08/08/2013
When baby’s born too early
Premature births occur in only five to 10 per cent of pregnancies, but would-be-parents should be prepared for all eventualities.
Pregnancy is an exciting time. Often, the excited couple would be busy shopping for the baby and trying to find out as much as they can about delivering much raising a child.
But few parents are prepared for a premature birth, thinking it can never happen to them.
Paediatric neonatalogiest Dr Salehuddin Sansuddin says a baby is considered premature if he or she is born before 37 weeks gestation instead of the full term of 40 weeks.
Premature births occur in five to 10 per cent of all births. According to medical website Mayo clinic, “a premature birth means that your baby hasn’t had the usual amount of time to develop in the womb before needing to adapt to life outside the womb.”
Dr Salehuddin says depending on when a baby is born, prematurity is divided into moderate prematurity (33-36 weeks), very premature (under 32 weeks) or extremely premature (under 28 weeks).
“The level of prematurity has a great impact on a baby’s survival and possible complications later. The very premature babies require specialized care and admitted to neonatal intensive care units (NICU) until they are more stable, often cared for by neonatologist,” he says.
Causes of Prematurity
Dr Salehuddin, who is with Sime Darby Medical Centre ParkCity, says there are many causes of premature labour.
“The baby may have to be delivered early in some situations to save the mother or baby’s life. For instance in pre-eclampsia (abnormally high blood pressure associated with pregnancy), placental abruption (placenta bleeding and detached from womb), chorioamnionitis (infection in the womb or sack of fluid surrounding the foetus) or placental insufficiency (insufficient blood and nutrition going to the baby),” he explains.
Other risk factors include multiple pregnancies (about 50 per cent of twin twin deliveries), previous miscarriage of preterm labour, gestational diabetes, smoking, drugs or excessive alcohol intake.
“However, in about one-third, the exact cause of premature labour is unknown. Leading a healthy lifestyle and looking after yourself well while avoiding the above risk factors give you the best chance of avoiding premature delivery,” he says.
Premature Labour
When water breaks early, it is called premature rupture of membranes. When this happens, immediately consult the doctor. An ultrasound will be done to check and confirm that the baby is healthy.
Dr Salehuddin says it may be possible to delay the onset of labour with medications to relax uterine contractions but this is not always effective.
“Giving the mother antenatal steroid injections such as betamethasone may help the premature baby’s lungs and improve survival without any significant risk to the mother,” he says.
“There are risks and benefits of having a normal or caesarean section. In general, the extreme and very premature infants may find caesarean section less stressful but this need to be balanced with the risks to the mother,” he explains.
On Standby
Either a paediatrician or neonatologies will be on standby to treat the baby immediately after birth. It may be necessary to transfer the mother or the baby to another hospital with a NICU under the care of a neonatologies to improve its chances of survival.
“The obstetrician or paediatrician can give parents guidance and counseling. If possible, visit the NICU and labour ward beforehand,” he advises.
The length of hospitalization, he adds, varies according to the level of prematurity and complications affecting the baby. From the NICU, the babies will gradually be moved out too special care nursery to feed and grow.
Longer Hospital Stay
“A premature baby will need to remain in hospital until he or she is able to breathe independently, gain weight and is feeding well. Most preterm infants are discharged just before or around their due date.”
To prepare for discharge, mothers are usually taught the essential skills including how to breastfeed and look after the baby at home.
“Learn to deal with emergencies. Course in basic life support are available in case of emergencies when baby is back home. Parents are also encouraged to ask questions and be involved. You will understand what your baby is going through better that way,” he says.
Complications
Complications can vary between premature babies, some more serious than others. These range from respiratory problems, infections and bleeding in the brain to poor bowel condition, to name a few.
“Unfortunately, not all premature babies survive. For those who do, there are many possible complications which vary from very mild to very severe.”
Those born more than 33 weeks generally survive without any major long term disability.
Those between 28 and 32 weeks also survive but with a slightly higher chance of long term neurodisability which can range from very mild to severe. The highest risk is in premature infants less than 27 weeks.
“The EPICure 2 study from the United Kingdom during 2006 shows that at 22 weeks, only 16 per cent survive after being admitted to NICU, 29 per cent at 23 weeks. Only 5 per cent survive without any known disability at 22 weeks compared to 61 per cent at 26 weeks. However the figures are expected to vary according to the complexity of each patient,” he says.
Home Care Important
At home, Dr Salehuddin says, mothers must stay healthy.
“Look after yourself. Remember that you are in for a long marathon, not a sprint. You have to pace yourself or you will get burnt out,” he says. “Share your worries, speak to your spouse, doctor or others in the same position as you.”
He encourages mothers to breastfeed their newborn. There is no substitute for breast milk in providing natural defense against infection and Breast milk reduces the incidence of necrotizing enterocolitis. It also helps mothers bond with baby and nurture baby despite the stress.
“Feed the baby, change the diaper and do other basic care when the baby is stable. This will allow you to bond with your baby.”
Dr Salehuddin advises parents to stop smoking as smoking increases the chances of cot death. Even if you smoke outside the house, small amounts of smoke particles is enough to endanger baby.
He also urges everyone to donate blood as premature infants to donate blood as premature infants often need recurrent blood transfusions.
-by New Straits Times-
