By Dr K Suresh Gowda
Preterm or premature babies are defined as those born before 37 weeks or 259 days of gestation. The earlier the baby is born the more the risks associated with their health. The complications can be either short-term, like respiratory and cardiovascular problems or long-term. Whatever the case, it can be a very stressful period for parents or caregivers. Some complications can show up later or cause problems for the child well into adulthood.
Premature babies may not have fully matured organs and this can result in serious complications. The earlier the baby is born, the more time she/he will have to spend in the Neonatal Intensive Care Unit (NICU) where they are monitored constantly. The risks involved are:
These infants are prone to heat loss because of the higher ratio of body surface area to volume. Heat is lost by conduction, convection, radiation and evaporation, mostly when in contact with lower ambient temperatures and even due to the presence of amniotic fluid. Additional interventions are undertaken in the NICU like incubators to keep the infant warm and prevent heat loss.
Serious breathing problems are common in preterm babies because their lungs are not fully developed and cannot produce surfactant, requiring them to be put on respiratory support.
Bronchopulmonary Dysplasia, also known as chronic lung disease, occurs usually in very low birth weight babies. It is also characterised by oxygen deficiency.
Apnea occurs in approximately one-quarter of all preterm infants and especially those born much prior to full-term. This means that the baby could stop breathing for 20 seconds or more and have a low oxygen or heart rate. This condition could last until infants are two to three months old.
Patent ductus arteriosus, or PDA, is a congenital heart defect common in premature babies where the ductus arteriosus, which is a vessel connecting the pulmonary artery to the descending aorta fails to close. When this happens, it gives way for some of the baby’s blood to bypass the lungs. If left untreated, PDA can lead to irregular heartbeat and congestive heart failure.
This is excessive bleeding inside or around the ventricles, the spaces in the brain containing the cerebrospinal fluid. It is most common in premature babies, especially those with very low birth weight babies who weigh less than 1.5kg.
The baby could have disorders that result in hypoglycaemia or hyperglycaemia. Such babies often have limited glycogen stores (sugar stored in the liver) or an immature liver function. Doctors monitor the blood glucose routinely to keep the glucose levels in check.
This occurs in about 2-10 per cent of very low birth weight babies where there is the infection in the gastrointestinal system of premature babies. This infection causes inflammation of the intestines and if left untreated leads to the walls of the bowels being destroyed.
Babies with low birth weight are very susceptible to infections which can result in them being kept in the NICU for longer than usual.
Preterm babies that survive are more likely to have neuro-developmental disabilities. The risk of these problems increases with a lower gestational period.
- The baby could have impaired cognitive skills due to impaired brain development.
- Baby is at risk of developing cerebral palsy or even delay in developing motor skills.
- The baby also has the possibility of developing sensory impairments.
NICU follow-up for preterm babies
Education and follow-up programmes are imperative for parents with preterm babies for the optimal development of the baby and its health. The earlier their problems are diagnosed, the better their chances are for proper development of brain and body. Teams of medical and developmental specialists who work closely with paeditricians and neonatologists help parents and caregivers by creating a customised programme to help with development of the child. Environmental influences can improve the cognitive function of the children, even when development is delayed. Parents need to enroll in a follow-up that will provide support to the baby’s development and regularly evaluate their health. As they reach school-going age, more resources will need to be devoted to address their needs.
(The writer is Neonatologist & Pediatrician, Motherhood Hospitals.)