Every family wants to have a healthy, normal, mature baby. The duration of a normal human pregnancy is 9 months. Though about 90% of the babies are born after the full term, around 8 to 18% of babies are born premature and this number has been increasing in recent times. It may be because of changing lifestyles, food habits, stress, etc.
In medical literature, we express the duration of pregnancy in weeks and the normal pregnancy is of 40 weeks. If a baby is born after completing at least 37 weeks, it’s called a term baby and if the baby is born before 37 weeks it’s called the Preterm baby. The prematurity can range from 26 weeks to 36 weeks of pregnancy.
When the baby is developing in the mother’s womb, its various organs of the body are formed at various stages and then they mature till the baby is born. The formation of organs usually takes place in the first 6 months of pregnancy. Usually, maturation happens in the last 3 months or 12 weeks. When a baby is born prematurely it will have almost all the organs but all of which are not mature enough to perform their functions to their fullest extent.
This immaturity of organs is one of the biggest hurdles the baby has to face and it’s a challenge for the pediatrician to help the premature baby to overcome these. The immaturity of various organs leads to complications in the baby like low blood sugar levels, blood calcium levels, sudden stopping of breath, breathing difficulty and indigestion. These premature babies are also at very much risk of developing infections because of their immature/underdeveloped immune system. Sometimes these problems can become so dangerous that it is fatal. Earlier the baby is born; higher will be the risk of survival and complications.
The ideal way to manage preterm babies is to provide a similar environment to that of the mother’s womb. But it is humanly impossible to create such an environment outside the womb. We should provide the best possible supportive care so that the baby can mature & grow normally and becomes fit enough to survive outside the mother’s womb. We have to look out for any complications. The baby may develop these during this process and we have to treat these accordingly.
Usually the very preterm babies require additional support like CPAP, Mechanical Ventilation, and Surfactant therapy to overcome lung immaturity. The feeding has to be started and advanced cautiously as their intestine and digestive capacity will also be weak. Usually, we start with oro-gastric tube feeding and then step up to spoon-feeding and then to direct breastfeeding. They are also vulnerable to serious infections as their immune system is also very immature and therefore have to be nursed in very aseptic conditions.
Not only the initial stabilization but also a long term follow up of these babies is required. We need to assess the maturity and growth of their eyes otherwise they may develop complications called Retinopathy of Prematurity. Their hearing assessment also is very important otherwise they may end up with speech problems. To promote their normal movements later in life the tone and functions of their legs, hands will be assessed periodically and supportive exercise or physiotherapy will be given. So it is not only just survival but survival with normal intellect, hearing, normal speech and movements is most important.
Retinopathy of prematurity (ROP) is a blinding disease seen in premature babies born before 34 weeks of pregnancy. Eyes of premature babies with ROP appear normal externally but the growth of the inner part of the eye (retinal blood vessel) is abnormal. Eyes of these babies should be examined at 2 weeks of age and examination continues every 1 to 2 weeks till the disease regresses which are usually about 3 to 6 months of age. Blindness due to ROP can be prevented by early detection and immediate treatment (within 24 hrs of diagnosis) by an eye doctor. Treatment includes retinal laser and in some cases injection of an anti-VEGF drug into the eye. Preterm babies are at risk of developing refractive error, squinting of eyes and amblyopia (lazy eye). Hence every child deserves lifelong attention from an ophthalmologist. It is the responsibility of each and every parent to get their child’s eye examined.
The earlier the baby is born, the higher the probability of health problems they face; some of which are partial/complete deafness in one/both ears and feeding difficulties. Hence, all premature babies need to be screened for hearing impairment and get evaluated for any possible swallowing issues, which are done by an Audiologist and Speech-Language Pathologist. In addition to this, the parents also need to be educated, counseled and provided with support regarding the child’s communication, cognition, auditory and swallowing abilities.
Holistic approach to pre-term baby care
The care of the premature baby is not an individual’s work but has to be collective comprehensive care provided by various people like doctors, nurses, ophthalmologists, audiologists and physiotherapists. With this type of holistic approach and with advanced technology the intact survival of premature babies has drastically improved in recent years.
A message for us all
This is what the mother of a premature child who underwent treatment for ROP told us. “Please tell all parents to be to get their baby’s eyes checked promptly by an Ophthalmologist, follow doctor’s advice and not delay the examination.” She realized the importance of eye examination in a preterm baby when she came across a 6-year child who was blind due to ROP as the parents did not follow the doctor’s advice. Her child is 8 years old now, her vision is good and the goes to regular school. She is thankful that her baby underwent treatment for ROP and vision is like any other normal child.
Dr. Mithun H K, Dr. Anupama Shyamsudhir, Ms. Nimalka, Yenepoya Medical College Hospital
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