All You Wanted To Know About Premature Babies

The following are some common concerns and queries that most new parents have about pre term or premature babies.

 

Babies born anytime before 37 weeks of gestation are called pre term or premature babies. Pre term babies have their own handicaps as they are probably not fully developed because they still have a growth period which has been cut short. 28 weeks is believed to be the minimum time of gestation for a human baby, after which, birth, survival and growth for the baby become viable.

 

In the west, doctors constantly work to reduce the viable period of gestation, i.e., they keep trying to save babies with even lesser gestational age and very less birth weight as well. This is a challenge for them as they need to make sure that such babies not only survive, but also have a good quality of life. Doctors have actually been able to achieve a further reduction in the period of gestation, and bring it to 22 weeks. There is enough evidence now to say that babies born even after 22 weeks can remain healthy.

 

In the context, it is important to note that neonatal care is a very expensive modality, and a majority of people cannot afford the care. Most western countries can do this as healthcare is the government’s responsibility in those countries, and pre term babies are well provided for.

 

In India too, some achievement in this specialized area has taken place, and we do see specialized centers where they have exclusive neonatal set ups. In India though, septicemia is a matter of great concern, and sometimes despite doing everything right, the baby dies due to septicemia. In the west, sepsis is not a major issue, and doctors are more able to make sure that pre term babies survive. They even have enough data to say that such babies are doing well in all spheres of activity, be it scholastic or cognitive. In India, however, this kind of data is still not available, and not much can be said about the quality of life of pre term babies born before the viable period of gestation.

 

 

• The commonest among the handicaps seen in pre term babies is breathing or respiratory disorders. Generally, a special pulmonary surfactant is produced in babies after 28 or 30 weeks of gestation. Pulmonary surfactant is a surface-active lipoprotein complex that increases pulmonary compliance, and prevents the lungs from collapsing after expiration. There could be an absence of the formation of this surfactant in pre term babies. Their lungs could collapse. Actually, since babies are so tiny, they get tired of making the effort to breathe, and stop breathing altogether, which is one of the causes for neonatal death.
• This condition is called as Hyaline Membrane Disease or Infant Respiratory Distress Syndrome (IRDS). Such pre term babies require extra care when being ventilated and given an artificial surfactant. The next challenge is to take them off the ventilator and make sure that they are fine. This is a long process and it can take from 48 hours to a week or so.
• Actually, the longer the babies are on ventilator, the more the chances of complication. They can become dependent on the ventilator, or the lungs can burst open once the surfactant is reduced. On the whole, the more the babies are dependent on the ventilator, the more difficult it becomes for doctors to take them off it. On the other hand, taking them off the ventilator early may limit their supply of oxygen. The baby may have hypoxia, which means that the baby is not getting enough oxygen to its brain. The human brain can tolerate only a few minutes of life without oxygen after which time the brain gets affected.

 

• All newborns have a normal fetal structure called the ductus arteriosus. This structure allows blood to bypass circulation to the lungs. This is necessary because the fetus does not use his/her lungs to breathe as the oxygen is provided through the mother’s placenta. The ductus provides an outlet for the blood flow. Usually, this duct closes within a short while after birth, on exposure to high levels of oxygen immediately after birth. When it doesn’t close, it is termed Patent Ductus Arteriosus. Doctors may need to intervene and correct this.
• There are drugs which are used to do this, but care must be taken for babies who are duct dependant. In such babies, if the duct is closed, the babies become hypoxic, or develop multiple problems. So, in some babies, it may be more prudent to keep the duct open.

 

The other system that can be at risk is the renal system. Pre term babies can have acute renal shut down because there is not enough fluid intake in the babies during the first 24 to 48 hours. Doctors need to make sure that these babies get the right quality and quantity of fluid for 48 to 72 hours after they are born.