A preterm baby refers to a baby that is born before the 37th week of pregnancy (a normal pregnancy lasts for about 40 weeks).
As they are born before they have fully developed, preterm babies (or preemies) are ill-equipped for life outside their mother's womb.
This typically means that preemies will face many life-threatening challenges.
The reasons for preterm birth are still not fully understood in half the cases.
Where the risk factor for preterm birth is known, it is often associated with hypertension, diabetes, bleeding due to abnormal positioning of the placenta, infection or inflammation, twin pregnancy and low or high maternal age (below 19 or above 40).
Special care needed
Preemies are "weaker" than full-term babies because most of their internal organs are not yet ready to function on their own.
In general, the more premature an infant, the higher the risk of complications he will face.
After delivery, they will be placed in the special care nursery (SCN), or if sicker, in the neonatal intensive care unit (NICU), which is designed to provide a comfortable and safe environment, giving the preemie his basic needs of warmth, nutrition and protection, in order to ensure his proper growth and development.
Some of the early complications that may arise include:
- Difficulty regulating their own body warmth - due to their smaller size and lack of glycogen/body fat, most preemies suffer from hypothermia (i.e. their body temperature is less than 35°C).
- Infections - their immature defence system and low immunoglobulin levels mean that they have an elevated risk of infections from bacteria and viruses in their surroundings.
- Immature nervous system - this can lead to higher rates of apnoea (cessation of breathing) and bradycardia. The possibility of bleeding in the ventricles in the brain also increases.
- Preemies generally lack the reflexes to suckle and swallow, rendering it necessary to feed them either intravenously or via a feeding tube.
- Underdeveloped lungs - a lack of surfactant in their lungs make them collapse more readily, which causes respiratory distress, possibly requiring a supply of extra oxygen or a respirator to help the preemie breathe.
- Underdeveloped cardiovascular system - this leads to a higher incidence of persistent ductus arteriosus (PDA), which if large enough, may lead to heart failure.
- Underdeveloped gastrointestinal (GI) system - which causes a higher incidence of ileus (lack of normal movement of the gut) and necrotising enterocolitis, which in its worst form, may require surgery.
- Immature liver - causes more frequent episodes of jaundice.
Possible long-term problems
Most preemies will grow and develop just like other full-term babies.
However, there are several long-term complications that are more common with preemies, such as:
- Central nervous system - about 10 per cent of preemies (in particular, those born earlier than 28 weeks of gestation and weighing less than 1000 grams) will experience complications such as cerebral palsy, mental deficiencies, epilepsy or hydrocephalus, following a bleed in the brain.
- Growth - a small number of preemies will fail to thrive, and have rickets and anaemia.
- Cardiovascular system - a PDA, if causing respiratory and heart problems, may require surgical ligation.
- Iatrogenic problems - too much exposure to oxygen may lead to diseases of the eye, retinopathy of prematurity (ROP) or chronic lung disease (CLD). Preemies who require an endotracheal tube to assist breathing may also suffer from subglottic stenosis (a narrowing of the upper airway).
- Psychosocial problems - due to the necessity of separating the preemie from his parents while he is treated at the NICU, a rift in the the mother-child bond might occur, leading to the preemie being unloved, neglected, and even abused.
- Preemies are also in the high-risk group for sudden infant death syndrome (SIDS).
Parents will have to work very closely with their child's paediatrician and neonatal nurses for the care of their preemie.
The SCN or NICU usually allows parents unlimited access to their preemie to enhance emotional bonding, physical touch and expression of breast milk for the baby's nutrition.
Prior to leaving the hospital, parents would be encouraged to room with their baby to provide the daily care needed by the preemie, under the supervision of the neonatal nurse, in order to troubleshoot any potential problems.
In certain NICUs, parents are taught the basics of neonatal resuscitation to prepare them for a possible emergency whilst at home with their baby,
The baby will be regularly seen in the paediatric clinic to assess their developmental milestones and growth, as well as to update their immunisation.
Paediatricians may engage the help of other specialists, e.g. developmental paediatrician, physiotherapist and occupational therapist, to provide preemies with the necessary therapy as they grow up.
Last but not least, family support is critical - caring for a preemie is demanding, more so than caring for a "normal" full-term baby.
Preventing premature birth
Preventing preterm birth remains a challenge because the causes of preterm births are numerous, complex, and poorly understood.
However, pregnant women can take important steps to help reduce their risk of preterm birth and improve their general health.
These steps include avoiding smoking, alcohol and drugs, regular antenatal care, and seeking medical attention for any early signs or symptoms of preterm labour.
Datuk Dr Musa Mohd Nordin is a consultant paediatrician and neonatologist. This article is courtesy of the Malaysian Paediatric Association's Positive Parenting programme in collaboration with expert partners. For further information, please visit www.mypositiveparenting.org.
The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care.
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