On a breezy January morning, there was a hustle at the Indira Gandhi Institute Of Child Health’s (IGICH) pediatric outpatient department. Over 50 parents were queued up outside the neonatologist’s room, hoping they could see a doctor soon and return home before sunset.
IGICH is a pediatric government hospital that offers free specialized (“tertiary”) services in Bangalore, a city in southern India. As a result, every week it gets hundreds of referrals for admissions of babies dealing with complications.
Standing in the queue that day was Reshma Gowda, who was gently rocking her six-month-old daughter Chintana. Huddled in her mom’s arms, the baby looked bright and healthy. But merely two months ago, Chintana’s parents weren’t sure she would survive. Her twin sister didn’t. Born prematurely in the eighth month, the twins weighed 1.4 and 1.3 kilos each, significantly lower than the 2.5 kilos a normal term baby weighs. Gowda brought them to IGICH within three days of birth.
Like all underweight children, Gowda’s twins were kept in the NICU until their internal systems were developed well enough to survive outside the incubator. The babies left the hospital at 37 days old, when they weighed as much as newborns.
26-year-old Gowda had a tough task ahead of her. The neonatologist had sent the infants home with strict advice to Gowda to swaddle them to her chest for 4–6 hours of “Kangaroo Mother Care” (KMC) or skin-to-skin contact, every day. Gowda was caring for the twins single-handedly with no help from family and no money to afford domestic help. Meanwhile, her husband worked long hours as a machine operator at an automobile factory, sometimes even at night. Counting on him for assistance was never an option.
“Low birth weight newborns need special care and attention because they can easily become hypothermic,” said neonatologist Dr. Jagadish Somanna, a research associate at IGICH. Hypothermia is a condition where a baby’s core temperature falls below 36.5 C —or 97.7 F — and could lead to various problems like pneumonia, sepsis, and even death.
“Maintaining the baby’s temperature is the most important point of care for such children,” he added.
To alert Gowda of the babies’ plunging temperature, a doctor tied battery-powered hypothermia monitoring bracelets onto their tiny wrists, which emitted a blue light every 30 seconds if they were normothermic (i.e., at a normal temperature) and blinked orange and beeped if the temperature dropped below 36.5 C. Gowda and her husband were unable to provide the recommended hours of Kangaroo Care to their infants, so the bracelet, which they received free of cost from IGICH for a pilot study by the manufacturing company, was a big help. “Whenever it alarmed I knew which baby was turning cold and covered her with extra sheets if I could not give her KMC,” she said.
But one morning Gowda was too tired to hear the bracelet beeping. “I had breastfed the babies at 5 am and gone to sleep after a long night,” she recalled. “When I woke up at 7 am, one of my girls was so calm I thought she wasn’t breathing.”
They rushed her to a nearby hospital, where the physicians tried to revive the 8-week-old child without success. Gowda’s daughter was gone even before she could name her.
(Many families in India have a tradition of waiting 2–3 months to name their children. No one knows the exact reason, but it generally happens in families and castes with a history of newborn deaths.)
Gowda was devastated, and decided to be extra careful with Chintana. One morning when Chintana’s bracelet didn’t stop ringing for 15–20 minutes, Gowda called the doctor and rushed to the hospital on her advice. Chintana was found to have sepsis, which could have killed her if she didn’t receive immediate medical attention. But she fought well in IGICH’s NICU and recovered within a week. Gowda is happy that the bracelet saved one of her daughter’s lives.
Launched in January 2016, the bracelet is the brainchild of Bempu Health, a Bangalore-based startup. Its inbuilt battery lasts four weeks, covering the period when a baby is at highest risk of hypothermia. With no emission of radiation or heat, the device is safe for a baby’s use.
In India, 8 million children are born prematurely every year. Prematurity is also the leading cause of infant deaths in the country. Since “preemies” are underweight, one of the biggest risks they face is hypothermia.
Bempu Health’s founder Ratul Narain discovered that most public hospitals in India are understaffed or have 2–3 babies on one NICU bed, so temperature monitoring is often overlooked. He thought a device that kept a watch on a baby’s temperature could be of great help in resource-poor settings. His innovation, which has been funded by grants from institutions like the Gates Foundation, USAID, and UKAID, has been used in NICUs in over 40 hospitals in India — and has been recommended as a carry-home device for neonates. (Disclaimer: The Development Set is supported by the Gates Foundation. We retain editorial independence.)
“Due to an oversubscription in public hospitals, newborns are [often] sent home even if they weigh 1.2 kilos, as opposed to facilities in the West where babies are discharged only after attaining 2.5 kilos,” explained Somanna, adding that the onus of caring for a “high risk” baby then shifts to mothers. “Illiteracy, low awareness levels, and burden of household chores make them ill-equipped to do so.” New parents sometimes avoid future hospital visits due to travel time and the cost of missing work.
Due to their critically low weight, underweight kids have low fat reserves and thin, immature skin impairs their ability to conserve heat. Even the slightest exposure to cold could set their temperature crashing. In rural areas, where mothers often bathe their children outdoors, the risk could increase.
“In response to heat loss, the baby’s metabolism shoots up to produce more heat, using up glucose and oxygen in the process,” said Somanna. Depletion of oxygen and glucose causes acidosis and hypoglycemia respectively, resulting in brain damage and even death.
FFor users of the Bempu bracelet, the biggest advantage is its ease of use. “All I had to do was keep it tied onto my baby’s wrist 24 hours — just the presence of the device reminded me to give her KMC,” said Afsana Begum, who used it on her neonate Mohammadi. Like Gowda, Begum received the bracelet at IGICH.
A study Somanna conducted found that babies who wore the band received more KMC, were breastfed regularly, and gained weight at a quick pace. Hospital readmissions were remarkably reduced as well. “In general, they received more attention, which is exactly what an underweight neonate requires,” said Dr. Archana Bilagi, a neonatologist at Bangalore’s St. Philomena’s Hospital.
With about 30% of children in India being born underweight, the Bempu bracelet could be a lifesaver for many kids like Chintana. But the bracelet’s retail price of 1,850 rupees ($28.50) keeps it out of reach for poorer households.
In addition, the bracelet’s four-week shelf life is often insufficient for severely underweight infants. “It may not be economically viable for every parent to purchase more than one bracelet,” said Dr. Amita Kaul, a pediatrician in Pune’s Surya Hospital.
Bempu’s Narain has handed out hundreds of devices during trial studies — including at IGICH — and has donated many of them to public hospitals. In order to extend his reach, he is working with the Indian government to make them available for free at public facilities.
Based on the widespread positive results of the bracelet’s numerous feasibility studies on neonatal mortality, the National Health Mission of Rajasthan recently proposed to include the cost of the Bempu bracelet to their upcoming budget. “If all goes well, we may be able to protect about 10,000 babies in Rajasthan this winter,” said Narain, enthusiastically.
