The fragility of life is nowhere more apparent than in the faces of the tiny, critically ill and highly compromised babies cared for in neonatal intensive care units of hospitals not only in South Africa but around the world.
Commenting on the challenges involved in caring for severely ill or prematurely born babies, Jacques du Plessis, managing director of Netcare’s Hospital Division, said that it is painfully difficult in any situation where a baby’s condition is so vulnerable that physical contact must be kept to a minimum to reduce the risk that this may pose to their health.
“The need for such measures was greatly amplified in the unprecedented times faced during the COVID-19 pandemic. No one wants to deny families the tangible and emotional comfort of touch, however in circumstances where this could potentially be detrimental to the baby – whose life the dedicated medical team is fighting to save – it is unfortunately sometimes deemed necessary to err on the side of caution.
“We wish to acknowledge the pain parents of highly premature babies in the neonatal intensive care units have experienced in such circumstances, particularly during the COVID-19 pandemic but even before. We are truly sorry to have added to the emotional hardship faced by parents of compromised premature babies.
“We wish to extend our sincere apology to all parents who had been affected and are re-evaluating our practices, also with regard to improving communication with parents. Practising the best clinical care should not compromise empathy. However, we wish to highlight that restricting physical contact in certain circumstances was done with the very best intentions of doing all we could to give the babies who were already medically highly compromised the best possible chance of survival.
“We have reflected on the complexities involved in balancing the need to uphold necessary medical precautions against the emotional needs of physical contact between parents and highly premature babies and are sharply reminded that touch is an essential aspect of Netcare’s core value of Care.
“In our abundance of caution approach and the medical specialists’ and nurses’ focus on preventing unnecessary clinical risks to the babies in our neonatal intensive care units, we acknowledge that unfortunately we have, at times, lost sight of the fundamental importance of human touch. These considerations may in certain instances also have inadvertently clouded the empathy we always strive to demonstrate in every interaction with patients and their families,” he says.
Speaking on behalf of Netcare’s hospital division, Du Plessis added that Netcare has taken these learnings to heart and is reviewing the pertinent matters through this lens to ensure that empathy and compassion remain paramount in providing care to its patients and engaging with their loved ones.
“The two babies referred to in the Carte Blanche programme ‘Separation Anxiety’ that aired, were born very prematurely, with the smallest baby weighing only 500 grams. Given their fragile health, the odds against their survival were immense,” he noted.
“The specialised care provided in the neonatal intensive care units was the only hope of giving them a chance of surviving – a responsibility that we take extremely seriously. These babies were on central lines and inotropes, which is indicative of the critical state that they were in.
“Doctors and nurses were desperately fighting to keep the babies alive and mercifully one of the two severely compromised babies survived thanks to the expertise, vigilance and dedication of the NICU teams responsible for their care. Tragically, and despite the very best efforts of the medical team one of the babies could not be saved.
“I once more wish to convey Netcare’s sincere condolences to Mr and Mrs Scholtz, the parents of baby Hayden, on the passing of their son. No parent should endure such pain. We appreciate that it must be unimaginably difficult for them to process the immense loss of their baby.”
Du Plessis added that while Netcare endeavours to always be empathetic and understands that parents want to hold their babies, doctors and nurses feel compelled to act in what they believe is the very best interests of patients at all times.
“As much as we support and encourage kangaroo care, in cases where physical contact is deemed to be detrimental instead of beneficial to the already vulnerable condition of babies, we could unfortunately not encourage physical contact as it would have been against the treating physician’s instructions and would have further compromised the babies. However, it is clear that together with the specialists we should do all we can to be more empathetic to each patient’s unique circumstances. In addition, better communication is of paramount importance, particularly in circumstances such as these.
“We fully understand that the hospitalisation of a loved one, and particularly a small, vulnerable baby can be very stressful and anxiety provoking for their parents. Looking at events now with the benefit of hindsight, we feel that greater access by parents could and should have been possible and we intend to change this throughout Netcare’s neonatal units around South Africa.
“We acknowledge the tremendous importance of compassion during a care episode in terms of the patient’s experience of care in the healthcare environment. To this end we have already embarked on compassion based training to all employees a few months ago, especially nursing staff and contracted workers to again sensitise them to the crucial importance of compassion in the care we provide to patients throughout our operations, and how we engage with their loved ones. The Care4YOU programme for our frontline workers equips them to bring compassion to bear in caring for their patients,” concluded Du Plessis.
Notes to editor
Overview of skin to skin and kangaroo mother care
Skin to skin and kangaroo care are used interchangeably with ‘skin to skin’ referring to the initial period shortly after delivery where a baby is placed on the mother’s chest and mom and baby are afforded time to be together. It is well known that this is an essential action that increases successful lactation.
Kangaroo care, on the other hand, is a therapeutic regime that is used in under resourced environments where the baby is secured to the mother’s chest, wearing only a diaper. Thermoregulation, survival and better neurodevelopmental outcomes associated with this intervention are well described and are globally accepted.
However, there are certain important eligibility criteria for the baby, which include very definite weight and medical stability benchmarks. Modified kangaroo care is used globally in neonatal units and Netcare Park Lane Hospital have practised a modified version of kangaroo care for well over a decade.
Babies who are stable at Netcare Park Lane Hospital have historically been placed on the mother’s chest for specified times while full monitoring is in place. With the advent of COVID-19 and against the background of Netcare’s policy of an abundance of caution, this modified version of kangaroo care had to be temporarily discontinued during the pandemic.
Venous access in seriously ill babies is a real challenge, with the handling of babies increasing the risk of dislodging lines. A dislodged line can disrupt continuous administration of life saving medication.
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