World Prematurity Day

Dr Riaan van Lill, Paediatrican at Busamed Harrismith Private Hospital provides insight into preterm birth, its possible causes and some of the treatment that may be required for babies born prematurely.

What does it mean when a baby is born premature?

A baby born before 37 weeks of pregnancy (3 or more weeks before the due date) is called “premature” or “preterm.” Pregnancy normally lasts about 40 weeks, counting from the first day of your last period.

This is not rare and can affect any person as can be seen from the numbers below.

Worldwide, the incidence of preterm birth is estimated to be approximately 10 percent (range 5 percent in parts of Europe to 18 percent in parts of Africa), and approximately 15 million children are born preterm each year. Of these preterm births, 85 percent occurred at 32 to 36 weeks gestational age (GA), 10 percent occurred at 28 to <32 weeks GA, and 5 percent occurred at <28 weeks GA.

What causes premature birth?

It’s not always possible to know the cause. But some reasons that might cause a person to go into labor early include:

• Bleeding or other problems in the uterus
• Being pregnant with twins, triplets, or more babies
• Infection in the uterus or other part of the body
• Problems during pregnancy, such as diabetes, high blood pressure, or heart or kidney problems
• Smoking, drinking alcohol, or using illegal drugs during pregnancy
• Stress

What kinds of problems can premature babies have after birth?

Premature babies can have many different problems after being born. Every baby is different. But in general, the earlier a baby was born and the less they weighed, the more likely they are to have health problems.

While a baby is still in the womb, their organs and body parts are growing and developing. Premature babies can have problems because they haven’t had enough time to develop all the way.

Some of the more common issues are:

• Trouble keeping warm – Very small babies can have trouble staying warm. There are things that can help keep a newborn baby as warm as possible, like special hats and blankets. It can also help to hold your baby directly against your skin. This is called “skin-to-skin” contact.
• Breathing problems – Premature babies sometimes have trouble breathing on their own after birth. That’s usually because their lungs have not fully developed.
• Heart problems – In some premature babies, a blood vessel that should close after birth stays open. In time, the blood vessel might close on its own, or it might need treatment. Low blood pressure is also common in premature babies.
• Infection – Babies who were born early are more likely to get infections. That’s because they are not able to fight off germs as well as full-term babies.
• Digestive system problems – Some premature babies have a problem with their intestines that causes diarrhea, vomiting, and sometimes blood in the bowel movements. This usually happens within a few weeks after birth and can be serious.
• Bleeding in the brain – Babies born early sometimes have bleeding inside the brain. This happens within a few days of being born. This bleeding can be mild and stop on its own, or it can be more serious. In very premature babies, brain imaging tests are done to look for this problem.
  Jaundice – This is when the skin or white part of the eye turns yellow. There are ways to treat jaundice.

What treatments might my baby need?

It depends on how early your baby was born, how much they weigh, and what health problems they have. Your baby might need to go to the neonatal intensive care unit, or “NICU.” This is a part of the hospital for babies who need special care.

A premature baby might need one or more of the following:

• A machine to help them breathe
• Extra oxygen
• A feeding tube (to deliver breast milk into the stomach)
• Medicines
• Surgery
• Light therapy (to treat jaundice)

If your baby’s condition is stable, the doctor or nurse might suggest that you hold your baby directly against your body for “skin-to-skin” contact also sometimes called Kangaroo Mother Care or KMC for short.

Will my baby have long term problems?

Maybe. Some premature babies have health problems later in life, while others do not. The earlier a baby was born, the higher the chances of long-term problems.

Some of the problems that can affect premature babies later in life are:

• Cerebral palsy – Cerebral palsy is a disorder that causes problems with movement and balance.
• Vision problems – Sometimes, babies who were born very early (usually before 30 weeks of pregnancy) have problems with their eyes. If this isn’t treated, it can cause trouble seeing. An eye doctor can check your baby’s eyes and suggest treatments if needed.
• Problems affecting the brain – Some premature babies grow up to have problems with thinking, learning, or memory, or attention deficit hyperactivity disorder (ADHD). There are programs that can help babies and children whose problems are caught early.
• Growth problems – Very premature babies are more likely to grow up to be shorter and weigh less than average.
• Ongoing health issues – Babies who were born premature might get sick more often as children or adults.

How can I get support?

Having a premature baby can be hard and stressful. Social workers and spiritual counselors can provide support during this difficult time. There are also support groups for parents of premature babies. It can be helpful to talk to other people who are going through the same things. Try to get help from these sources and from relatives and friends. That way you will have support both in the hospital and at home.