Supports for Preterm
What is preterm birth?
Preterm birth is defined as delivery before 37 weeks of pregnancy have been completed. Generally, preterm birth can be categorized into three subtypes:
- extremely preterm (before 28 weeks)
- very preterm (28 to 32 weeks)
- moderate to late preterm (32 to 37 weeks)
According to the World Health Organization, the rate of preterm birth ranges from 5% to 18% of babies born across the globe. A medical report published by The Chinese University of Hong Kong in 2014 shows that the preterm birth rate in Hong Kong stands at 6.5% in recent years.
Preterm birth is the leading cause of death in newborns, and the second major reason for death in children under the age of 5 after pneumonia. Causes of prematurity remain unknown, but the following risk factors may increase the chance of preterm birth:
- History of miscarriage or preterm delivery
- Uterine abnormalities (e.g. cervical incompetence)
- Teenage mothers or women with advanced maternal age
- Placenta praevia or premature separation of placenta
- Hydramnios or oligohydramnios
- Smoking or alcohol abuse by mother
- Premature rupture of membranes
- Pre-eclampsia of the mother, multiple pregnancy, congenital abnormalities, etc.
Common health problems
Due to the underdeveloped organs in preterm infants, they are vulnerable to a variety of health problems, the most common being respiratory diseases, including:
- Respiratory distress syndrome
The underdeveloped lungs in preterm infants lead to insufficient surfactant production, which causes a tendency of the alveoli to collapse and impaired gas exchange. As a result, the newborns may suffer from breathing difficulty, or worse, respiratory failure. Generally speaking, respiratory distress syndrome is commonly seen in infants born before 32 weeks of pregnancy or those having a birth weight of less than 1.5 kg. Respiratory apparatus, along with synthetic surfactants, are used by doctors to improve the breathing condition of the infants. Oxygen therapy is necessary in some cases to maintain normal blood oxygen level. The earlier in pregnancy a preterm infant is born, the longer period of oxygen therapy is required. Respiratory support with oxygen is required for some preterm babies even after their discharge from the hospital.
Preterm infants have an underdeveloped respiratory centre due to the immaturity of the brain and as such, in the event of hypoxia or a change in the partial pressure of carbon dioxide in blood, the central nervous system would experience a delay, resulting in an apnea (of more than 15 seconds). Apnea is clinically defined as the cessation of breathing for more than 20 seconds or less than 20 seconds if it is accompanied by oxygen desaturation or bradycardia. Spontaneous breathing will usually resume with the use of external stimuli. While the drop in oxygen saturation can be measured by pulse oximetres, the symptom naturally subsides with growth in most infants after being discharged.
- Chronic lung disease
Chronic lung disease is commonly developed among preterm infants who have been put on a ventilator for a prolonged period of time (more than 2 weeks) and require supplemental oxygen after 28 days of life. During the first year after being discharged, these infants are more likely to be re-admitted to the hospital for lung problems. Most gradually outgrow the condition as their lungs mature.
Apart from respiratory problems, preterm infants may also suffer from the following health problems:
- Patent ductus arteriosus
Normally, the ductus arteriosus connecting the pulmonary artery and the aorta closes on its own after birth. In some infants, however, the ductus arteriosus fails to close or re-opens. The condition can be treated by the control of water intake and medication. Surgery may be required in severe cases.
- Intraventricular haemorrhage
Intraventricular haemorrhage easily occurs in preterm newborns with unstable health conditions. In the case of mild bleeding, in which ventricles are not enlarged, the problem will resolve itself without any sequelae; however, in the case of severe bleeding, in which ventricles are enlarged, this may result in a neurological deficit.
- Retinal degeneration
The underdevelopment of the retina is the cause of retinal degenerationin preterm infants. Infants who require a high concentration of supplemental oxygen for a long time after birth have a chance to trigger the abnormal growth of blood vessels in the retina, resulting in various degrees of degeneration. Most patients show improvement without any treatment.
Physiological jaundice appears much earlier in preterm infants than full-term infants. It also takes longer for jaundice to disappear. Symptoms include yellowing of the infant’s skin, which can be treated with phototherapy. Some preterm infants may suffer from pathological jaundice due to certain diseases. Their skin may appear to be dim yellow, but in most cases, jaundice will gradually disappear as health condition stabilises.
- Gastro-intestinal malfunction
As preterm infants generally have low digestion and absorption capacity, they should be fed with small portions of food in a progressive way. Premature newborns with extremely low body weight are normally fed through the gastric tube for a certain period. Rarely infants would develop necrotizing enterocolitis, which will require special treatment.
It is very common for extremely preterm infants to develop unilateral or bilateral inguinal hernia when they are close to being stabilized enough to be discharged from the hospital (with a body weight of 2 kg). Surgery is required to cure the problem.
- Septicaemia in newborns
As the immune system of preterm infants is not yet fully developed, they are vulnerable to infections of bacteria or viruses, which can invade the bloodstream and spread, resulting in a systemic inflammatory response. Examples of typical symptoms include loss of appetite, cold limbs, persistent jaundice and slow response. Septicaemia may cause severe complications such as meningitis, which requires special attention and immediate treatment.
The likelihood of the above health challenges is associated with how early the baby is born. The earlier in pregnancy a baby is born (i.e. the shorter the gestational weeks), the more likely it is to have health problems.
Despite the various health issues that preterm infants face, their survival rate has vastly improved with the advancement of medical technology. As long as proper care is provided, the lives of some preterm babies, who would have died easily in the past, can now be saved. In recent years, even premature infants weighing as low as 0.5 kg can survive without severe sequelae.
With the attentive care of medical staff and parents, most preterm infants can strive through their complications and gradually towards health. Once they are able to breathe spontaneously, maintain a stable body temperature, drink from a bottle and steadily gain weight, they are allowed to go home.
Adjusting to a newborn at home
Preterm infants may have got used to the noisy environment during their long stay at the hospital, where there is a clear distinction between day and night. After bringing the newborn home, parents should pay careful attention to the home environment and make appropriate adjustments to care for the infant.
- Parents can keep some music or a radio playing at home to prevent the preterm infant from feeling uncomfortable with the sudden change to a quiet environment.
- Meanwhile, the lighting at home should not be too dim to avoid a sudden change in the environment which may cause discomfort to the infant.
- Parents can take a week or two to make step-by-step adjustments to restore the home back to normal.
- Parents should maintain proper hygiene at home and avoid going out or visits by friends and family in order to protect the infant from bacterial infections and being over-stimulated.
- Parents should pay careful attention to changes in weather and room temperature, and dress the infant appropriately. They should stay alert to the infant’s body temperature, as its health and emotions are affected when feeling too warm or too cold.
- Preterm infants generally need more sleep after being discharged from the hospital. Parents should ensure that their baby can sleep well.
- When feeding the infant, parents should follow the feeding schedule from the hospital to ensure the baby
- For infants who need supplemental oxygen through a ventilator, instructions from the doctor should be followed during feeding to minimize the risk of suffocation of the infant.
Parents can provide their infant with appropriate stimuli in a safe and clean environment to help it adapt to the external environment.
- Colourful pictures or sound-emitting toys can be hung around the baby’s room to provide him with different visual and audio stimuli.
- Parents can wear colourful clothes or accessories as visual stimulus and encourage the baby to touch them
- A lack of concentration from the baby is a sign that it is tired, parents should stop the activity and let the baby rest.
- Be gentle and slow with holding and carrying the baby or changing its posture. Parents should change the position of the infant in a proper way and provide sufficient support to its neck.