Understanding and managing preterm (Premature) babies
Preterm baby (PTB) or premature birth occurs at least three weeks before the baby’s estimated due date. Premature babies, especially those born very early, often have complicated medical problems. An estimated 15 million babies are born prematurely every year, and Nigeria has the third highest number of premature babies globally.
And though it sounds a bit unsettling, medical experts say it doesn’t have to end sadly. Paediatricians advised that such preventive strategies as progesterone, pessaries, and cerclage might help prevent premature birth. Effective screening and prevention of premature births vary among the different pregnancy populations. In single or multiple pregnancies with a short cervix, without previous premature birth, a pessary or progesterone might prevent preterm babies.
Mrs. Temitope Shukanmola, a paediatric nurse at Family Health Hospital, Lagos, explained that there are categories of preterm birth.
She said: “Extremely preterm are babies born with less than 28 weeks gestation. Very preterm are born between 28 and 32 weeks gestation, while late term are born between 32 weeks and before the 37 weeks gestation.
“The first thing you notice with these categories of babies is their skin. Depending on how early the baby is, the skin may be fragile, wrinkled, shiny and almost translucent. They have fine, soft hair, though this gradually disappears as they mature. There is an absence of a layer of brown fat underneath their skin. That layer of skin is needed to prevent water loss, trap heat and fight against infections.”
Shukanmola said preterm babies are usually very small in appearance, as they look and feel very fragile.“You can even carry them with one hand,” she said. “And they weigh lesser than normal, depending on how early the baby is. Their heart rate is usually low. Some of them have low baseline heart rate, which becomes more evident when they are asleep. The use of breathing aids may be administered to help regulate their breathing.”
She explained that other features of preterm babies include the eyes, which at 24 weeks gestational stage appear thin and fused shut. They have a sleep-like appearance, but as they mature, the eyelids begin to open slowly.Similarly, the ears at 24 weeks will appear flat, thin and almost translucent, but as the baby matures, it starts to recognise familiar noises and at gestational stage, they are firm and normal.
She said: “A preterm baby may look limp because of muscle weakness. They usually have a flat posture on the mattress. But from 28 to 29 weeks, the baby’s reflexes begin to develop, and it may start to gasp. As the baby grows stronger, it adopts a more flexed position, and the movements become more coordinated.
“Also, the genitals of a premature baby look different from that of a full term baby. The sex organs may look larger than average or expected. But the organs normalize with growth.”On the causes of premature birth, she said: “The main cause of preterm birth is unknown, but it can be triggered by certain things. These include when the mother is carrying multiple babies, twins or more. Also, if the mother has a problem with her uterus or cervix during pregnancy, she may have preterm baby. There is the issue of pre-eclampsia, which is a disorder associated with high blood pressure and a high amount of protein in the urine of pregnant women. When this happens, the mother has to be sectioned to avoid eclampsia.”
She listed other causes to include placenta abruption, which is the sudden separation of the placenta from the uterus before childbirth, as well as premature rupture of the membrane, which occurs when there is breakage of the amniotic sac before the onset of labour.
“A patient with history of premature birth is at risk of giving birth to a preterm baby. It can also occur when a pregnant woman is underweight or overweight before getting pregnant. Smoking and use of drugs and harmful substances by an expectant mother puts her at risk of premature birth. Health issues, such as diabetes, blood clotting disorders and infections can also lead to premature birth.She urged pregnant women to take good care of themselves, as everything that happens to them will affect the baby one way or another.She said: “For immediate treatment, once the baby is born, either through labour or cesarean section, special care has to be administered to ensure survival. Oxygen has to be connected to assist the baby breathe well, if necessary. The airways should also be cleared. Cortico steroids and adrenalin should be administered to assist the lungs function well.
“The baby has to be put in incubator to help regulate body temperature. And if to be carried by the mother, the baby would be strapped the mother’s chest without clothes from both sides, with the mother using her body heat to keep her baby warm. It is called ‘kangaroo care.’ Intravenous tubes may be used for feeding and giving medications to the baby. The baby’s temperature, blood pressure, heart rate and oxygen should be monitored diligently. As they grow, preterm babies should be monitored carefully, in case complications arise.”
What are premature babies susceptible to?
“Premature babies are prone to medical complications due to their low immune system,” she explained. “They may have respiratory complications, problems with their breathing like ‘apnea,’ which is prolonged pauses during breathing and incomplete lung development.
“There could also be temperature instability, which is the inability to maintain body heat, due to low body fat, leading to their having low blood sugar levels. Problems with their digestive tracts, difficulty in feeding, and being unable to coordinate sucking and swallowing properly could occur. Blood and metabolic problems like jaundice, anaemia and immature kidney function could arise.”
But this is not all, as she said there could be brain damage, and such problems as ‘intraventriculer hemorrhage,’ which is bleeding in the brain and can result in serious brain injury and poor muscles. They are also prone to infections.Preterm babies are also susceptible to sudden infant death syndrome (SIDS). Premature birth can go on to affect the child’s development and growth issues like developmental milestone. The child may not develop according to his age, may have impaired learning and they tend to pick up later than normal kids. There may also be visual, hearing and dental impairments, as well as psychological and behavioral problems.
She explained that premature babies are not the only ones affected by the condition, as their mothers also suffer some psychological pains.She said: “The mother is constantly experiencing the fear of losing her baby, and the pain of watching that child going through all these medical procedures, and lack of sleep for wanting to monitor the baby all the time.
“ There are also the financial constraints. The medical expense for caring for a premature baby is on the high side. From the hygiene processes, baby formula, medications and check-up fees, this might prove a challenge for the parents, and without proper care a preterm baby might not survive. Women who have had history of preterm birth are always afraid of having another child for fear of a repeat of events.”
To avoid premature births, she advised that pregnant women should go for regular check-up, take all medication given to them and always undergo laboratory investigations ordered by the doctor.She said: “They should also avoid stress and adding or losing too much weight. There should be no smoking and taking of harmful substances. There is need to have an adequate obstetric history, so the pregnant woman is aware of whatever complications she may have.
“Women with history of preterm birth, short cervix or both can reduce the risk of preterm birth with progesterone supplementation.
Also, cervical cartilage, a surgical procedure that involves stitching the cervix close with sutures to provide extra support to the uterus can be applied.”To help poor parents take care of premature babies, she urged government to look into the medical sector and provide equipment to handle preterm babies.
“Most preterm deaths occur as a result of lack of sophisticated equipment and proper care,” she explained. “Premature birth is a very delicate issue, so it should be handled with care. “Professional medical personnel should be on ground to address their needs and medical care should be made to suit the finances of both the high and low in the society. Every baby should be given a chance at survival. Mothers should be educated on premature birth, and how to efficiently handle and take care of them.”
Dr. Elizabeth Disu, a paediatrician and founder of Abiye Maternal and Child Health International Foundation, a non-governmental organisation, urged pregnant women to register with qualified midwives for antenatal care, as soon as pregnancy is diagnosed to avoid premature birth.
“This would avail the pregnant woman proper care and early detection of maternal illnesses, conditions and infections that might interfere with pregnancy and cause early labour,” she said. Disu noted that pregnant women need good, balanced nutrition, consisting of all the food classes, such as protein, carbohydrates, oils and fats, as well as minerals and vitamins. This can be achieved by eating a variety of foods, with ample portions of vegetables and fruits.
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