World Prematurity Day         

Children are the most precious commodity of humankind. This makes health issues of children a major focus of interest in this era. One of the biggest health crises that affect newborns is Prematurity, with nearly 15 million newborns dying annually due to its complications. In addition, a considerable fraction of the surviving preterm babies have long-term health complications that persist throughout their lives. Therefore, in order to raise awareness regarding this health issue, November 17 has been declared as the World Prematurity Day. In this week’s Health Capsule, we have spoken to Dr. Deepal Perera, Consultant Paediatrician, Apeksha hospital, Maharagama, in order to increase awareness about the issues related to prematurity among our readers.

Defining prematurity
A normal human baby spends approximately nine months in his mothers’ womb before seeing this world. A baby usually reaches full maturity around 37 weeks after conception. Each day that he spends inside the mother’s uterus until he is fully matured supports the growth and development of his body and organs. 

Basically, until he reaches full maturity, each day that he spends inside the uterus prepares him better for the life outside it. If he is delivered prematurely, he is ill prepared to face the challenges of the outside world when compared with the babies born after completing the term, and are therefore likely to experience more short and long-term problems.

A baby is called premature when he is born after a pregnancy lasting less than 37 weeks, explains Dr. Perera. Even though an early birth is associated with poor survival, thanks to the development of healthcare facilities, babies born as early as 25 weeks of gestation now have a chance to live, he adds. 

Risk factors
Many have the question as to what causes a baby to be delivered early, without completing the usual term inside the mother. The causes for preterm delivery can be categorised into maternal factors, fetal factors and uterine factors, explains the doctor. Maternal factors like diabetes in pregnancy, hypertension and smoking during pregnancy increase the risk of preterm delivery, while abnormalities in the uterus and the fetus will also have an effect. These factors alone or in combination can cause a baby to be born prematurely. 

Dangers of preterm birth
Complications of preterm birth can also be divided into short-term and long -term complications, according to Dr. Perera. Having a low birth weight at the time of delivery is one important consequence of preterm birth. This condition is associated with other major implications connected with the baby’s health. A baby is categorised as having a low birth weight when he weighs less than 2.5 kg at birth. Some babies weigh as low as 1 kg or less and are called extremely low birth weight, and have poorer chance of survival when compared to other babies. 

Since the lungs of these babies may not be mature enough, they may have difficulty in expanding, causing respiratory difficulty. This is a condition called surfactant deficient lung disorder. Such babies may need artificial ventilation of a preemie until their lungs mature and function on their own.
One of the most common and immediate problems that preemies have is hypothermia after birth, according to Dr. Perera. Due to the lower body fat content of their bodies, they have difficulty maintaining their body temperature. Similarly, lower blood glucose levels after birth can also occur and cause long-term damage to other organs if not treated timely. 

Preterm babies also have a higher risk of bleeding inside the brain soon after birth. Jaundice, or yellowing of the baby can also occur due to the increased levels of a substance called bilirubin in the blood. In the absence of timely treatment, these particles of bilirubin can enter the brain and deposit in brain tissue, causing brain damage. 

Have you seen how newborn babies make sucking motions when touched near the corner of their mouth? This automatic action is called the suckling reflex and aids newborns in initiating breastfeeding. But this reflex may not be well developed in preemies and therefore it may be difficult to initiate breastfeeding in them. Therefore they may need feeding through a tube or through an intravenous line, until breastfeeding is established. 

Preemies are also more prone to have anaemia and other vitamin and nutritional deficiencies after birth and therefore need careful assessment and follow-up. They also have a higher risk of developing rickets due to the deficiency of calcium in their bodies.

Long-term effects
Long-term consequences that these premature babies face include neuro-developmental disorders like cerebral palsy, learning difficulties, mental retardation, low IQ and epilepsy. In addition, they have an increased risk of having hearing and vision problems. Therefore premature babies need careful follow up after birth which should include eye and hearing checkups.

Prevention and treatment
 Even though technology is much advanced, still there is not much that can be done to prevent premature births. Avoiding smoking, controlling diabetes and hypertension during pregnancy will reduce the risk of preterm birth. 

 Mothers at risk of delivering babies prematurely should be managed at hospitals that offer specialist care and facilities for preemies, giving them an optimum chance of survival. Special medication that helps the child’s lung mature has to be administered to the mother when possible. Starting breastfeeding soon after birth, keeping the baby warm and following up the baby’s health condition, is important in giving the maximum care to the baby, concludes Dr. Perera.

They say that it takes a village to raise a child. So, let’s all get together and increase the focus on the issue of prematurity, so that these babies who arrived prematurely can still grow up to take their rightful place in the world.