PRETERM BABY

• Normally pregnancy lasts between 38 and 42 weeks.

• Any delivery before this i.e. < 37 completed weeks is called preterm. And birth after 42 weeks is post-term

• Preterm babies may weigh less as they haven’t gained all the nutrients from the mother.

 

RISK FACTORS FOR PRETERM DELIVERY-

There are various causes. Some are as below

Multiparity-

• If the mother has had multiple children, she can present with preterm delivery.

 

Complications of pregnancy-

• Twins decreased blood supply to the baby.

 

Uterus (Womb) abnormalities-

• Adhesions or abnormality in the womb

 

Medical conditions in mother-

• Like fits, heart or kidney problems or infections

 

Premature membrane rupture-

• The membranes in which the baby grows may rupture early.

 

Why is it important to know about preterm delivery?

• Studies show that babies born early have more mortality( death ) and morbidity( disablement) compared to term babies(> 37-week gestation)

• Different countries have different experiences with dealing with prematurity and hence the successful management of a child varies from country to country.

 

PROBLEMS MORE SEEN IN PREMATURE BABIES

Breathing problem-

 

Respiratory Distress –

• As the name says, there is distress in babies who are born early as the chemicals needed to open the lungs are not yet synthesised.

• So after birth, a tube is put into the baby’s lungs and the chemical is given.

 

Difficult ventilation –

• There are more chances of rupture of lungs(pneumothorax).

 

Apnoea-

• The brain of a premature baby fails to remind the baby to breathe.

• When the baby reaches 34 weeks of gestation, they breathe independently.

 

Heart Problems-

• Babies may suffer from a hole in the heart( PDA ).

• As the heart is formed in parts and eventually fuses with gestation, babies born early suffer incomplete closure.

• This condition is treated with 3 days of oral medication or heart surgery in complex cases

 

Brain Problems-

• The brain is highly fragile and sensitive to changes in blood pressure, oxygen levels.

• Any sudden changes can lead to bleed into the brain and long-term problems.

 

Tummy Problems

• Immature intestines may not be able to tolerate the feed or may suffer from infection.

• If this condition is not suspected earlier, it can be life-threatening as the intestines can rupture.

 

Kidney Problems

 

Sugar problems–

• Being unable to maintain sugar levels,

 

Repeated infections-

• Especially fungal infections

 

Temperature problems–

• Being unable to maintain body temperature

 

Eye Problems–

• Risk of eye injury.

• Similar to the brain, the developing vessels in eye rupture and cause long-term vision problems

 

MANAGEMENT

• Always talk to your doctor if you feel any abnormality during pregnancy- like decreased baby movements in tummy, watery discharge, contractions or other suspicious symptoms

• The Hospital intended for delivery should be equipped with Neonatal Unit and deal with prematurity adequately.

• Make sure the paediatrician attends and is ready for the delivery.

• Always look into APGAR score – Low scores could have detrimental effects (talk to our paediatrician)

• Keep baby warm- Use warm towels, clothing, room heaters or under head heaters- as advised by doctor

 

Breathing management-

• If the baby is having breathing problems, Breathing support is given.

• Ventilators may be started in extreme cases where the machine does the breathing to the baby and the breath is given through a tube in baby’s chest.

 

Heart problem management-

• Medications for maintaining blood pressure may be needed.

• Surgery may be considered if serious defects in the heart are found.

 

Feeding measures-

• Intravenous fluids are given temporarily until feeds are established.

• If a child cannot be fed milk for a few days, then Nutrition is given through veins. This is called TPN.

• In some babies, a tube may be passed from nose to stomach and milk may be given (NG feeding).

• Bottle feeding is started only after 34 weeks. And not before that.

 

Other measures-

• Supporting kidney functions

• Appropriate Antibiotics

 

Lines–

• In certain cases, instead of pricking the baby each day for infusing antibiotics or fluids, a central line is inserted.

• This is a long tube that is inserted in foot or hand that runs up to the heart. These lines last longer than normal cannula.

 

What are the CRITERIA FOR DISCHARGE?

This varies from hospital to hospital

• The baby has to be at least 34 weeks gestation, so baby can breathe independently and feed and grow adequately.

• It is generally believed that Babies > 1800 grams can maintain body temperature. ( Discharge weight depends on various other factors, talk to your doctor about more details)

• Baby should be free from infections

• Baby should be Growing and gaining weight adequately.

 

FOLLOW UP

• The baby needs to be seen regularly for weight gain and other common problems until they are at least term (40 completed weeks)

• Some babies are followed up even longer if there are concerns

• Ask about vitamin supplements which should be started, particularly vitamin D and Iron supplements.

• Preterm babies undergo immunisation/ Vaccination as normal babies

 

• Breathing difficulty- stoppage breathing or change in colour

• Difficulty feeding, unable to feed or signs of dehydration.

• Abnormal behaviour, unresponsive episodes or high pitch inconsolable cry.

• Fever, irritability, bloated tummy or blood in vomit/ stool should be seen by a doctor immediately.

 

SEE YOUR DOCTOR IF YOU HAVE ANY CONCERNS. DON’T DISMISS IT AS NORMAL VARIANT