Confusion over newborn’s death
Declaration of newborn death first in Faridpur and later in Chittagong, recently made a very chaotic situation in Bangladesh. Doctors were being blamed for their negligence.
It is to be noted that in both the situation, babies were premature with incredibly low birth weight. Perinatal mortality is a great problem like other developing countries, which claims 37% of all under five deaths globally.
Death is defined as an irreversible permanent cessation of all vital functions of an individual, such as heart, respiration and brain activity. Assessing cessation of respiration and heart rate may not be very difficult but assessing brain death is often not easy.
No pulse, no heart sound, non recordable blood pressure, and a flat ECG mean heart has stopped working. Brain death assessment has to be done by dilated fixed pupil, no reflexes, and EEG showing no response.
Practically we do not perform EEG in most of the times. Other sophisticated tests can also be done to ascertain brain death. Even if it is sure that there is no sign of life, physicians have to wait for thirty minutes or more, and then reassess systematically before declaring a death.
Physicians have to be more cautious about declaring a death of premature low birth weight babies since assessing the signs of death is really often very difficult on a small baby.
It is better to call for the help of colleagues before final declaration of death.
The author is a Professor of Paediatrics at Community Based Medical College, Mymensingh.
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