Early ar­rivals

All you need to know about de­liv­er­ing a preterm baby

Mother & Baby (Australia) - - Contents -

Lit­tle won­ders

Dis­cov­er­ing you are preg­nant is one of the most ex­cit­ing times in your life, but it can also be fraught with worry and doubt. Go­ing into labour early can be a very real pos­si­bil­ity, es­pe­cially if you have a high-risk preg­nancy. While there are a num­ber of fac­tors as­so­ci­ated with preterm births, there’s also a lot of sup­port out there for fam­i­lies with pre­m­mie ba­bies, too. M&B spoke to As­so­ciate Pro­fes­sor Craig Pen­nell from the Uni­ver­sity of Western Aus­tralia’s School of Women’s and In­fants’ Health about po­ten­tial risk fac­tors, de­vel­op­men­tal de­lays and tak­ing care of a baby who is born so lit­tle and so young.

Q HOW EARLY IS CON­SID­ERED PRE­MA­TURE?

Craig says: “A baby born pre­ma­ture is any­thing less than 37 weeks ges­ta­tion.”

Q WHAT DOES ‘CORRECTED AGE’ MEAN?

Craig says: “The best way to de­scribe corrected age is by us­ing an ex­am­ple. So, if a baby was born at 30 weeks ges­ta­tion, when they are 12 weeks (or three months) old, it would be the equiv­a­lent of 42 weeks ges­ta­tion. The corrected age there­fore would be two weeks old. We do that be­cause of mile­stones. For ex­am­ple, a baby should be smil­ing at around six weeks; but a baby who is born at 28 weeks won’t be smil­ing when they get to six weeks old.”

Q WHO IS AT A HIGHER RISK OF BIRTHING A PRE­MA­TURE BABY? IS THERE ANY­THING THAT MAKES PAR­ENTS’ RISK FAC­TORS HIGHER?

Craig says: “Preterm birth oc­curs in about eight per cent of preg­nan­cies. The strong­est risk fac­tor is ge­net­ics. If the par­ents of the baby were born pre-term, or have siblings that were preterm, there is a higher chance they will give birth ear­lier. There are also a num­ber of other fac­tors, in­clud­ing the age of the par­ents (less than 18 or more than 35), if mum smokes or is tak­ing drugs and al­co­hol dur­ing preg­nancy or if the baby is a prod­uct of IVF. Ma­ter­nal con­di­tions like di­a­betes, high blood pres­sure, au­toim­mune and blood clot­ting dis­eases may also lead to a preterm birth, as well as pre­vi­ous cer­vi­cal surgery, so if you’d had ab­nor­mal Pap smears or biop­sies, or surgery to re­move pre­can­cer­ous cells. Also, women with uter­ine ab­nor­mal­i­ties like a dou­ble or half uterus, or dif­fer­ent struc­tural anom­alies are all as­so­ci­ated with in­creased risk of preterm birth.”

Q WHAT ABOUT MUL­TI­PLE BIRTHS? IF I AM PREG­NANT WITH MORE THAN ONE BABY, WILL I GIVE BIRTH EAR­LIER THAN OTH­ERS?

Craig says: “Yes. For twins, you’re look­ing at de­liv­er­ing around the 34-37 ges­ta­tion week mark, for triplets, most are de­liv­ered around the 34-week mark, and with quads, they’re de­liv­ered at around 30 weeks ges­ta­tion.”

Q AM I AT A HIGHER RISK OF HAV­ING A PRE­MA­TURE BABY SEC­OND TIME AROUND IF MY FIRST BABY WAS PRE­MA­TURE?

Craig says: “If you’ve had a preterm baby be­fore, your risk is gen­er­ally dou­bled.”

Q IF I HAVE A PRETERM BABY, WHEN SHOULD I GET THEM VACCINATED?

Craig says: “The pae­di­a­tri­cian will give you in­di­vid­u­alised ad­vice about that, but gen­er­ally it’s done on corrected age.”

Q SHOULD I BE CON­CERNED ABOUT THEIR DE­VEL­OP­MENT LATER IN LIFE?

Craig says: “The risk of de­vel­op­men­tal prob­lems in­creases the ear­lier the baby is born. For ex­am­ple, if you were to look at a baby born at 24 weeks ges­ta­tion, they have the largest num­ber of is­sues, in­clud­ing pos­si­ble learn­ing de­lay dif­fi­cul­ties all the way through to blind­ness, deaf­ness and cere­bral palsy. As you get fur­ther along in preg­nancy, the risk lessens. By the time you get to 32 weeks, most of the se­vere con­di­tions are no longer a prob­lem, but there still can be learn­ing is­sues or the risk of de­vel­op­ment de­lays up un­til around 37 weeks. We al­ways try to get ev­ery­one to 40 weeks, or as close to it as pos­si­ble.”

Q HOW DO MED­I­CAL PRO­FES­SION­ALS HELP GET THEIR PA­TIENTS TO FULL TERM?

Craig says: “We start with pre­con­cep­tion coun­selling, to make sure high-risk women with un­der­ly­ing med­i­cal con­di­tions can have their con­di­tion sta­bilised and what­ever can be done to min­imise the risk of preterm birth can be done be­fore preg­nancy.

Ed­u­ca­tion also plays a big part. We ad­vise peo­ple not to have kids be­fore 18 and if you can, try to have them be­fore 35. If you do choose to have them after 35, you need to be aware preterm birth is a risk. We also tell pa­tients to avoid smok­ing, tak­ing drugs and drink­ing al­co­hol dur­ing preg­nancy, as that in­creases risk of a pre­ma­ture birth by about 40 per cent.

Once you are preg­nant, the most com­mon thing we do is check the cer­vi­cal length when we do an anatomy scan. If it’s short, we of­fer treat­ment, which could be pro­ges­terone med­i­ca­tion or some­times the cer­vi­cal stitch. We also in­crease the sur­veil­lance of those who are at greater risk and keep low-risk preg­nan­cies as nor­mal as pos­si­ble. Also, if we know some­one is go­ing to be de­liv­er­ing early we want to make sure they’re lo­cated close to a ter­tiary hos­pi­tal – it’s not ideal to have your baby at 26 weeks out in the coun­try.”

Q HOW YOUNG CAN A PRE­MA­TURE BABY BE BORN?

Craig says: “At 23 weeks ges­ta­tion the best sur­vival data is about 46 per cent. At 24 weeks it goes up to 76 per cent. At 28 weeks, it’s 96 per cent. By 34 weeks, it’s quite sim­i­lar to term ba­bies.”

Twins are usu­ally de­liv­ered around the 34-37 ges­ta­tion week mark

Q CAN I STILL BREASTFEED MY PRE­MA­TURE BABY?

Craig says: “Breast­feed­ing is good for all ba­bies, but it is re­ally im­por­tant for preterm ba­bies, es­pe­cially be­cause of the im­mune ben­e­fits. In the hos­pi­tal once your baby is born, you are helped to ex­press breast­milk via pumps. Once ba­bies are at the point where they are able to tube feed, with a tube down the nose into the stom­ach, they will be given ex­pressed breast­milk. Ba­bies are es­sen­tially fed through a drip for the first part of life when they’re re­ally lit­tle, but cer­tainly big­ger ba­bies are able to have ex­pressed breast­milk. As soon as they are big enough and don’t need res­pi­ra­tory help, the aim is to tran­si­tion the baby onto the breast.” That typ­i­cally doesn’t hap­pen un­til around 2.5kg, as be­fore that, they might just have a few sucks and fall asleep.”

Q IF MY BABY REQUIRES CARE, CAN I STILL HAVE SKIN-TO-SKIN CON­TACT?

Craig says: “For late preterm births, around 35 and 36 weeks, they can usu­ally have some skin-to-skin time in labour ward or in the op­er­at­ing the­atre be­fore they go to the nurs­ery. But for re­ally small ba­bies who are 600800g, once they’re sta­ble in the nurs­ery they tend to have ‘kan­ga­roo care’. This is when mum sits in a re­cliner chair and the baby lies on its stom­ach, with their legs and arms to the side, ly­ing on mum’s chest. They can even have that while hav­ing ven­ti­lated sup­port. Mums can have that con­tact and care with baby from very early on.”

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