Premature Babies: Challenges & Concerns

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Premature babies are babies that are born between twenty four and thirty seven weeks of pregnancy . If they are born between twenty and twenty four weeks there are very less chances of survival.

Baby weight of a  full term Indian baby weighs 2800 gms on an average. If the baby is born below 2000 gms then the baby may require specialized care. Depending on their general health they are either kept in incubators , NICU or they require care by specially trained staff . Their blood pressure, heart rate, breathing and pulse is monitored closely. They are discharged only when the neonatologist decides that thy are fit to stay at home. Sometimes these children might require  a panel of paediatricians, neonatologists, ophthalmologists and psychologists.

Usually the low birth weights baby respond very nicely and are discharged , but in some cases they might develop a variety of complications .Some of these complications are –

1- Problems related to breathing :
Small, immature lungs, Weak breathing muscles, A soft ribcage, ‘Stop-breathing’ (apnoea) attacks,  Respiratory distress syndrome , A hole in the membrane around a lung, making it collapse (pneumothorax), Brain damage, Pneumonia are some of the complications who present as breathing difficulties.

2- Respiratory distress syndrome (RDS)
When the lungs of the baby fail to expand and are collapsed this condition is called RDS or Respiratory Distress Syndrome . This can cause severe respiratory problems in the baby. Babies born before 30 weeks are susceptible to RDS, as they do not produce surfactant naturally.  The treatment of choice for such babis is surfactant administration.

3- Chronic lung disease
If a baby is born preterm and it still needs oxygen at the time it would be 36 weeks in utero or oxygen is required for more than 28 days post delivery then the child is said to suffer from chronic lung disease (broncho-pulmonary dysplasia or BPD).
The risk factors for developing chronic lung disease are babies born before 28 weeks , on ventilator for long time because of high air pressure required for maintainence to inflate the lungs.

3- Brain damage
Perterm babies especially those  born before 28 weeks tend to have a much smaller vulnerable ,less developed brain . These kind of babies may have  one or more of several disabilities, including defective eyesight, cerebral palsy and, later in childhood perhaps, clumsiness (dyspraxia), a poor attention span (attention deficit disorder), speech problems and learning difficulties.

4- Lack of oxygen (hypoxia)
The smaller a baby is, the more likely a lack of oxygen is to damage the brain. Before and during birth, several problems can reduce a baby’s oxygen supply by slowing the placental blood flow to the two arteries in the umbilical cord.

5- Hemorrhage into the brain and its spaces
It is very common in very premature babies because there blood doesn’t clot as it should.It occurs in one in four born before 25 weeks.Even an extensive bleed sometimes leaves no permanent damage, and many lesser bleeds cause no noticeable problems.

6- Cerebral palsy
Very low-birthweight babies are the most likely to develop brain damage leading to cerebral palsy, and an ultrasound or MRI (magnetic resonance imaging) scan can identify those most at risk. The severity and signs of cerebral palsy vary, but it usually shows up as stiffness, involuntary movements, or poor co-ordination and balance.

7- Anaemia
There are no iron stores in preterm babies and so they easily become anemic . This aggravates in babies whose mother bleed from the placenta before labour ,there’s a Rhesus problem . Blood transfusion is the management of choice for such babies.

8- Retinopathy of prematurity (ROP)
This is seen especially in preterms weighing less than 1000g (2lb 3oz) .These babies are so immature that the tiny blood vessels at the back of their eyes haven’t yet grown . When such a baby starts receiving higher levels of oxygen (either from air or from extra oxygen) than are normal in the womb, the outer, bare areas of each retina produce chemicals which stimulate the blood vessels to grow in the wrong direction .And subsequently it causes retinopathy.

9- Infection
Premature babies are much more likely to develop infections (for example, pneumonia and gastroenteritis) because their immune systems are relatively immature. Breastfeeding and proper newborn care reduces this risk.

10-Necrotising enterocolitis (NEC)
Due to reduced blood flow and infection in the bowel the bowel lining is inflamed and destructed which leads to necrotizing enterocolitis. The factors which lead to it are : Shortage of oxygen before birth (for example, with severe pre-eclampsia and an altered blood flow in the umbilical cord). This reduces the bowel’s blood supply (because the body directs blood to the brain to protect it); Prematurity; Low birthweight: four out of five babies with NEC weigh under 2500g (5lb 8oz), and up to 13 per cent of very low-birthweight babies are affected; Formula-feeding.

It is a great killer and it  kills one or two in every five affected babies.