What do you know about Preterm babies?
Well here are some key facts;
- Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising.
- Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for nearly 1 million deaths in 2013.
- Three-quarters of them could be saved with current, cost-effective interventions.
Across 184 countries, the rate of preterm birth ranges from 5% to 18% of babies born.
Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. There are sub-categories of preterm birth, based on gestational age:
- extremely preterm (<28 weeks)
- very preterm (28 to <32 weeks)
- moderate to late preterm (32 to <37 weeks).
Induction or caesarean birth should not be planned before 39 completed weeks unless medically indicated.
An estimated 15 million babies are born too early every year. That is more than 1 in 10 babies. Almost 1 million children die each year due to complications of preterm birth. Many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems.
Globally, prematurity is the leading cause of death in children under the age of 5. And in almost all countries with reliable data, preterm birth rates are increasing.
Inequalities in survival rates around the world are stark. In low-income settings, half of the babies born at or below 32 weeks (2 months early) die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, almost all of these babies survive.
More than three-quarters of premature babies can be saved with feasible, cost-effective care, e.g. essential care during child birth and in the postnatal period for every mother and baby, antenatal steroid injections (given to pregnant women at risk of preterm labour and under set criteria to strengthen the babies’ lungs), kangaroo mother care (the baby is carried by the mother with skin-to-skin contact and frequent breastfeeding) and antibiotics to treat newborn infections.
To help reduce preterm birth rates, women need improved care before, between and during pregnancies. Better access to contraceptives and increased empowerment could also help reduce preterm births.
Why does preterm birth happen?
Preterm birth occurs for a variety of reasons. Most preterm births happen spontaneously, but some are due to early induction of labour or caesarean birth, whether for medical or non-medical reasons.
Common causes of preterm birth include multiple pregnancies, infections and chronic conditions such as diabetes and high blood pressure; however, often no cause is identified. There could also be a genetic influence. Better understanding of the causes and mechanisms will advance the development of solutions to prevent preterm birth.
Where and when does preterm birth happen?
More than 60% of preterm births occur in Africa and South Asia, but preterm birth is truly a global problem. In the lower-income countries, on average, 12% of babies are born too early compared with 9% in higher-income countries. Within countries, poorer families are at higher risk.
The 10 countries with the greatest number of preterm births1:
- India: 3 519 100
- China: 1 172 300
- Nigeria: 773 600
- Pakistan: 748 100
- Indonesia: 675 700
- The United States of America: 517 400
- Bangladesh: 424 100
- The Philippines: 348 900
- The Democratic Republic of the Congo: 341 400
- Brazil: 279 300
The 10 countries with the highest rates of preterm birth per 100 live births:
- Malawi: 18.1 per 100
- Comoros: 16.7
- Congo: 16.7
- Zimbabwe: 16.6
- Equatorial Guinea: 16.5
- Mozambique: 16.4
- Gabon: 16.3
- Pakistan: 15.8
- Indonesia: 15.5
- Mauritania: 15.4
Of 65 countries with reliable trend data, all but 3 show an increase in preterm birth rates over the past 20 years. Possible reasons for this include better measurement, increases in maternal age and underlying maternal health problems such as diabetes and high blood pressure, greater use of infertility treatments leading to increased rates of multiple pregnancies, and changes in obstetric practices such as more caesarean births before term.
There is a dramatic difference in survival of premature babies depending on where they are born. For example, more than 90% of extremely preterm babies (<28 weeks) born in low-income countries die within the first few days of life; yet less than 10% of babies of this gestation die in high-income settings.
Management of Preterm
At the hospital, the neonatal intensive care unit (NICU) provides round-the-clock care for your premature baby.
Specialized supportive care for your baby may include:
- Being placed in an incubator. Your baby will probably stay in an enclosed plastic bassinet (incubator) that’s kept warm to help your baby maintain normal body temperature. Later on, NICU staff may show you a particular way to hold your baby — known as “kangaroo” care — with direct skin-to-skin contact.
- Monitoring of your baby’s vital signs. Sensors may be taped to your baby’s body to monitor blood pressure, heart rate, breathing and temperature. A ventilator may be used to help your baby breathe.
Having a feeding tube. At first your baby may receive fluids and nutrients through an intravenous (IV) tube. Breast milk may be given later through a tube passed through your baby’s nose and into his or her stomach (nasogastric, or NG, tube). When your baby is strong enough to suck, breast-feeding or bottle-feeding is often possible.
- Replenishing fluids. Your baby needs a certain amount of fluids each day, depending upon his or her age and medical conditions. The NICU team will closely monitor fluid, sodium and potassium levels to make sure that your baby’s fluid levels stay on target. If fluids are needed, they’ll be delivered through an IV line.
- Spending time under bilirubin lights. To treat infant jaundice, your baby may be placed under a set of lights — known as bilirubin lights — for a period of time. The lights help your baby’s system break down excess bilirubin, which builds up because the liver can’t process it all. While under the bilirubin lights, your baby will wear a protective eye mask to rest more comfortably.
- Receiving a blood transfusion. Because your preemie may have an underdeveloped ability to make his or her own red blood cells, a blood transfusion may be needed to raise blood volume — especially if your baby has had several blood samples drawn for various tests.
Medications may be given to your baby to promote maturing and to stimulate normal functioning of the lungs, heart and circulation. Medication may be given to the baby depending on your baby’s condition.
When specific complications arise, sometimes surgery is necessary.
Taking your baby home
Your baby is ready to go home when he or she:
- Can breathe without support
- Can maintain a stable body temperature
- Can breast- or bottle-feed
- Is gaining weight steadily
- Is free of infection
- In some cases, a child may be allowed to go home before meeting one of these requirements — as long as the baby’s medical team and family create and agree on a plan for home care and monitoring.
Its the responsibility of your baby’s health care team to help you learn how to care for your baby at home. Do not hesitate to share adequate information about these before discharge from the hospital:
Other children in the household
Adult relatives and friends to provide help
Primary pediatric care
Additional Resources: WHO/Mayo Clinic