Dr Anumodan Gupta
Prematurity refers to the broad category of neonates born at less than 37 weeks’ gestation. Preterm birth is the leading cause of neonatal mortality in India.
Although the estimated date of confinement (EDC) is 40 weeks’ gestation, the World Health Organization (WHO) broadened the range of full term to include 37-42 weeks’ gestation.
Preterm is defined as babies born alive before 37 weeks of pregnancy are completed.
The earlier in pregnancy a baby is born, the more likely he is to have health problems. Some premature babies have to spend time in a hospital’s neonatal intensive care unit (also called NICU). This is the part of a hospital that takes care of sick new-born’s. But thanks to advances in medical care, even babies born very prematurely are more likely to survive today than ever before.
The problem
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.
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.
Where and when does preterm birth happen?
More than 60 percent of preterm births occur in Africa and South Asia, and India (about 3519100 premature) leads the list with the greatest number of preterm births 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. (SOURCE: WHO)
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.
Solution
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. Preventing deaths and complications from preterm birth starts with a healthy pregnancy. WHO’s antenatal care guidelines include key interventions to help prevent preterm birth, such as counselling on healthy diet and optimal nutrition, and tobacco and substance use; fetal measurements including use of ultrasound to help determine gestational age and detect multiple pregnancies; and a minimum of 8 contacts with health professionals throughout pregnancy to identify and manage other risk factors, such as infections. Better access to contraceptives and increased empowerment could also help reduce preterm births.
Common Questions in parent’s mind??
* Why was my baby born early?
* How serious is my baby’s condition?
* What kind of tests and treatment will my baby need?
* Will my baby need to go to a specialist hospital for treatment, surgery or intensive care?
* How soon will my baby get better?
* Will my baby need long-term care?
* What outcome should I expect for my baby?
* When can my baby go home?
Patient Education
Communicate clearly to the expectant parents regarding potential adverse outcomes. Clear up any inappropriate expectations on the part of the family. The smallest and most immature infants are at greatest risk of adverse neurodevelopmental outcomes
(The author has done MD paediatrics GMC Jammu)
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