Born too soon

World Prematurity Day falls on Nov 17, and this is an opportune time to heighten awareness of the dangers associated with preterm birth.

PREMATURE infants, also known as preemies, come into this world earlier than full-term infants.

A normal pregnancy lasts for approximately 40 weeks. Preterm birth is the birth of a baby occurring before 37 completed weeks (less than 259 days) of pregnancy.

They look different from full-term babies, and find simple things like feeding and breathing difficult.

There has been significant progress in the care of premature infants, but not in reducing the prevalence of preterm birth.

Preterm birth is among the top causes of infant deaths worldwide. Every year, about 15 million babies are born prematurely – more than one in 10 of all babies born around the world.

Newborn deaths – those in the first month of life – account for 40% of all deaths among children under five years of age.

Prematurity is the world’s single biggest cause of newborn death, and the second leading cause of all child deaths, after pneumonia.

Many of the preterm babies who survive face a lifetime of disability.

Preterm babies have a higher risk of complications that could lead to death within the first year of life. Their lungs and digestive systems are often not fully developed, and they face a higher risk of brain damage.

These premature babies have not had time to grow and thus they have a low birth weight (birth weight below 5lb 8oz [2.5kg] is defined as low birth weight [LBW]; weight below 3lb 5oz [1.5kg] is very low birth weight; and weight below 2lb 3oz [1kg] is extremely low birth weight.

Common danger

A common cause for infant mortality due to LBW is Respiratory Distress Syndrome (RDS), which may involve atelectasis (collapsed lung or lungs), hypoxaemia (low oxygen absorption), and high carbon dioxide levels.

Approximately 50% of the neonates born at 26-28 weeks’ gestation develop RDS, whereas less than 30% of premature neonates born at 30-31 weeks’ gestation develop the condition.

In RDS, the infant’s immature lungs do not produce enough of an important substance called surfactant.

Surfactant allows the inner surface of the lungs to expand properly when the infant makes the change from the womb to breathing air after birth.

The lungs start to make surfactant only later in the pregnancy, thus, preemies are not able to keep their alveoli open as well as full-term babies. They have to work very hard to fill their alveoli when they breathe, and do not get enough oxygen to their bodies.

Fortunately, RDS is treatable, and many infants do quite well.

Symptoms of RDS include:

*Bluish colour of the skin and mucous membranes

*Brief stop in breathing

*Grunting

*Nasal flaring

*Rapid breathing

*Shallow breathing

*Shortness of breath and grunting sounds while breathing

*Unusual breathing movement – drawing back of the chest muscles with breathing

Investigations for RDS include a blood gas analysis (which will show low oxygen and excess acid in the body fluids).

A chest X-ray will show a characteristic “ground glass” appearance in the lungs, which often develops six to 12 hours after birth.

Treatment for RDS includes respiratory support and early administration of artificial surfactant.

Babies with moderate to severe RDS may need help breathing or oxygenating their blood.

Respiratory support often comes in the form of a nasal cannula, continuous positive airway pressure (CPAP) or mechanical ventilation.

Babies with severe RDS can be given surfactant directly into their lungs, to help the lungs stay inflated while they mature.

Can RDS be prevented?

If premature delivery is unavoidable, then steroids given to the mother before delivery can help a baby’s lungs produce surfactant. Steroids work best when they are given between 24 hours and seven days before birth.

RDS usually develops shortly after birth while the baby is still in the hospital. If you have given birth at home or outside a medical centre, seek emergency attention if your baby develops any breathing difficulty.

Other complications of premature birth include:

*Heart problems – The most common heart problems premature babies experience are patent ductus arteriosus (PDA) and low blood pressure (hypotension).

*Brain problems – Risk of bleeding in the brain.

*Temperature control problems – Premature babies can lose body heat rapidly as they don’t have the stored body fat of a full-term infant, and they can’t generate enough heat to counteract what’s lost through the surface of their bodies.

*Gastrointestinal problems – Preemies are likely to have immature gastrointestinal systems.

*Blood problems – These include anaemia (body doesn’t make enough red blood cells) and infant jaundice (baby’s blood contains an excess of a yellow-coloured pigment of red blood cells called bilirubin).

*Metabolism problems – Abnormally low levels of blood sugar (hypoglycaemia).

*Immune system problems – An underdeveloped immune system, common in premature babies, can lead to infection.

Long-term complications

Cerebral palsy is a disorder of movement, muscle tone or posture that is caused by injury to a preemie’s developing brain, either during pregnancy or while the baby is still young and immature.

Premature babies are also more likely to lag behind their full-term counterparts on various developmental milestones, due to impaired cognitive skills.

They can also suffer from vision, hearing and dental problems, as well as behavioural and psychological problems, and chronic health issues.

Another cause of concern for premature babies is Respiratory Syncytial Viral infection (RSV).

It is so common that most children have been infected with the virus by age two.

However, infection with the respiratory syncytial virus can be severe in some cases, especially in premature babies and infants with underlying health conditions.

Although there’s no vaccine for RSV, there is a protective medication, palivizumab, which can help protect children under age two who are at high risk of serious complications when they get the infection, such as those born prematurely, or with congenital heart or lung disease.

When the pregnancy test turns positive, thinking on how to prevent having a premature baby is not at the top of a new mum’s to-do list. However, planning for a healthy pregnancy is an important part of being an expectant mother.

Many causes of pre-term birth are unexplained and unknown. However, there are many risk factors that increase the chances of babies being born early.

The risk factors for premature labour include:

*A previous premature birth

*Pregnancy with twins, triplets or other multiples

*An interval of less than six months between pregnancies

*Conceiving through in vitro fertilisation

*Problems with the uterus, cervix or placenta

*Chronic conditions like high blood pressure and diabetes

*Smoking cigarettes, drinking alcohol or using illicit drugs

*Mothers under the age of 18 and over 30 years have a greater risk of going into labour early

*Being underweight or overweight before pregnancy

*Lack of prenatal care

*Poor nutrition

*Some infections, particularly of the amniotic and lower genital tract

*Multiple miscarriages or abortions

*Stressful life events and physical injury

Safe motherhood begins before conception with good nutrition and a healthy lifestyle. With appropriate prenatal care, the ideal result is a full-term pregnancy and the delivery of a healthy baby.

The postpartum period in a positive environment will support the physical and emotional needs of the mother, baby, and family.

The birth of a premature infant is a journey few are aware of unless they are faced with the overwhelming experience. The joy of giving birth is challenged with helplessness, often coupled with fear and guilt.

Researchers are investigating foetal programming – the way maternal stress, nutrition, health, or illness experienced during pregnancy, affects offspring from infancy through childhood and into adulthood.

It is very important to provide pre- and post-natal healthcare, education and nutrition to women who otherwise have little or no access to these types of services, to help them understand pregnancy and infant care.

This Nov 17 marks World Prematurity Day, and it is a great opportunity to connect globally and heighten awareness of this important issue.

Let us ensure that no family endures the traumatic and life-changing experience of having a premature or sick baby, without easy access to critical information and community support to help them through their journey.

As a sign of support, do set your Facebook status to read “I am supporting World Prematurity Day – 15 million babies are born too soon every year” on Nov 17.