Pregnancy and child birth are the most ordinary and yet extraordinary events in a family. All parents and their families have concerns and anxieties about their expected baby. Turn of events may not be always favorable and sometimes babies may come out too fast before they themselves are prepared.
So, when is a baby called preterm? A normal pregnancy is medically numbered in weeks. Scientifically a normal completed pregnancy lasts for 40 weeks, what we term as ten lunar months. Any delivery which happens before 37 completed weeks of pregnancy (approximately nine lunar months) is termed as preterm birth. Again, why are babies born preterm and premature? Is it a big problem? The answer is YES. Globally and particularly in India, there has been a rapid increase in the proportion of preterm birth. To be exact of the 27million babies born in India in a year, 3.5 million babies are born preterm and preterm birth in now the leading cause of infant death in our country. Some of these are induced preterm births- like delivery being induced early due to maternal or fetal conditions like hypertension in mother, diabetes in mother, maternal vaginal bleeding, poor growth of baby inside uterus, intrauterine fetal stress, blood group incompatibilities where continuing pregnancy might be a threat for mother and baby’s life or well being. Some preterm births happen by themselves in cases of twins or triplets, where mothers bag of water rupture (premature rupture of membranes), where mother has a urinary or vaginal infection. Sometimes preterm births happen without any reason.
The first thing the family feels when mother is about to deliver a preterm baby is extreme anxiety and uncertainty. The first few things that crop up when browse on problems of preterm birth is “pneumonia”, “cerebral palsy”, “breathing difficulty” etc. This adds to their concerns and questions. Yes! Babies born preterm have unique problems and complications. But not all of them behave in the same way and with adequate treatment and awareness more than 95% of them can be saved with very minimal complications. The degree of problems depends on how premature the baby is, how healthy the baby was inside mothers uterus and whether the mother had any complications like infection, hypertension or diabetes.
Babies are born after 34-35 weeks of pregnancy can be managed by the mother side and can be breast fed, though few of them do have breathing difficulty and might need intensive care. Though they look like fully mature babies they do face problems in breast feeding, a higher incidence of hypoglycemia (low blood sugars) and jaundice (not the jaundice which occurs in adults due to liver problems). These babies when with mother will still require constant monitoring and assistance. The Usually in our current scenario babies who are born after 28 weeks of pregnancy (7 lunar months) are doing fairly well and by 2 years of age they match their counterparts who were born at term. The challenge in today’s world is the babies born before 7 months of pregnancy. The expected problems when a baby is born preterm is
- Lung immaturity which leads to breathing difficulty as soon as the baby is born. This might require some respiratory support through the nose and not commonly with ventilator. A medicine called “surfactant” is now available which is given open the collapsed lungs of preterm babies. It is given to selected babies whose breathing problem is significant and is sick.
- Preterm babies are naturally low in immunity. This makes them prone for infection. That is why the strict precautions and hygiene measures are taken in a neonatal intensive care unit, if one of you had already had an experience
- The brain is not completely developed when a baby is born preterm and some things can go wrong during delivery or later during growth. There might be small bleeding inside the brain and the nerves in the brain may become weak (periventricular leukomalacia)
- The retina of the eyes will need frequent check up to rule out a condition called “Retinopathy of prematurity”.
Apart from this the baby might take time to learn breast feeding and will need other modalities of feeding like cup and spoon or paladai
All preterm babies as mentioned don’t behave in the same way and the support required and time for them to grow will vary from one baby to another. “Prematurity is not an illness. As the name implies it’s a premature state and maturation will happen with time and proper care.
Though multitude of reasons have been implied in the increasing incidence of preterm births like industrialization, agricultural toxins, life style changes, alcoholism and passive smoking no single reason can be pinpointed and preterm birth cannot be actually prevented or eradicated. There are tests available like antenatal scans where people actually looked for early signs (eg cervical length measurement) whether the mother will go for preterm birth. Early identification of medical and pregnancy related disorders like diabetes and hypertension will require proper management and control. Maintaining general personal hygiene, having healthy diet, avoiding mental stress during pregnancy will help to avoid preterm deliveries. In case of a preterm birth, there is no need to panic as our medical system has evolved so much in the field of care of these preterm babies- you can have antenatal discussions with your pediatrician on your baby’s condition, there are well evolved transport system and a good neonatal intensive care unit with proper infection control can assure you the best of outcomes. To highlight, current neonatal intensive care unit policies do not separate the newborn from the mother. It’s a family centered care where our focus is not just on the babies, but also on the mothers needs, choices and also the family. Parents are encouraged to visit babies frequently in NICU, share the joy of simple care like feeding, massaging and dressing up. Kangaroo mother care where babies are put in skin to skin contact with mother and father has revolutionized the parents experience in NICU- its gives them emotional support, allays fears regarding their small baby and also helps in feeding and weight gain of the baby.
To summarize, preterm births will become even more frequent in upcoming years owing to life style changes. However the field of medicine will expand its knowledge to assure quality of life even to the smallest of the preemies.