A preemie baby is a newborn baby that was born before the 37th week of pregnancy. Unfortunately, despite the doctors’ efforts of and significant achievements in medicine, the percentage of premature births remains at a high level for many years throughout the world. Every year, about 15 million children are born prematurely. (data for the year 2018 from the article).
The smallest premature babies, who have a chance to survive are those that are born after the 23rd week of pregnancy. In recent years, the survival rate of these children has increased impressively – from 20 to 60%.
Premature baby weight
Thanks to the huge progress of neonatology, now it is possible to save children even with an incredibly small body weight, that is, less than 750 grams, and some patients of intensive care units have a body weight of less than 500 grams! I don’t know if anyone who hasn’t seen such a child can imagine it. This is a child that almost fits in the palm of your hand and weighs like a bottle of water.
However, not only the premature baby weight is important, but also the maturity of the newborn. The earlier a preemie baby is born, the greater the anatomical and functional immaturity in different systems, and therefore the greater the need for their support.
What for a preemie baby born between the 22nd and 23rd weeks of pregnancy, palliative care is usually applied, because the chances of survival are very low, and the expected quality of life, especially in the long term, is very unfavorable.
This survival limit of most newborns has been unchanged for many years. This is primarily due to the development of the lungs. Below this limit, their design prevents gas exchange, even if very advanced mechanical ventilation is used.
Birth of a preemie baby
The smallest premature babies are placed in a special heat bag immediately after premature birth to prevent heat loss. The newborn is then placed in a neonatal resuscitation station.
This is the place where the child receives help in adapting and stabilizing his condition. The type of support at the adaptation time depends on many factors, primarily on the degree of prematurity, as well as on pathologies in pregnancy, which “caused” prematurity. Most often, the newborn required respiratory support, ventilation and more rarely, directly the intensive care unit.
After initial stabilization, the newborn is transferred to a regular neonatal ward. Those newborns whose condition has not stabilized are transported in a transport incubator to the neonatal intensive care.
What health problems do premature babies face with right after birth?
First of all, those are associated with the respiratory system.
Respiratory failure can affect every preemie baby. A child may require non-invasive respiratory support such as CPAP, or HFNC, ventilation (breathing). A special type of respiratory failure, typical of premature infants, is respiratory distress syndrome.
Another problem for a preemie baby and neonatologists is the fight against immaturity of the digestive system.
This immaturity of the digestive system can cause a number of problems when feeding. For a preemie baby, mother’s milk is always the preferred food, and if this is not possible, the feed is milk “from the can”. Milk feeding, especially in immature newborns, occurs through a special catheter inserted through the nose or mouth into the stomach. Portions of milk are systematically increased.
There may also be a need for the so-called parenteral nutrition. In this case, the preemie baby receives the nutrient fluids intravenously through peripheral catheter. The less mature the child, the longer the process of transition to dairy nutrition.
Functional disorders of the gastrointestinal tract are the most common problem of the digestive system, and the most serious digestive problem, which mainly affects premature infants, is necrotic enterocolitis (NEC). This disease is associated with the damage of the intestinal wall. The etiology of this disease is not fully understood.
Feeding the preemie baby having NEC should be made only parenterally. In the most severe cases, NEC may even require surgical bowel removal. Very serious, but at the same time very rare consequence of this disease (affecting children after the surgery) is a short bowel syndrome or a nutrients absorption violation. Here, medical treatment may be temporary, since the child’s intestine also increases with growth and over time its length may be sufficient to perform its tasks.
The cardiovascular system
A preemie baby also has problems with the circulatory system. The main problem is hypotension or too low blood pressure. The reason for this is, among other things, the immaturity of the heart. Liquid therapy as well as catecholamines (including adrenaline, dopamine and dobutamine) are used in the treatment.
Another common problem may be the open ductus arteriosus (PDA – patent ductus areosa). The arterial duct itself is a blood vessel that is the part of the normal blood circulation for the fetus. It connects the aorta and the pulmonary artery. Under normal conditions, the duct should close within a few days after premature birth. In premature babies it does not overgrow. This condition makes premature babies’ recovery more difficult, affecting, among other things, breathing, circulatory and digestive systems.
Premature babies also have to deal with the immaturity of the hematopoietic system, which can lead to anemia in the neonatal period. Babies who were born especially early may even require additional blood transfusions. Less severe anemia require hematopoietic treatment with appropriate doses of iron and vitamins. Iron stores in premature infants are insufficient, because most of the iron the fetus receives from the mother in the last weeks of pregnancy. Therefore, every preemie baby, even if he has no anemia, should receive preventive doses of iron.
Intraventricular hemorrhage is a common pathology of premature babies. It is associated with the flow of blood into the ventricles of the brain. Due to the high immaturity of the nervous system and blood vessels. The rate of bleeding is inversely proportional to the age of the fetus. So more often it occurs in the most immature infants. The greatest risk of the bleeding is in the first days of life.
Bleeding in the brain ventricles is distinguished by some degrees. Fortunately, the first and second stages of the bleeding usually do not have any clinical consequences and in this case the problem is resolved by itself. However, in case of more extensive bleeding (III and IV degree), the brain cavity can expand, and special treatment may be required, and there is a risk of developmental disorders. After discharge, the child may need to visit the doctor with a systematic measurement of the head circumference and repeated brain ultrasound.
The main problem of the vision is abnormal retinal vascularization. In the case of progressive retinopathy, laser treatment is used, or, in certain cases, a drug that is injected directly into the eye.
Premature babies have a high risk of other visual impairment, including strabismus, amblyopia, cataract. Therefore, long-term observation of the vision development in the first 6-7 years of life is extremely important.
Premature babies have reduced immunity. They are more susceptible to infection than other children. Stay in the neonatal ward, premature babies often already struggle with infections. Decrease immunity caused by the immaturity of the immune system and the lack of antibacterial agents, which are transmitted to the child only after the 32nd week of pregnancy. That is why it is so important to feed premature babies with natural food, especially colostrum, it is rich in antibodies. Premature babies should not come into contact with infected people. Vaccinations are also necessary, but their schedule depends on the development and stability of the babies. Under good circumstances, there won’t be any different to the usual.
Every month of development in the womb is worth its weight in gold. Every week and even every day spent under the mother’s heart is important in the development of the baby.
The first months of life of a preemie baby is a very difficult time for both him and his parents. If you are the parents of a preemie baby, do not hesitate to ask the doctors what is happening to your preemie baby and how you can participate in the treatment process. Your presence next to the child is extremely important, no less than the presence of caring doctors and nurses.