Premature babies. Appropriate care enhances proper child development.

When a baby is born more than three weeks earlier than the estimated due date, that baby is called “premature baby”. Premature babies have not grown and developed as much as they should have before birth. Thus, as a consequence, it might potentially impair growth and child development. The parents of premature babies are always concerned whether their kids will be able to grow up healthily as the normal kids. In fact, child development substantially depends on both maternal factors and babies themselves. The special care appropriately suggested by expert pediatricians and regular health check-ups are the essential keys to largely helps premature babies to continue their growth and development in the similar way to the normal babies do.

 

Contributing factors to premature birth that impair baby’s growth and development

There are known risk factors of premature delivery derived from both mothers and babies, including:

 

Mother’s factors

Maternal factors that increase chances of premature birth might include:

• Giving birth before 37 completed weeks of pregnancy. Younger gestational age is associated with increased risk of complications and premature birth;
• Younger than 16 or older than 35;
• Some infections, particularly the infection of the amniotic fluid and lower genital tract. Typically, baby is surrounded and cushioned by a fluid-filled membranous sac called the amniotic sac. At the beginning of or during labor, membranes will rupture — also known as water breaking. If water breaks before labor starts longer than 18 hours (called prelabor rupture of membranes), chances of premature birth significantly increase; 
• Problems with the placenta, uterus or cervix e.g. short cervix; 
• Some chronic underlying conditions such as hypertension, cardiovascular disease and diabetes;
• Having a previous premature birth;
• Multiple miscarriages or abortions;
• History of preeclampsia, a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys; and
• Pregnancy with twins or other multiples.

 

Baby’s factor

• Certain genetic diseases or disability
• Impaired growth in the uterus

 

Complications of premature birth

A premature birth occurs before the start of the 37^th week of pregnancy. Premature babies, especially who are born very early, often develop complicated medical problems. Birth weight also plays an important role. Complications of prematurity vary, ranging from mild to serious conditions. But the earlier the baby is born, the higher the risk of complications. Complications can be shown both short-term and long-term health problems. 

• Breathing difficulties: A premature baby may exhibit trouble breathing due to an immature respiratory system and impaired gas exchange. Furthermore, if the baby’s lungs do not produce surfactant, a substance that allows the lungs to expand and contract properly, the baby may develop respiratory distress syndrome. Premature babies may also develop other lung disorders. 
• Brain problems: The earlier a baby is born, the greater the risk of bleeding in the brain. In some babies, larger brain bleeding potentially causes permanent brain injury.
• Blood problems: Premature babies are at higher risk of blood problems such as anemia and newborn jaundice. Anemia is a common condition in which the body does not produce enough red blood cells. Newborn jaundice is described as a yellow discoloration in a baby’s skin and the whites of the eyes caused by excessive bilirubin levels in the bloodstream. 
• Metabolism problems. Abnormal metabolism of premature babies often exhibit an abnormally low level of blood sugar (hypoglycemia) due to premature infants typically have smaller stores of stored glucose and have more difficulty converting their stored glucose into more-usable, active forms of glucose.
• Vision problems. Premature babies might have some eye disease that affects the retina. When the retina is pulled away by abnormal retinal vessels, it can lead to impaired vision and cause blindness.
• Heart problems: The most common heart condition that premature babies experience is patent ductus arteriosus (PDA). PDA is a persistent opening between the aorta and pulmonary artery. While this heart defect often closes on its own within the first 24 hours after birth, left untreated it can lead to heart failure as well as other complications.

 

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Diagnostic tests and procedures

After premature baby is moved to the Neonatal Intensive Care Unit (NICU), tests and procedures may involve breathing and heart rate monitor, fluid input and output, blood tests, echocardiogram, ultrasound and eye examination.

 

Special care for premature babies

In case of premature birth, special care will be appropriately given in every step by pediatrician and obstetrician supported by the agreement of parents. The neonatal intensive care unit (NICU) or special care nursery provides round-the-clock care for premature babies. Special care for premature babies cover:

• Respiratory functions: Premature babies often have breathing problems due to their lungs are not fully developed. Infants with breathing problems may be given lung surfactant and certain medicines to enhance their breathing function and reduce the use of a mechanical ventilator as much as possible. In the same time, oxygen level must be maintained within the normal range. 
• Nutrition: In order to prevent malnutrition, premature babies may receive fluids and nutrients e.g. protein, lipids, vitamins and electrolytes through an intravenous (IV) tube. When the baby is able to suck, breast-feeding is highly recommended since breast milk contains essential components especially for boosting immune system and reducing the chances of developing necrotizing enterocolitis in which the cells lining the bowel wall are injured and inflamed. Premature babies who receive breast milk have a much lower risk of developing necrotizing enterocolitis.
• Cardiovascular system: Cardiac abnormalities are under close supervision by regular heart check-ups with echocardiogram. Medicine that helps closing the heart defect might be prescribed. In some cases with patent ductus arteriosus (PDA), surgery to close the PDA with stitches or clips might be advised. 
• Neurological system: Since the extent of brain bleeding is the determinant factor ultimately most associated with increased morbidity and mortality in premature babies, brain imaging test will be performed a week after birth and at least once before being discharged to identify any possibilities of brain hemorrhage and to ensure that there is no neurological complication left untreated. 
• Vision development: Retinopathy of prematurity is a disease that occurs when blood vessels swell and overgrow at the back of the eye (retina). Sometimes the abnormal retinal vessels gradually injure the retina, pulling retina out of position and causing impaired vision. Eye exam is vital to determine retinal damages and to provide appropriate treatments. 
• Bone and joint system: Extremely preterm babies have greater risks to develop osteopenia, a decrease in the amount of calcium and phosphorus in the bone, resulting in weak and brittle bones. Calcium and vitamin D are normally prescribed to preterm babies with brittle bones.

In addition, to ensure the healthy growth, premature kids should receive child development programs continuously. Recommendations instructed by pediatricians must be strictly complied. Regular follow-ups and vaccination in certain age ranges remain essential.

 

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Parents can significantly enhance child development 

Parents can help improving physical growth and child development during the babies are hospitalized by kangaroo mother care (KMC) which is skin-to-skin contact. It is a technique of newborn care where babies are kept chest-to-chest with the parents, typically their mothers. It is most commonly used to improve heart rates, respiratory rate, temperature controlling, weight gain and physical growth. Kangaroo mother care also helps reducing baby’s stress, resulting in longer sleep. Additionally, it can significantly reduce the length of hospital stay. More importantly, kangaroo mother care should be given together with breast feeding in order to strengthen baby’s immune system while facilitating bonding and connection between mothers and babies. 

 

World Prematurity Day is held on 17 November each year to raise awareness of preterm birth and the concerns of preterm babies and their families worldwide.  Neonatal Intensive Care Unit (NICU), Bangkok Hospital aims to emphasize the importance of appropriate maternal care in order to minimize the chances of premature birth. Nonetheless, if preterm birth is unavoidable, we are 24/7 ready to provide around-the-clock intensive care with multidisciplinary team highly specialized in neonatal care. step of treatment, obstetrician, pediatrician and neonatologist always make sure that the selected treatment plans provide the best possible outcomes which agreed by the parents. Supported by efficient referral and medical evacuation, parents can rest assured that their babies always receive timely and appropriate treatment in which safety remains at the heart of our care.