Premature babies: ‘Most will do very well,’ says expert

WHEN  thinking of a premature baby, the image of a tiny baby inside the hospital’s incubator likely comes to mind. Premature babies are born at any time before the 37-week mark.  In fact, every pregnant woman’s idyllic view: the baby will be born, placed in her arm but never in the incubator because he was born too early.

The reality, especially when it is unexpected, is the baby is born and needs to be handed over for doctors and nurses to monitor him, to check that he is stable and to do whatever is necessary. That was Mrs Helen Adekunle’s dilemma after her first baby was born at a private hospital a month earlier than the expected date of delivery.

“At the hospital, I had to stay close to the neonatal intensive care unit (ICU) to breastfeeding him and hold him to my chest to ensure he is kept warm,” Mrs Adekunle said. “It was a trying time for me; the long period of sitting to feed the baby, express milk or carry him on my chest is very tiring, considering what I had just passed through in his delivery.”

Mrs Adekunle is one of several mothers with premature babies. They are all faced with challenges raising their premature children from infancy to adolescence. Approximately 15 million babies are born early each year, accounting for about one in 10 of all babies born in the world. Premature birth is the leading cause of death in children under the age of five worldwide.

Medical advances have significantly improved outcomes, so babies can survive premature birth even in countries with a low level of technology and adequate support for the mother and health facilities.

Dr Kemi Tongo, a consultant paediatrician, University College Hospital (UCH), Ibadan, said babies born too soon, have extra challenges outside the protection of their mother’s womb, and so need more care than their counterparts that were born full-term, even home.

Premature babies often have trouble maintaining their temperature, breathing, and feeding because several of their systems are not yet ready for living outside. For instance, some cannot feed at all or even if they do, cannot take enough breast milk before they get tired. Their breathing needs to be monitored; and also are at increased risk of infection.

According to her, “It is not to say that with low tech, we cannot care for some preterm babies. It only means that everybody has to be on their toes, especially the health workers and the parents too, particularly in setting like ours where you pay user fees at the point of care before you get any service.

“Their families too have challenges because they never anticipation the baby coming too early.  They are not emotionally prepared and then the demands of that period; caring for premature babies can be very challenging to both families and even health care workers.”

But, with a minimal package of care for newborn babies, including management of infection, feeding support, thermal care and access to a ventilator or respirator to support breathing at the hospital, babies born too early can survive.

In the lungs, the challenge is to ensure that enough oxygen can get into the blood through the lungs, and this is often much more difficult with premature, underdeveloped lungs. To accomplish this, there are various modes of assisted ventilation that might be needed.

Also, in the brain, there is a possibility of injury because of the immaturity of the brain structurally at the time of delivery and possibly further injury during the intensive care course when a baby is born very early.

So, without adequate care and support, babies that are born premature, especially those born extremely premature, face a lifetime of complications such as cerebral palsy, learning difficulties, visual, hearing and behavioural problems and increased risk of chronic ill-health from diabetes, cardiovascular and kidney disease.  Compared to their contemporaries born at term, they also die more.

Ensuring that these babies survive, she added, will require family support for the new mother to nurse the premature baby. She stated: “the challenges of the premature baby depend on when babies are born, they are extreme preterm, moderate preterm or late preterm. It can be tough; she needs all the support that she can get at home.”

Nonetheless, Dr Tongo said the 803, 200 premature babies born each year in Nigeria happen for various reasons, including diseases in pregnancy such as pre-eclampsia, gestational diabetes and hypertension in pregnancy; nutrition deficiency, abnormalities in the mouth of the womb(cervix), abnormalities in the unborn baby and, lifestyle practices like alcohol intake and smoking. Sometimes, it is an aftermath of a fall, domestic violence or an accident.

However, she stated that mothers can reduce the chances of having a premature baby by ensuring they registered early and attend antenatal care regularly, as well as maintain good health-seeking behaviour and healthy lifestyle.

“If a woman registers early for antenatal care and they notice that she has hypertensive issues if they manage her early enough, hopefully, it will not get to that stage that they have to hurriedly bring out a preterm baby that is already compromised. If she registered for antenatal care early enough, she will receive counselling, nutrition advice, bed rest when necessary, and so hopefully it will push the baby till term,” she added.

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