Caring for those born too early

Conceiving a child is usually something of great happiness to both the parents. The mother always tries her best to take care of herself and the foetus in a manner that would facilitate the safety of the foetus within and the safe delivery of the child. The safest birth is the full term birth however World Health Organization (WHO) estimates that around 15 million babies worldwide are born before 37 weeks. This is more than 1 in 10 babies born. Approximately 1 million preterm babies die annually due to complications. To raise awareness on preterm births, World Prematurity Day is observed on 17 November annually. The theme of the 2019 World Prematurity Day is “Born Too Soon: Providing the right care at the right time in the right place.” In this backdrop, Daily Mirror spoke to Dr. Kosala Karunaratne, Consultant Pediatrician at the Lady Ridgeway Hospital.

PRETERM DELIVERY AND ITS CAUSES

“A baby delivered before 37 weeks is known as a preterm baby,” informed Dr. Karunaratne. When asked about the causes of preterm delivery, he informed that usually the causes are mostly related to the mother (maternal causes) and rarely related to any complications with the baby, but said usually the cause is identified.

MATERNAL CAUSES

Maternal diseases (high blood pressure, cholesterol, infections, chronic conditions)

If mother had been smoking, drinking or taking illicit drugs Complications with the mother (problems with the uterus, cervix or placenta)

Genetic complications Having a previous preterm birth Giving birth to twins, triplets or other multiples Conceiving through IVF Being underweight or overweight during pregnancy Stressful life events that could lead to trauma Multiple miscarriages or abortions

Physical injury or trauma Dr. Karunaratne also noted that there were various types of preterm deliveries: Extremely Preterm Delivery (less than 28 weeks)

Very Preterm Delivery (28- 32 weeks)

Moderate- Late Preterm Delivery (32-37 weeks) “Depending on the type of preterm delivery, the severity or presence of certain complications and conditions in the baby might differ,” Dr. Karunaratne stated.

COMPLICATIONS OF A PRETERM BABY

A preterm baby will have immature organs and this could lead to life-threatening situations. “One of the most common complications is that the preterm baby cannot regulate their own temperature thereby losing a lot of heat. If this issue isn’t properly managed, the baby could die of hypothermia,” he said. Dr. Karunaratne explained that the skin of the baby is thin and the surface area is high, therefore the heat loss is more. He also added that the fat layer under the skin is not developed in preterm babies. “This is why we’ll have to keep these babies in the incubator and regulate the temperature and moisture,” he expressed.

“Lungs of the baby are also immature. Also, until the 30th week of pregnancy, the lungs of the baby do not produce surfactant- a substance allows the lungs to expand,” he stated. Without surfactant, the lungs cannot be inflated and lungs collapse when ventilated. Due to immature lungs and lack of surfactant, the preterm baby finds it hard to breath and complications can occur in the respiratory system. A ventilator machine helps the preterm baby to breath and a tube is inserted to prevent the lungs from collapsing. This respiratory condition is known as ‘Respiratory Distress Syndrome (RDS).’

He also pointed out that the brain of the baby is also immature. “There could be bleeding in the brain and the baby could have fits. If there’s an excessive amount of bleeding in the brain, the baby can die,” Dr. Karunaratne revealed.

Due to an underdeveloped heart, there could be cardio-vascular complications which would lead to a possible heart failure. Dr. Karunaratne also noted that the immunity of a preterm baby is low and this could cause the baby to be prone to all infections therefore the baby has to be kept in a sterilized environment. He also added that at the first sign of an infection, antibiotics are administered.

“Preterm babies are most likely to have immature gastrointestinal system, which can cause complications in the baby receiving adequate nutrition,” he stated. He stated that to overcome this, nutrition will have to be provided in saline form via the veins. “Breast milk is not substituted, mothers are encouraged to feed the baby,” he added.

Dr. Karunaratne also stated that the prevalence of a preterm baby to develop jaundice is very high as the liver is underdeveloped. Due to this, there could be excess bilirubin which could lead to the baby developing jaundice.

“Bones of a preterm baby are also soft and immature. Preterm babies grow very fast and this may cause issues with the bone strength and density. Calcium, phosphate and vitamin D will have to be administered to improve bone health,” he said.

Dr. Karunaratne noted that preterm babies need around the clock care as they are very vulnerable to various health issues due to them not developing the necessary organs for survival. However, he also stated that there could be long term complications in preterm babies due to some of these organs not developing successfully even after birth.

Long term complications Cerebral palsy Retinopathy

Chronic diseases Impaired learning Behavioural and psychological problems including developmental delay

„Anemic conditions which could

lead to blood transfusion „Nutritional issues

NEONATAL CARE IN SRI LANKA

To provide preterm babies with specialized care, there are Neonatal Intensive Care Units (NICUS) in major districts around Sri Lanka and qualified neonatalogists. Neonatologists are specialized pediatricians who are trained in managing preterm babies. Dr. Karunaratne noted that neonatologists in Sri Lanka usually are overworked as there is a dearth of neonatologists. He also noted that parents of preterm babies too needed to be educated on how to manage with a preterm baby and had to be counselled. “It’s not a pleasant experience for the mother to be separated from her baby when the baby is born and the mother needs counselling in this regard. We should have trained and qualified counsellors to counsel parents,” he suggested.

While premature delivery is the leading cause for deaths of children under 5 in the world and one of the leading causes in Sri Lanka, the mortality rate of preterm babies is quite low. According to a 2016 WHO Report, approximately 24 500 babies in Sri Lanka are born premature but since due to Sri Lanka’s novel ‘preterm growth charts’, introduced in 2016- an innovative system to monitor the growth and development of preterm babies, and excellent neonatal care- Sri Lanka has managed to reduce the mortality rate of preterm babies.

Echoing these sentiments, Dr. Karunaratne requested that infrastructure of neonatal care must be developed and doctors should be encouraged to become neonatologists. “If we increase the quality of neonatal care and management of preterm babies then we can fulfil the aspect of providing the right care at the right time at the right place.,” he concluded.

Due to an underdeveloped heart, there could be cardio-vascular complications which would lead to a possible heart failure