EXCLUSIVE: World Prematurity Day 2021: Prematurity is the leading cause of deaths in children, says Expert
We all have heard about a premature baby. But if we were to ask you when is a baby considered premature not many would be able to answer that. A normal pregnancy lasts about 40 weeks (9 completed months). Any baby who is born before 37 weeks of pregnancy is named a premature baby.
What is concerning is the fact that prematurity is the leading cause of death among children under 5 years of age. Why, you ask? Premature babies are often at the risk of developing several complications which may affect their lifespan.
“Every year an estimated 15 million babies are born prematurely, that is 1 in 10 children. Prematurity is the leading cause of death among children under 5 years of age. In India, around 3.5 million babies are born preterm every year which accounts for 13 per cent,” says Dr S V N S Sowjanya, MBBS, MD Pediatrics, DNB Neonatology, Consultant Neonatologist, Fernandez Foundation.
Prematurity comes with a lot of challenges. By nature, a tiny human being needs 9 months’ time inside the mother’s womb to be prepared to survive on his or her own. So, when a baby is born before 9 months, most of the body organs are not mature in terms of size and functionality. “The more the prematurity, the more is the immaturity of the body systems,” Sowjanya tells you while listing the challenges.
Breathing and Circulation: The premature baby may not be able to establish breathing on his/her own or even if they do, they might have troubled and difficult breathing which would require support. The baby may not be able to transport adequate oxygen to the tissues. “The functioning of the heart may be weak and may require medications to support the blood pressure and circulation. Normally, there are a couple of apertures inside the heart which are open in the womb but are expected to close after birth. Preterm babies may have the persistent openings causing issues with breathing, oxygenation and circulation requiring medications to close them,” explains Sowjanya.
Feeding and Nutrition: The intestines are also immature and unable to digest the milk which can cause vomiting, abdominal distension etc. Preterm babies can better tolerate their own mother’s milk or human milk as compared to formulas. “Since the brain is immature, these babies cannot have suck swallow coordination at birth and hence require to be slowly trained as their general condition stabilises. In the initial phase, they may require tube or spoon-feeds. We may have to supplement protein, fat and carbohydrates by IV route,” says Sowjanya.
Bleeding: The blood vessels in the brain of a small preterm baby are so fragile that they may rupture and cause bleeding in the brain. “This condition is life-threatening especially if severe and there can be long term complications,” she says.
Sowjanya adds that for babies who are too small (born before 7 months or less than 1000gms), there is an immediate life risk and they may need ventilatory support in the first few days of life. Sometimes such babies’ lungs are so immature that they cannot develop and are not mature enough after birth and may be dependent on respiratory support and oxygen (Chronic lung disease) even after 1-2 months of delivery.
“There is also an inherent risk for neurological delay compared to a term peer more so if there is bleeding in the brain or too premature ( less than 28 weeks). Such babies may have seizures, delayed milestones and intellectual disabilities. Another most important risk is infection or sepsis. The immune system is so underdeveloped that they can catch infections easily and infections are the most important cause of death in such small babies. Hence is the need to emphasise hand hygiene practices while handling small babies,” explains Sowjanya.
The silver lining, however, is that if a mother has had a not-so-risky preterm pregnancy, there are chances that she may deliver a healthy premature baby. “Usually this depends on the maternal condition during pregnancy. If the mother did not have any additional risk factors like diabetes, hypertension and hypothyroid during pregnancy, then the babies would be healthy enough to cope up and catch up with the term peers with adequate support,” she concludes.