Managing the risks of preterm babies: All you need to know
A preterm birth is defined as the birth of a baby before 37 completed weeks of gestation. Prematurity and its complications are the leading causes of neonatal morbidity, infant and under-5 mortality, with one in every 10 infants being a preterm. Globally, 3.2 million births are premature, and India continues to be the highest contributor.
The last trimester of pregnancy contributes significantly to organ development and the storage of nutrients in the foetus. When a baby is born preterm, there is a lack of maturity in all organ systems, especially the lungs, which are the last to mature fully. Hence, most preterm babies require some form of respiratory support during the initial hours of life in the form of ventilation, surfactant instillation into the lungs, etc. These babies are also prone to infections, feeding difficulties, low blood pressure, bleeding tendencies, etc. When a baby is born premature with complications, the family has to undergo significant emotional stress and pass through a tough time. Preterm delivery, however, cannot be completely prevented if the causes are genetic or uterine anomalies, but in the majority of cases, good antenatal care and regular checkups can prevent the premature onset of labour. It is advisable to have regular antenatal visits and scans done to monitor cervical length, amniotic fluid, and foetal parameters during pregnancy. Pregnancy-induced hypertension, gestational diabetes, anaemia during pregnancy, poor weight gain, and medical conditions co-existing in the mother are some of the causes that contribute to premature delivery. It is advisable to maintain good nutritional care throughout Pregnancy, and to avoid strenuous activities and psychological stress during pregnancy.
Most of the immediate complications of prematurity require Neonatal intensive care unit (NICU) admission for management, where the baby undergoes many procedures and continuous monitoring until stabilisation. In recent times, due to advances in technology, availability of gadgets, and NICU management protocols, there has been a significant decline in mortality due to prematurity and an increase in the survival of extremely low birth weight and premature babies. With better survival, the question about long-term complications and future implications of prematurity on development is always on the minds of the baby’s family.
It is a misconception that preterm babies end up with incomplete growth in the future. The efficiency of managing complications in these babies determine long-term outcome. Prevention of intraventricular bleed, lung-protective ventilatory strategies, and developmentally supportive care in the NICU go a long way in neuro-protection during the early phases of life. A comprehensive discharge and follow-up policy with developmental assessment at every visit helps in the identification of subtle abnormalities and offers timely intervention.
Mothers must be trained in feeding techniques and be equipped to deal with difficulties encountered during the early stages of life while the baby is still immature to suck and swallow effectively. It takes 34 to 35 weeks of gestation for sucking and swallowing to develop, while the baby is mature enough to breastfeed from 36 weeks onward. Extremely preterm babies often need a longer time on tube feeds and IV fluids, which is slowly followed by spoon feeding as the gestational age crosses 32 to 34 weeks. Mother’s own milk (MOM) is the most biologically suitable milk for preterm infants as it helps in the maturity of the gut and colonisation of the gut with healthy flora. For better weight gain, improvement in lactation in the mother, and earlier hospital discharge, Kangaroo Mother Care (KMC) is practised widely throughout all NICU units and followed up at home after discharge.
The more premature a baby, the higher the risks and complications. Extremely preterm babies who are less than 28 weeks of gestation take a longer time in the hospital. The risks of ventilation, infection, cardiac problems, gastrointestinal complications, and retinopathy of prematurity are particularly higher in these babies.
Meticulous management during these times plays a vital role in determining the long-term neuro-developmental outcomes. Beyond the NICU period, proper nutritional management in the post-discharge period, follow-up of growth and development, immunisation, etc, helps in good catch-up growth and an overall good outcome in these babies.
Dr. Divya Durga, MBBS, MD Pediatrics, DM Neonatology