Premature Babies

Quick Links Common Problems Low weight baby Premature babies need special care Out of the Hospital Precautions for to-be mothers A Note on Umbilical Cord Care

More and more, it seems children are being born before their due date. This increase in prematurity is due to infertility treatments, which often result in multiple births. This is common because more than one egg may be fertilized. In addition, there is a steady background rate of prematurity common in many societies. It could be also due to pregnancy and childbirth at a late age or medical complications. The high survival rate of these infants and their delicate clinical condition often mean that more parents and physicians have to understand how to manage these infants.

Premature babies are defined as those born between twenty four and thirty seven weeks of gestation. An average Indian baby weighs about 2800 gms (2.8 kgs) when born at full term. According to the World Health Organization, any baby who weighs less than 2500 gms (2.5 kgs) is termed as a "low birth weight" baby, irrespective of when the baby is born during a pregnancy. Babies, who weigh less than 2000 gms (2 kgs), need specialized neonatal care for the initial few weeks after birth, until they are much stronger and ready to go home.

Pre-term babies are those who are born before the 37th week of pregnancy. Since they have not completed their full term and development in their mother's womb, they have a low birth weight. However, low birth weight babies are full term babies (born in the 39th or 40th week of pregnancy) but weigh much less than 2500 gms. Newborn babies, who have a birth weight less than the 10th percentile, are called small for date (SFD). SFD babies refer to a premature baby who may be born close to its due date but who weighs significantly less than would be appropriate to its gestational age. Full term SFD babies, constitute a large majority of newborns in our country. Out of 10 full term babies, three babies are born with low birth weight.

The chances of survival for a baby born before twenty four weeks of pregnancy are rather slim. Premature babies are even more vulnerable than full-term babies and need to be treated with special care. These tiny, frail creatures are often born with problems, as many of their faculties are not fully developed. The nutritional requirements, medical needs, behaviour and development are unique. Often they are recovering from serious illness, and they can catch up in growth and development for several months or years after discharge.

Premature babies are put straight into intensive care. They are usually kept in incubators. They require round-the-clock nursing. They are fed intravenously and sometimes put on the respirator to help them breathe if necessary. Their vital signs like blood pressure, heart rate, breathing and pulse are closely monitored. Premature babies are kept in intensive care till the doctors are of the opinion that they are out of danger. Even after they have been discharged from the hospital, these babies will require periodic evaluations from pediatricians, neonatologists, ophthalmologists and psychologists to keep a check any problems that might crop up.

Bringing a premature baby home after several weeks or months in the hospital is very exciting -- but also stressful. Premature infants develop for two to four months outside the womb. During this time, they are exposed to different types of stimuli such as light, noise, touch, and pain. They benefit from being swaddled in a blanket in the early weeks and often prefer a quiet environment with dim lights to achieve a quiet alert state that is needed for feeding and staying calm. So, parents have to take extra care.

Common Problems

Premature infants can have continued medical problems after discharge. The most common problem is chronic lung disease -- sometimes called bronchopulmonary dysplasia (BPD). BPD can occur because the infants still have some inflammation in their lungs and may require extra oxygen or medication to help them breathe comfortably.

Another common problem in premature babies is excessive spitting or gastroesophageal reflux, more commonly called acid reflux.Spitting up usually doesn't bother full-term babies. But in premature babies, it may cause them to stop breathing or make their heart slow down. This can begin or get worse after discharge as the acid production in your baby's stomach increases. Reflux is often treated by thickening formula or breast milk, and with medicines* that decrease acid in the stomach or that help prevent milk from coming back up . (*Please refer a pediatrician prior to giving any medication to your child).

If your baby is discharged from hospital with medicines for chronic lung disease or acid reflux, it is very important to give these medicines as directed. Ensure you refill them when they are close to running out and have your pediatrician adjust the doses as your baby grows every couple of weeks for at least the first two to three months. If your baby is sent home on a heart or breathing monitor, it is important to use it as directed.

Problems of low weight

Premature babies are always smaller than they should be for their age when they go home. To increase weight, they often need special transitional formulas (with higher calories) or added powdered formula if they are taking breast milk.

Your premature baby may develop slower than a full-term baby. This is to be expected -- it may take up to two years to catch up with children who were born on their expected birth date. Developmental delay can be more serious if your baby had bleeding in his brain or a stroke. Those born before 28 weeks gestation may not catch up until three years of age particularly with language development. Premature babies may benefit from intervention services such as physical, occupational, speech therapy or developmental therapy during the first couple of years.

Remember, just because the symptoms are gone that doesn't mean the problem is better. It means the medicines are working. These problems will resolve over time and the medicines can be stopped when your baby gets bigger and stronger.

Premature babies need special care

Yes, babies born prematurely (before the due date) may need special care during their first 2 years, especially if they were very small at birth (less than 3 pounds).

Here's some advice on how to care for your baby when he or she comes home from the hospital.

involve your doctor in the baby's growth and development

Daily feeding schedule

At first, most premature babies need 8 to 10 feedings a day. Don't wait longer than 4 hours between feeding, because if you do, your baby may get dehydrated (dehydrated means lacking fluids). Six to 8 wet diapers a day show that your baby is getting enough breast milk or formula. Premature babies often spit up after a feeding. This is normal, but you want to make sure that your baby is still gaining weight. Talk to your doctor if you think your baby has stopped gaining or is losing weight.

Switching to solid food

Most doctors advise giving a premature baby solid food at 4 to 6 months after the baby's original due date (not the birth date). Premature babies are not as developed at birth as full-term babies are, so it may take them longer to develop their swallowing ability. If your baby has medical problems, a special diet may be helpful.

Your baby's immunizations

Immunizations (also called vaccines or shots) are given to premature babies at the same ages they are given to full-term babies. Your baby might be helped by getting a flu shot when s/he reaches 6 months of age. Premature babies might get more sick due to the flu than full-term babies. Talk with your doctor about flu shots for your entire family. This can help protect your baby from catching the flu from someone in the family.

Cause

Several factors contribute to the birth of a full-term, low weight baby such as:

Special concerns

Low birth weight is one of the main causes of high infant mortality rates. Compared to a normal birth weight baby, infant mortality rates are about 12 times higher if a baby weighs less than 2500 gms. Low birth weight and small-for-dates (SFD) makes non insulin-dependent diabetes and cardiovascular disease (high blood pressure, coronary heart disease and strokes) more likely, which is why it's especially important for low birth weight babies to avoid becoming overweight as adults.

A majority of low-birth weight babies do catch up with their peers in time and go on to lead perfectly normal, healthy lives. Very low birth-weight babies are particularly likely to be smaller than their peers for some years. While most small-for-dates babies do catch up (two out of three in the first six months), some remain small throughout life.

Precautions for mothers to-be

Make sure you eat well and wisely, avoid smoking and consuming alcohol, take regular gentle exercise and try to rest and relax. Regular visits with your doctor, which include assessment of your health, diet and the development of your baby, are essential. Your post-childbirth appointments are also a good time to discuss any worries with your doctor.

A Note on Umbilical Cord Care

Umbilical cord care in newborns is very important. Usually the umbilical cord stump should automatically fall off in 10 days to 3 weeks. Before the umbilical cord stump falls off it will change color from yellow to brown or black - this is normal. Some doctors suggest gently touching a clean cotton swab to the area or rubbing gently with spirit until the cord stump dries up and falls off, but others recommend leaving the area alone. Talk to your child's doctor to see what s/he prefers.