Premature Babies: How to Care for Them?

Posted on: 2021-07-23 15:14:07

According to the World Health Organisation (WHO), a Preterm birth is defined as a baby born alive before 37 weeks of pregnancy are completed. There are sub-categories of preterm birth, based on gestational age:

  • extremely preterm (less than 28 weeks)
  • very preterm (28 to 32 weeks)
  • moderate to late preterm (32 to 37 weeks).

  • Induction or cesarean birth should not be planned before 39 completed weeks unless medically indicated.
    Globally, an estimated 15 million babies are born too early every year, or in other words, preterm. That is more than 1 in 10 babies. Approximately 1 million children die each year due to complications of preterm birth. More than 60% of preterm births occur in Africa and South Asia, but preterm birth is truly a global problem. In the lower-income countries, on average, 12% of babies are born too early compared with 9% in higher-income countries. Within countries, poorer families are at higher risk.
    In India, 27 million babies are born each year out of which 3.5 million babies are born prematurely as per the estimates. Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths.

    Why do premature births happen?

  • Most of the time, premature births happen naturally and often doctors do not know the reason behind it. Sometimes, premature birth is planned because it's safer for the mother and/or the baby. This could be because either of the two has a health condition.

  • Premature birth is more likely to happen when a mother has a health problem — like diabetes — or does harmful things during her pregnancy, like smoke or drink. If she lives with a lot of stress, that also can make her baby be born too early.

  • If a woman has given birth early before, she is more likely to give birth early again. The more premature deliveries one has had, and the earlier their babies were born, the higher this risk becomes.

  • Twins and triplets are often born prematurely. More than 50% of twins and almost all triplets are born before 37 weeks. Even if these mothers do not go into premature labor, they are often advised by their doctors to give birth before their due dates to avoid complications and risks.

  • Preterm prelabour rupture of membranes (PPROM) is when a woman's water breaks before labor before 37 weeks of pregnancy.

  • About 50% of women with PPROM will go into labor within the first week after their waters break. The further along she is in the pregnancy the more likely she is to go into labor within 1 week of the waters breaking. PPROM is associated with 3-4 out of every 10 premature births.

  • Placental abruption is when the placenta starts to come away from the inside of the womb wall. It can cause stomach pain, bleeding from the vagina, and contractions. This can increase the risk of premature birth. If it is serious, or the mother is close to her due date, the baby may need to be born immediately (usually by cesarean section). But if she is still early on in her pregnancy and the abruption is minor, she may just be monitored closely, usually in a hospital.

  • Why do Premature Babies need Special Care:

    Various conditions might occur in premature babies. It is important for any individual who is expecting a baby soon to educate themselves with premature newborn issues.
    There can be various short-term and long-term problems in newborn babies. A few of them are listed as follows:

    1) Initial Breathing problems: A premature baby may have respiratory distress due to immature lungs. The lack of oxygen, as a result, can affect other organs which are immature too. This condition affects infants before 35 weeks. Infants born between 23 to 32 weeks might develop a lung disease known as bronchopulmonary dysplasia and breathing conditions known as apnea. A tube may be placed in the windpipe and a ventilator will help the baby breathe.
    2) Hypothermia: A preterm baby does not have the capacity to maintain their body temperature and the ensuing hypothermia can lead to death, if not addressed. Babies are kept in a baby warmer or an incubator, with temperature control.
    3) Premature babies may not be able to suckle and swallow before 34 weeks of gestation and may need a small, soft tube placed through the nose or mouth into the stomach. Sometimes very premature babies may need to be fed through the veins until they stabilize enough to receive nutrition through the stomach.
    4) Heart Issues: An issue that can be serious in newborn babies is heart disease. The most common condition experienced is ductus arteriosus and low blood pressure. Babies born before 30 weeks have a high risk of developing such diseases.
    5) Eyesight problems: Infants born before 30 weeks have a high risk of developing eyesight and vision problems. They may develop conditions such as retinopathy of prematurity, a condition where blood vessels swell and overgrow in the light-sensitive layer of nerves behind the eye. A premature baby may have various other conditions that can impair vision and cause blindness.
    6) Hearing problems: Premature babies have the risk of developing various hearing problems. It is a must that premature babies have their hearing abilities checked before going home. It is important that premature newborn baby care is prioritized in such cases.
    Due to the health risks and concerns in premature babies, they are given newborn baby care and medical attention immediately after their birth. Depending on how early the baby arrives; a neonatologist is called in to determine if the infant needs any special treatment. In addition to medical assistance, parents should seek newborn baby care tips to take care of their newborn baby.

    Premature babies may have the following issues:

  • Anemia - Lack of enough healthy red blood cells to carry adequate oxygen to the body's tissues

  • Bleeding into the brain or damage to the white matter in the brain

  • Sepsis - A serious condition resulting from the presence of harmful microorganisms in the blood or other tissues and the body’s response to their presence, potentially leading to the malfunctioning of various organs, shock, and death.

  • Hypoglycemia - Low blood sugar

  • Neonatal respiratory distress syndrome

  • Neonatal jaundice - Newborn jaundice is a yellowing of a baby's skin and eyes. Newborn jaundice is very common and can occur when babies have a high level of bilirubin, a yellow pigment produced during the normal breakdown of red blood cells.

  • Problems due to immature lungs, pneumonia, or patent ductus arteriosis

  • Intestinal inflammation (necrotizing enterocolitis) - Necrotizing enterocolitis (NEC) is a serious gastrointestinal problem that mostly affects premature babies. The condition inflames intestinal tissue, causing it to die. A hole may form in your baby's intestine. Bacteria can leak into the abdomen (belly) or bloodstream through the hole.

  • Problem with feeding or suckling or coordinating swallowing and breathing

  • Treatments available in India:

    The rate of premature births in India is rising and is presently around 21% of babies, according to a report released in November 2013. The report, Delivered Too Soon, was prepared by the Indian Foundation for Premature Babies (IFPB), a grouping of doctors across India. The report said three-quarters of premature babies could be saved with current, cost-effective interventions, even without the availability of neonatal intensive care facilities.
  • NICU:
  • NICU stands for newborn intensive care unit. This is a nursery in a hospital that provides around-the-clock care to sick or premature babies. It has health care providers who have special education and facilities to give your baby the best possible care.

  • Incubators:
  • Incubators are clear plastic cribs that keep babies warm and protect them from germs and noise. These allow medical personnel access to the baby for treatment while minimizing potential environmental health risks.

  • Carbon Dioxide Monitor:
  • A small circular pad attached to the baby’s skin to measure the baby’s oxygen and carbon dioxide levels. The transcutaneous monitor needs to heat the skin to get these measurements, so it is moved to different areas of the baby’s skin periodically to avoid heating the skin in excess. There may still be a small red mark on the skin after this monitor has been removed, but the mark will fade.

  • Feeding Tube:
  • A tube placed into the mouth or nose; it is connected to the stomach to help deliver breast milk or formula to babies who are unable to eat.

  • Umbilical Catheter:
  • A small tube inserted into one of the vessels in the belly button; this catheter is connected to the aorta and can be used to draw blood and deliver necessary fluids, medications, blood, and nutrients to the baby.

  • C-PAP (Continuous Positive Airway Pressure) Machine
  • A method of administering air to the baby’s lungs that use tubes inserted into the baby’s nose or mouth and through the windpipe. The tubes are connected to a mechanical ventilator. The ventilator assists the baby with breathing rather than breathing for the baby completely.
    In 2012 the American Academy of Paediatrics has divided neonatal care into four distinct levels. Level I facilities (well newborn nurseries) provide a basic level of care to neonates who are low risk. They have the capability to perform neonatal resuscitation at every delivery and to evaluate and provide routine postnatal care for healthy newborn babies. Level II (specialty-level facility) is for the care of stable or moderately ill newborn babies who are born at ?32 weeks gestation or who weigh ?1500 g at birth with problems that are expected to resolve rapidly.
    Level III NICUs are defined by having continuously available personnel (neonatologists, neonatal nurses, respiratory therapists) and equipment to provide life support for as long as necessary. These units have facilities for advanced respiratory support and physiologic monitoring equipment, laboratory and imaging facilities, nutrition and pharmacy support with pediatric expertise, and social services.
    Level IV units include the capabilities of level III with additional capabilities and considerable experience in the care of the most complex and critically ill newborn infants and should have pediatric medical and pediatric surgical specialty consultants continuously available 24 hours a day. Level IV facilities would also include the capability for surgical repair of complex conditions.

    Medical Success Stories supported by CHF:

    Baby of Ancy :

    The baby of Joseph and Ancy Anson was a 17-day old baby boy when the parents had contacted CHF for help. His father worked as a daily wage laborer, who lost his job due to the pandemic. His mother is a homemaker. The baby boy is the youngest child of the Ansons and has two elder siblings. Born as a preterm baby, he was suffering from neonatal seizures and sepsis. The baby was kept in the NICU and was given ventilator support for 1 week. The baby’s treatment was successfully done in Lourdes Hospital, Kerala.
    The estimated cost of treatment was Rs. 3,00,000. Baby's parents were unable to gather the treatment funds, so on behalf of them, CHF raised the funds and supported his treatment.

    Twins of Deevyashri :

    Born in the 7th month itself, the twin babies of Deevyashri and Chandrashekhar were suffering from prematurity, respiratory distress, and infections. Both the babies were kept in the NICU for their treatment. Baby 1 was given ventilator support and Baby 2 was on HFNC. Their father being the only earning member in the family with a minimum earning was not able to afford the cost of his babies' treatment and hence asked Child Help Foundation for support. After the necessary verification CHF supported the twin’s treatment.

    B/O Ushakumari :

    B/O Ushakumari is a 1-month-old premature baby boy from Alappuzha, Kerala. Baby’s father works as a daily wage laborer and his mother is a housewife. At birth, the baby had low weight and suffered from difficulty in breathing. He was admitted to SBM hospital, Kerala, where the doctors said that he will need CPAP and other supportive care for his breathing difficulty. The estimated cost of his treatment is Rs. 4,00,000. The family could not raise these funds due to low incomes. CHF came forward to help them by raising funds for the infant's treatment.

    Since the pandemic has begun, Child Help Foundation is constantly working towards ensuring that pregnant women from underprivileged backgrounds are getting their full nutritional needs. Under our Emergency Medical Support Program, Child Help Foundation is raising funds to support the treatments of premature babies.