Premature Baby (Preterm Birth)

Definition

A baby born with a gestational age less than 37 weeks from the mother’s last menstrual period is known as a premature baby. These babies may either be lower in weight than gestational age or may be low in birth weight but of adequate weight for gestational age. Immunity along with the organs and the respective functioning in these babies is not adequately developed and therefore appropriate care is necessary until they can sustain these life processes on their own.

Symptoms

The severity of symptoms depends on how early the baby is born. Symptoms include :

  • Low birth weight.
  • Respiratory distress with intermittent breathing.
  • Intolerance to cold and unable to maintain adequate body heat (temperature).
  • Inability to suckle properly thereby affecting feeding.
  • Intrauterine growth restrictions (IUGR).
  • Wrinkled skin and lower than normal  subcutaneous fat.
  • Low blood glucose.
  • Low blood calcium.
  • Neonatal jaundice, even with low levels of bilirubin.
  • Increased susceptibility to infections due to low immunity.
  • Chances of brain hemorrhage.

Symptoms such as hearing or vision impairment, developmental delays, learning disabilities may develop later on. Increased frequency of hospitalization in the early period of life compared to normal babies is seen.

Causes

The cause of premature birth is mostly unknown. Certain causes and risk factors that can be related to premature births include :

  • Smoking tobacco, poverty and malnutrition
  • Past history of premature births, genitourinary infections/inflammation of the membrane and fluid covering the baby (chorioamnionitis).
  • Development of hypertension along with edema or proteinuria or sometimes both during pregnancy which usually occurs after the 20th week of gestation (preeclampsia) can lead to premature births.
  • Excessive fluid surrounding the baby (polyhydramnios).
  • Closely separated pregnancies.
  • Multiple pregnancies.
  • Uterine malformations.
  • Placenta placed at the cervical opening (placenta previa).
  • Early rupture of membranes or early detachment of the placenta (abruption).
  • Accidental or purposeful preterm labor.

Treatment

If the gestational age is less than 32 weeks the baby needs to be admitted to specialized centers such in NICU (neonatal intensive care unit). As a precaution all prematures babies are initially admitted to the NICU for observation even if they are breathing and suckling as normal.

  • Airway and breathing are appropriately maintained at NICU with the use of equipment such as endotracheal tube, ventilators, CPAP machines or an oxygen hood.
  • The baby is to be kept warm and protected from cold usually in an incubator.
  • Phototherapy is given to treat jaundice.
  • Initially, blood glucose is carefully monitored and measured before each 3-hour feed.
  • Breast milk or low birth weight formula is given.
  • Meeting the nutrient need in such babies is difficult due to underdeveloped intestinal tract and efforts to improve nutrients intake is necessary. The baby is to be tube fed if oral feeds are not tolerated. If oral feeding is contraindicated such as in respiratory distress then IV nutrients are provided.
  • Kangaroo care technique can be used in which the baby is placed on the abdomen of the mother with its head between the breast which helps maintain its body temperature, improve sleep and breathing rhythm and increase psychological bonding.

Severe complications and death is uncommon in developed nations due to the availability of advanced medical care.

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