Neonatal sepsis, a bacterial bloodstream infection, is the most common diagnosis in newborns admitted to the Neonatal Unit. Many babies may also have specific infections such as pneumonia or meningitis. Neonatal sepsis is the primary diagnosis in 42% of the unit’s patients, according to the most recent data from the hospital. This is in keeping with a recent study which found that 48% of neonates admitted to provincial hospitals in Laos had sepsis or other infections1.
Neonatal sepsis can be caused by such bacteria as Group B streptococcus and E. coli. The early signs of infection in neonates can be subtle and doctors need to be alert to these, as well to known risk factors for neonatal infection, such as when the mother has a fever or her waters break several hours before delivery. The obstetric team at the Provincial Hospital within which we are housed, alert the neonatal team to any delivery with risk factors for sepsis.
The mainstay of treatment is antibiotics and many babies also need supportive care, including intravenous fluids and/or glucose, assistance with breastfeeding and sometimes oxygen or CPAP to support breathing. Almost all babies make a full recovery and their long-term prognosis is usually excellent.
Globally, neonatal mortality accounts for almost half of all deaths under the age of five. Neonatal sepsis is the third leading cause of neonatal deaths worldwide and was the second in the recent Lao study cited above. Thanks to your support, the Neonatal Unit is making a significant contribution to neonatal survival in Laos.
Neonatal Mortality and Morbidity in Regional Provincial Hospitals in the People’s Democratic Republic of Laos. Schmidt et al, Journal of Tropical Pediatrics, Volume 62, Issue 3, June 2016, Pages 213–219
Immediately after baby Sonesiphone was born at a hospital in Oudomxay Province, his parents saw that something was seriously wrong. They feared that their newborn son would not survive and decided to rush him to Lao Friends Hospital for Children. It was a long and stressful journey of seven hours.
The infant was admitted to Emergency Room upon their arrival and the ER team immediately recognized his condition as gastroschisis. This is a condition in which the baby’s abdominal wall is imperfectly formed and intestines develop outside the body.
Doctors prescribed treatments of IV amino acids, fluids and antibiotics while a surgeon attached a plastic silo bag to protect his organs. When the swelling in his intestines subsided six weeks later, a surgery team closed the hole in his abdomen. He has recovered and returned home with his parents.
LFHC has treated several infants born with gastroschisis during the past five years. The first life-saving treatment of one of these infants occurred in 2016 during the 2nd anniversary celebration of the hospital’s opening. Dr. Tim Wiener, then one of the board members of Friends Without A Border, happened to be attending the event at the hospital.
Upon hearing about the infant boy’s condition, Dr. Wiener, a pediatric surgeon, immediately left the anniversary celebration and joined a surgical team in the hospital. He showed the team how to protect the baby’s intestines and how to subsequently care for him.
Despite the infant’s premature birth weight and the host of infections and fevers that followed in the coming weeks, the team of loving parents, dedicated volunteers and talented medical staff was able to keep the baby alive.
Beriberi is quite common in northern Laos and can be life-threatening for infants. Last month, LFHC doctors saved the lives of two critically ill babies afflicted with beriberi.
Two-month-old Airvid Xong was close to death when his parents brought him to the hospital’s Emergency Room, His illness had started three days earlier with a simple runny nose and cough, but now he had difficulty breathing, was vomiting and unable to breastfeed.
As soon as he arrived, the triage nurse noted that he wasn’t breathing and alerted the team. The doctors ascertained that he also had no pulse and started to resuscitate him, using CPR, adrenaline, fluids and antibiotics. They quickly determined that he was solely breastfed and his mother was on a restrictive “taboo” diet, so they administered thiamine (vitamin B1) as well.
Airvid was so shocked that the staff was unable to obtain intravenous access in the usual way, so they inserted needles into a bone and a central vein in his groin to administer the life-saving treatment. Outreach staff supported the parents through these traumatic events.
One hour after arrival, Airvid was stable and breathing, supported by our CPAP machine. However, the team remained concerned about his prognosis, as his brain and other organs had been deprived of oxygen for at least some minutes prior to arrival and during his arrest, and his parents were told to expect the worst. Shortly after resuscitation, Airvid developed seizures, which were treated but seemed to confirm everyone’s fears.
In the ensuing days however, Airvid steadily improved. The team was able to stop his seizure medication and his parents felt that he was back to his normal self. The day that his mother was able to breastfeed him again was a memorable day in Inpatient Department. He was discharged after two weeks and will be followed up in the hospital’s Development Clinic, but it is hoped that he will develop normally.
The other case of infantile beriberi last month involved 2-month-old Thai Lee, who came to LFHC close to cardiac arrest.
Following resuscitation protocols, the team supported his breathing, performed CPR and administered adrenaline. Doctors also quickly administered intravenous vitamin B1 after noting that Thai was exclusively breastfed, was in shock and had an enlarged liver. Thai’s heart rate then recovered but a few minutes later, he arrested. He was given CPR and adrenaline, and this time he recovered and stabilized. The CPAP machine was used to support his breathing. He was given Intravenous medication to support his blood pressure and antibiotics to cover for the possibility of infection.
Two hours after arriving in the ER, Thai was stable enough to move into the Inpatient Department and was taken off CPAP the following morning. By that time, he was breastfeeding and back to his normal self. He was discharged five days later, after completing a course of antibiotics.
Vitamin B1 deficiency, or beriberi, is common in northern Laos due to poverty and a cultural practice of restricting breastfeeding mothers’ diets. Many of these women develop numbness of their arms and legs from the B1 deficiency, as was the case with Thai Lee’s mother. This is often life-threatening for their infants, who develop a type of heart failure and shock, but our staff is experienced enough to instantly recognize and treat it.
These two cases also illustrate the importance and effectiveness of pediatric resuscitation training, and show how our team is able to transfer that training to their clinical practice, work together and do everything that they can to save their patients.
LFHC has been hosting an external research study on infantile beriberi since 2019.
Soon after Kazu Thongsy was born, doctors at a provincial hospital pronounced her dead. What they failed to realize is that the infant, born 12 weeks premature to a critically ill mother, was so tiny that she had an apnea, a suspension of breathing.
Kazu’s distraught father noticed his newborn daughter gasp for air. He told the doctors what he had seen and immediately rushed her to LFHC’s Neonatal Unit.
Our doctors and nurses saved the baby’s life and the hospital’s Outreach team ensured that father and daughter remained a family after the death of his wife. Read more about her story here.
Today, Kazu Thongsy is a happy and active 3-year-old. Her widowed father is a schoolteacher and relies on his extended family to care for his daughter while he is away at school.
She receives lots of love and affection from her large family, especially her grandmother and uncle. She plays happily with all the other village children, sharing the few toys she has.
Social distancing requirements sparked by the Covid-19 pandemic forced Friends Without A Border to cancel its annual New York Gala and all of its other live fundraising events in 2020. As a consequence, the organization faced a serious shortfall in its budget for Lao Friends Hospital for Children.
Undaunted, management for the organization and the hospital came up with a bold idea to generate revenue: the International Virtual Run for Children.
The event, which occurred October 16-18, raised more than $115,000.
A virtual run allowed participants to practice social distancing by running, walking or cycling in their neighborhoods (or even at home on treadmills or stationary bikes) – thus avoiding mass gatherings typical of marathons and other races.
The event modified the Luang Prabang Half Marathon, the annual fundraiser for the hospital that attracts more than a thousand runners. Travel restrictions imposed by the Lao government to prevent the spread of the coronavirus prevented runners from other countries entering this year’s half marathon. Instead, runners in Luang Prabang were joined this year (in spirit) by runners, walkers and cyclists in England, Germany, Singapore, Canada, Japan, Australia, the U.S. and a few other countries.
Doctors and nurses gathered for a special thank-you photo (below) to show their gratitude to the Lowry family, which raised more than $5,500 in memory of their daughter Sage Lowry, who served at LFHC as a volunteer nurse.
Team We Run raised more than $9,700 in its campaign. In its extraordinary effort, the team ran from the capital city of Vientiane to Luang Prabang, covering a distance of nearly 240 miles.
Friends Without A Border extends a warm thank-you to all who participated in this fundraiser and to those who supported the event with their donations.
When a little girl name Mone arrived at Lao Friends Hospital for Children a few years ago, she was feverish, extremely weak and unable to eat.
Mone’s condition was difficult to diagnose, but tests soon led doctors to conclude that she suffered from a rare form of typhoid which caused encephalopathy, a type of brain damage.
Her chances for survival were slim, but our dedicated doctors and nurses designed an aggressive treatment to help the child. She was given nutrition through feeding tubes and the staff physiotherapist worked to restore the motor skills of her arms and legs.
Mone remained hospitalized for a month. She was sent home, but returned to LFHC after developing aspiration pneumonia. After another week of hospital treatment, she returned home once again.
An infant born in late May at a district hospital was rushed to LFHC with a severe form of gastroschisis, a malformation in which the baby’s intestines grow outside the body.
The hospital staff noted that in addition to the intestines, the infant’s liver, stomach and bladder were also exposed. An Emergency Room team quickly stabilized the baby, Airnoy Jame, and administered IV fluids and antibiotics. They also carefully wrapped the exposed organs to protect them from infection and injury.
Airnoy Jame was then taken to the operating theater, where a surgical team placed a silo over the organs. A silo is used when the gastroschisis is large. Eventually, surgeons gradually reinsert the organs through the silo into the baby’s body.
Airnoy Jame remained in the silo for four weeks. During that time the team worked diligently to treat his infections, provide blood transfusions and ensure that he had the nutrition necessary to grow.
After the surgeons closed the baby’s abdomen, his mother, who had always been by his side, was finally able to hold her son. It was several more weeks before he was ready to go home, but on July 30 he was discharged to the care of his grateful parents.
Six-year-old Joy Thapphalao was riding on a motorcycle with his family one day in April when they were involved in a traffic accident. Joy survived, but felt a great deal of pain in his right hip.
His family was very concerned, but didn’t know exactly what to do. They treated him with a local medicine, but after six days of home care, they decided to take Joy to a nearby hospital. The staff there told the family that there wasn’t much that could be done for the boy and sent them home with some over-the-counter pain medication.
Fourteen days after the accident, Joy arrived at LFHC where he was diagnosed with a dislocation of the right hip. Surgical pins were inserted to allow Joy’s hip to heal in the correct position and he was placed in traction.
LFHC used WFPI (World Federation of Pediatric Imagers) to assist in reviewing Joy’s X-rays to ensure that he would have the best possible outcome. Joy spent more than a month in traction at LFHC. During that time, the team of doctors and nurses worked to coordinate his care, while our child life therapist and physiotherapist worked to improve his mobility.
Joy is recovering and returns to LFHC for follow-up visits. He is able to walk with some difficulty but without pain and his father made special crutches to help him get around faster.
Globally, road traffic injuries are the leading cause of death for children and young adults between the ages of 5 and 29, according to the World Health Organization. Joy is a survivor.
Three LFHC doctors report that they are gaining valuable insights and experience as participants in the Pediatric Residency Program in Vientiane, a national three-year training residency.
Dr. Vilaivone Senkeo is in her second year of the program, while Dr. Phoumy Manivong and Dr. Bounloth Sordaluck are in their first year. Thanks to the support of the Ptarmigan Charitable Foundation, LFHC has been able to encourage and help these doctors in pursuing their pediatric training.
Dr. Senkeo has one more year of residency to complete her pediatric training and will then return to LFHC. She said her residency has exposed her to clinical cases, departments and treatments that she had not experienced at LFHC. She also learned more about coordination with different departments for patient diagnosis and treatment, particularly regarding emergency room cases. Dr. Senkeo said she is confident that what she has learned will help her and her colleagues continue improving quality of care at the LFHC.
Dr. Manivong started his pediatric residency last year and noted that training with neonatal cases and emergency room cases has been a particularly valuable experience. He said he has been working with challenging emergency cases in which he had had the opportunity to expand his knowledge and skills. Dr. Manivong mentioned that he is gaining confidence and acquiring leadership skills during his residency and looks forward to sharing his experiences with LFHC colleagues, students and patients’ families when he returns to our hospital.
Dr. Sordaluck said she is exploring such new areas as hematology/oncology and learning different processes in the Intensive Care Unit and the emergency room. She said her residency recently focused on treatments for patients with anemia, leukemia and electrolyte imbalance. She also practiced basic and advanced life support, while also practicing in five different
departments (hematology/oncology, ICU, emergency room, infectious diseases department and general ward). She is convinced that this experience is going to help her and LFHC to improve teamwork, patient treatment and the patient referral process.
The Pediatric Residency Program is a highly competitive national selection process. We are very proud of the performance of these doctors and look forward to seeing them continue their professional growth.
During the past few months, the LFHC team has faced an extraordinary challenge: caring for two of the smallest infants ever admitted to the Neonatal Unit.
The first, Airnoy Larnoy arrived at LFHC on Feb. 12 after spending three days at a district hospital. She weighed a mere 28 ounces (800 grams) at birth and was much smaller than our average neonatal patient.
Our nurses and doctors were concerned about the infant’s ability to survive, but they were not discouraged. Over the next several weeks, they worked diligently to care for her. They administered IV antibiotics, IV fluids, multiple medications, phototherapy, a nasogastric tube to help her feed and a blood transfusion. The clinical staff became optimistic as she responded to the intensive care and started to grow.
Airnoy Larnoy was discharged weighing more than four pounds (just over 2 kg). It was an exciting day for the staff, which deftly handled a very challenging case and saved the life of another tiny patient.
Not to be outdone, a second tiny infant, Airnoy Vahn, arrived on March 7, weighing only 21 ounces (600 grams). Born at home, he and his parents travelled for two hours to reach LFHC. The team at LFHC immediately applied life-support measures. Much like Airnoy Larnoy, Airnoy Vahn required a lot of specialized support, but showed steady progress over the course of his stay, which lasted nearly 12 weeks. By the end of May, he was discharged, weighing 3.3 pounds (1.95 kg), and secured his place as the smallest Neonatal Unit patient to be successfully discharged from the Neonatal Unit to date, as well as a huge victory for LFHC.
During their long stays, the families got to know and support each other. Both mothers lovingly cared for their infants and worked with the doctors and nurses to tend to the needs of these tiny patients.
These two success stories are a testament to the achievements of the Neonatal Unit and enhance the reputation that the hospital has earned in the surrounding communities.
The first 28 days of life represents the most vulnerable time for a child’s survival and accounts for approximately 46% of all deaths of children under the age of five, according to the World Health Organization. This is especially true for infants born prematurely, which is the leading cause of death in this age group.
The LFHC Neonatal Unit opened in 2016 with the goal of providing specialized care to our smallest patients. Given the increasing number of babies who needed specialized care, this unit was expanded in 2018. There are now nurses dedicated to the Neonatal Unit and assuming leadership roles. Nurses working in the unit have completed additional training courses and received mentorship from expat volunteers with expertise in this field to ensure that they have the skills necessary to care for premature patients. Several neonatal physicians have also volunteered in past years to help develop the unit.