Premature babies

With up to a quarter of South African babies making their arrival in the world before their due date, moms of premmies aren’t alone. Here’s what you need to know about your early bird

What happens when baby decides to come early?

Babies born before 37 weeks of pregnancy are regarded as premature, and those born before 28 weeks are said to be extremely preterm. Between 15 and 25 percent (in private and public healthcare, respectively) of South African babies arrive early, according to the United Nations Children’s Fund (Unicef). The reasons for this are largely unknown and difficult to predict, says Johannesburg gynaecologist Dr Monica Nkabinde.

WHAT CAUSES PRETERM BIRTH?

The likelihood of giving birth prematurely increases when a mom-to-be is expecting multiples, and foetal abnormalities might also be a cause. Medical conditions during pregnancy that may result in premature birth include pre-eclampsia (very high blood pressure), premature rupture of the membranes, bleeding of the placenta or injury to the abdomen, such as in a car accident. Other risk factors for premature birth are previous preterm births, miscarriages or multiple abortions, urinary tract infections, vaginal or sexually transmitted infections, kidney disease, uterus and cervical abnormalities, clotting disorders, obesity and malnutrition. Lifestyle risks include poor prenatal care, smoking, drinking alcohol or using drugs, while environmental risk factors include crowding and pollution, domestic violence, lack of social support, long working hours with long periods of standing, and stress. “It’s a very good idea to try to avoid extreme physical and psychological stress during pregnancy,” says Dr Nkabinde.

WHAT ARE THE CHALLENGES OF A PREMATURE BABY?

A premmie isn’t just a very small baby. With the support and the protection of the womb prematurely removed, these babies may experience a range of immediate and long-term problems. Dr Nkabinde says, “In the short term, complications include respiratory distress syndrome due to lung immaturity, which may require ventilation and a prolonged ICU stay; apnoeic attacks, where the neonate ‘forgets’ to breathe from time to time; susceptibility to infections; intestinal disorders such as bowel necrosis; and jaundice caused by immaturity of the liver. “Long-term complications include neurodevelopmental impairment that may show itself in delayed developmental milestones, cerebral palsy or intellectual impairment. “Non-neurological disorders include chronic lung diseases and other physical impairments such as blindness and deafness.”

WHAT’S THE GOOD NEWS?

It’s not a given that all premmies will experience these complications, and some may have no problems at all. Adds Dr Nkabinde, “When preterm birth occurs after 34 weeks, the outcome is generally very good. Most of these babies will do very well provided there were no other contributing factors, such as foetal distress or infection in the womb. Babies born between 29 and 32 weeks also have a reasonably good outcome, depending on the availability of well-equipped health facilities.” And while some very small babies may take a while to catch up, most premature babies reach the same developmental milestones as their peers in two to three years. After that, any differences in size or development are probably due to individual differences rather than premature birth.

WHAT DO YOU NEED TO KNOW ABOUT NICU?

All babies born before 35 weeks’ gestation will need special attention in a neonatal intensive care unit (NICU), to be helped with breathing and to learn how to eat, as the swallowing reflex may not have developed yet. Even babies born closer to term have trouble staying warm because they don’t have enough body fat, so they may need to spend some time in NICU. “The duration of stay in the ICU depends on the level of prematurity, how well the neonate responds to treatment and what complications arise,” Dr Nkabinde

explains. “While strict infection-control measures will be put in place in terms of immaculate hand hygiene, and limiting the number of visitors and visiting hours, the parents are always encouraged to have as much physical contact with the premature baby as possible. Mothers are encouraged to breastfeed and to ‘kangaroo-carry’ the baby once the ICU staff deems it advisable.” Kangaroocarrying the baby involves wrapping it up warmly and securely against the front of the mom’s body. “It’s important to have a strong family support structure, as this is a very difficult and stressful period for the parents,” Dr Nkabinde adds. “In the absence of a strong support system, it’s advisable that parents see a psychologist.”