.
Now, you are asking, what is that on the upright stand on the left?! Those are hand towels drying on a convenient hook! We have small towels to use whenever we wash our hands between each patient, they then go in a bucket to soak and then are washed, rinsed and hung to dry... no disposable paper towels here.
This baby also received antibiotics intravenously (penicillin and gentamicin) and breast milk via an oro-gastric tube. He may need a blood transfusion at some stage as it is not uncommon for very small babies to become anaemic. He has aminophylline to reduce the risk of him stopping breathing due to his immaturity.
If I was caring for this baby in Macclesfield I would have done a lot of blood tests for full blood counts, chemistry screen, blood gases etc but this infant has had very little investigation but, happily, is doing well so far.
You can see this is therefore on the one hand quite basic neonatal care compared to what is available in the west but it is quite sophisticated by Ugandan standards. It shows the importance of our reliable hydro-electricity to run the above equipment. It also highlights the value of our staff. It's good to see Sister Ann Moore, who has faithfully led the work on the Special Care Baby Unit for many years together with Nurse Edith, having more support from Dr. Josephine and our paediatric intern and myself. We now try and do a Neonatal Grand Round on Thursday mornings to review the babies and incorporate some teaching.
We are grateful to have Dr. Gabriel, consultant Surgeon, here at Kisiizi as he will do some operations on newborns if required. For example, we had a baby recently with a spina bifida which he closed, and another with a large growth over the lower spine which he resected. As has quite rightly been pointed out to me after my initial publishing of this post, I should not forget to praise the anaesthetic team as well as the surgeon! We are actually working hard to develop our Anaesthetic Clinical Officers. Gershom was able to spend a month in UK, 2 weeks in Chester and 2 in Reading, quite recently, and then Dr. Neil Fergusson, Consultant Anaesthetist from Chester, did a return visit here for a fortnight. Now we are looking forward to Dr. Angela Cooper, also a consultant, joining us for six months. Angela is a volunteer with Church Mission Society, and has a particular interest in pain control. Medius, another Anaesthetic Clinical Officer, will hopefully be able to attend the annual scientific conference of the Uganda Society of Anaesthetists to be held in the north of the country in Gulu later this month.
Please pray for the Staff on the unit, it can be very busy and at times frustrating, and we do lose some babies but this is balanced by the satisfaction of seeing some very unwell or very premature babies going home well.
Here is a picture I took on my night round showing an incubator with a 960 gram baby born about 12 weeks too early. On the left you see the oxygen concentrator which removes nitrogen from room air leaving (mainly) oxygen which is humidified then administered to the baby with nasal prongs. You can also see a glass bottle on the floor, this takes the expiratory arm of the circuit to provide some back pressure, giving the baby Continuous Positive Airway Pressure. This is beneficial in babies with surfactant-deficient lung disease, a common problem in pre-term babies especially here where we don't have any surfactant to give ( it costs a couple of hundred pounds a dose but of course is freely available in the NHS).
On the right you will see the syringe pump for his intravenous fluids to ensure he doesn't get too much too fast which would be risky. This size of baby may only be on a few mls an hour.
The incubator itself, of course, is keeping his temperature at the right level and also forms an isolation chamber in one sense. Happily our Staff are trained in how to keep such incubators clean as otherwise there is a risk of infection.
Above the incubator is a light giving phototherapy for jaundice. This photo-oxidises the yellow pigment bilirubin and makes it easier for the baby to excrete. No, its not ultra-violet, though many of the medical students still seem to think so! Its just visible blue light. It's important to control jaundice, especially in such tiny infants, as an excessive level may cause deafness or brain damage.
Now, you are asking, what is that on the upright stand on the left?! Those are hand towels drying on a convenient hook! We have small towels to use whenever we wash our hands between each patient, they then go in a bucket to soak and then are washed, rinsed and hung to dry... no disposable paper towels here.
This baby also received antibiotics intravenously (penicillin and gentamicin) and breast milk via an oro-gastric tube. He may need a blood transfusion at some stage as it is not uncommon for very small babies to become anaemic. He has aminophylline to reduce the risk of him stopping breathing due to his immaturity.
If I was caring for this baby in Macclesfield I would have done a lot of blood tests for full blood counts, chemistry screen, blood gases etc but this infant has had very little investigation but, happily, is doing well so far.
You can see this is therefore on the one hand quite basic neonatal care compared to what is available in the west but it is quite sophisticated by Ugandan standards. It shows the importance of our reliable hydro-electricity to run the above equipment. It also highlights the value of our staff. It's good to see Sister Ann Moore, who has faithfully led the work on the Special Care Baby Unit for many years together with Nurse Edith, having more support from Dr. Josephine and our paediatric intern and myself. We now try and do a Neonatal Grand Round on Thursday mornings to review the babies and incorporate some teaching.
We are grateful to have Dr. Gabriel, consultant Surgeon, here at Kisiizi as he will do some operations on newborns if required. For example, we had a baby recently with a spina bifida which he closed, and another with a large growth over the lower spine which he resected. As has quite rightly been pointed out to me after my initial publishing of this post, I should not forget to praise the anaesthetic team as well as the surgeon! We are actually working hard to develop our Anaesthetic Clinical Officers. Gershom was able to spend a month in UK, 2 weeks in Chester and 2 in Reading, quite recently, and then Dr. Neil Fergusson, Consultant Anaesthetist from Chester, did a return visit here for a fortnight. Now we are looking forward to Dr. Angela Cooper, also a consultant, joining us for six months. Angela is a volunteer with Church Mission Society, and has a particular interest in pain control. Medius, another Anaesthetic Clinical Officer, will hopefully be able to attend the annual scientific conference of the Uganda Society of Anaesthetists to be held in the north of the country in Gulu later this month.
Please pray for the Staff on the unit, it can be very busy and at times frustrating, and we do lose some babies but this is balanced by the satisfaction of seeing some very unwell or very premature babies going home well.
Re: surgery on neonates at kisiizi: as you say, worthy of praise ... but of both surgeon AND anaesthetist !
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