Premature Infants

The birth of a child into a family is supposed to be a special moment. It is supposed to solidify the love between couples as they now have a common responsibility, to affectionately care for their new-born. However, this is not always the case especially with premature babies. Stanford Children’s Health, 2018, points out that giving birth to a sick or premature baby can be quite unexpected for any parent.

According to Ionio and colleagues, 2016, parents of premature babies, in particular mothers, since the birth of their babies, are at risk of developing higher levels of anxiety, depression, anger and stress. (Ionio, Colombo, Brazzoduro, Mascheroni, Confalonieri, Castoldi and Lista, 2016, 618).

According to Lawn and colleagues, 2013, an estimated 15 million babies are born preterm, and the survival gap between those born in high and low income countries is widening, with one million deaths a year due to direct complications of preterm birth, and around one million more where preterm birth is a risk factor, especially amongst those who are also growth restricted. Most premature babies (>80%) are between 32 and 37 weeks of gestation, and many die needlessly for lack of simple care. (Lawn, Davidge, Paul, Xylander, Johnson, Costello, Kinney, Segre, and Molyneux, 2013).

According to Glass and colleagues, 2016, despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (ELBW) (< 1000 grams) remain at high risk for death and disability with 30–50% mortality and, in survivors, at least 20–50% risk of morbidity. (Glass, Costarino, Stayer, Brett, Cladis, and Davis, 2016.)

The central hospital in Jyväskylä only admits infants born after 32 weeks. Infants born before 32 weeks are transfereed to Kuopio University Hospital.  Infants with cardiac problems are transferred to Helsinki hospital while those with more severe health issues are taken to Sweden for specialised treatment.

According to Lawn and colleagues, 2013, for babies who do not breathe at birth, rapid neonatal resuscitation is crucial.(Lawn, Davidge, Paul, Xylander, Johnson, Costello, Kinney, Segre, and Molyneux, 2013). This sometimes happens at the maternity ward at the central hospital where there is a resuscitation room fully equipped in preparation to give resuscitation to new-borns who need support during their first hours of life.

According to Lawn and colleagues, 2013, extra care for small babies, including Kangaroo Mother Care, and feeding support, can halve mortality in babies weighing <2000 g (Lawn, Davidge, Paul, Xylander, Johnson, Costello, Kinney, Segre, and Molyneux, 2013.) Kangaroo care is a very common practice at the neonatal ward at the central hospital. Both parents are encouraged to offer skin-to-skin contact with their new-born. This is very beneficial to the new-born and also the parents. It creates a very special bond between the new-born and its parents.

Mothers are highly encouraged to breastfeed their new-born. Previous studies have shown that breast milk is the best food for a new-born as it comes with good nutrition that is important in helping a new-born develop. According to Lawn and colleagues, 2013, case management of new-born children with signs of infection, safe oxygen management and supportive care for those with respiratory complications, and care for those with significant jaundice are all critical, and are especially dependent on competent nursing care (Lawn, Davidge, Paul, Xylander, Johnson, Costello, Kinney, Segre, and Molyneux, 2013.)

One of the most common infection affecting new-borns is Streptococcus-B bacteria. This infection is passed to new-borns mostly at birth because the bacteria lies along the mother’s vaginal tract and also the rectal tract. These infected infants are treated with antibiotics commonly Benzyl penicillin and Tobramycin which are administered through I.V. During treatment their vital signs are closely monitored since these infections can sometimes affect the heart rhythm which can drop to below 90 bpm.

Babies with respiratory complications can receive extra oxygen either through the invasive or the non-invasive method. Their incubators can deliver extra oxygen for the babies who need it. The blood oxygen saturation of these infants is closely monitored and should at least be above 92%. However according to Glass and colleagues, 2016, evidence from recent trials attempting to define the appropriate target for oxygen saturation in preterm infants suggests arterial oxygen saturation between 91–95% (compared to 85–89%) avoids excess mortality (Glass, Costarino, Stayer, Brett, Cladis, and Davis, 2016.)

Jaundice is a very common issue with new-born children. This is due to the bilirubin which the body may not be in a  position to get rid of since the organs are still developing. Blood tests can show the bilirubin levels in the child and those with high bilirubin levels receive phototherapy. The placed under special blue light.

In conclusion, the birth of a premature infant should start to be seen as normal and that parents should be made to feel comfortable and to trust the healthcare personnel in caring for their premature new-born till the time of discharge. New technology and invention of medicine and many research have helped chart a way that ensures even very premature infants below 28 weeks can still be saved. However, parents should always discuss with their doctors during pregnancy on issues that can help prevent premature birth. This way we save the babies from lifetime health complications that come along with premature birth.

 

 

References:

Glass, H.C., Costarino, A.T., Stayer, S.A., Brett, C., Cladis, F., and Davis, P. 2016. Outcomes for extremely premature infants. Journal of Anesthesia and Analgesics; 120(6): 1337-1351.

Ionio, C., Colombo, C., Brazzoduro, V., Mascheroni, E., Confalonieri, E., Castoldi, F., and Lista, G. 2016. Mothers and Fathers in NICU: The Impact of Preterm Birth on Parental Distress. Europe’s Journal of Psychology; 12(4): 604–621.

Lawn, J.E., Davidge, R., Paul, V.K., Xylander, S., Johnson, J.G., Costello, A., Kinney, M.V., Segre, J., and Molyneux, L. 2013. Born too Soon: Care for the preterm baby. Journal of Reproductive Health; 10(1): s1-s5

Stanford Children’s Health. 2018. The Neonatal Intensive Care Unit. Accessed on May 28th 2018. Retrieved from http://www.stanfordchildrens.org/en/topic/default?id=the-neonatal-intensive-care-unit-nicu-90-P02389

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