Premature birth complications: Everything you should know about it
Premature birth complications can throw off new parents. But a proper understanding of these issues can help you and your baby cope with them.
Every child is a miracle. But there is something special about premature babies. They can make you jump with joy and cry at the same time. And watching a preemie grow up to be a healthy child can be incredibly gratifying. Premature birth complications often makes it very hard for these little ones. Yet, they fight to survive even at such a tender age.
A premature baby is defined as one who is born any time before 37 weeks of gestation. Babies born so early often suffer from various health problems owing to their underdeveloped bodies.
According to data by the World Health Organisation (WHO), an estimated 15 million babies are born premature. In fact, premature birth complications are the leading cause of death among children below the age of five.
That is why most experts recommend a premature baby to be kept in the neo-natal intensive care unit (NICU). Here, they get complete care till they grow stronger and healthier. In case you are wondering, here are some basics about the NICU.
- Importance of NICU. Premature babies or those with birth complications or health issues are kept in the NICU. This is usually on the basis of the doctor’s recommendations.
- Equipment at the NICU. There are five primary kinds of equipment used. These include monitors and alarms to respond to the baby’s needs immediately. Isolettes and warmers monitor the baby’s body temperature. In addition, A NICU also has phototherapy machines to treat jaundice. There is also respiratory equipment, and finally, machines and tubes used as IVs.
- Caretakers at NICU. There are specialised personnel who care for the babies in the NICU. These include neonatal nurse practitioners, nurses on shifts, a neonatologist, a respiratory therapist and a nutritionist among others. Basically, there are a lot of specialists who are responsible for your baby in the NICU.
- Questions you should ask the specialists at NICU. As concerned parents, you would certainly have a lot of questions. But what you need to understand on an immediate basis is: the nature of the problem, when you can take your baby home, types of tests done on your baby and who will help your baby. Apart from this, you should also ask if you can help the baby, and most importantly, who will take you through the entire process.
Initially, the NICU may look scary, but once your baby is settled, it is in this place that he/she will receive tailor-made care. This is a crucial step after a preemie’s birth.
If the premature baby comes out of the NICU healthier and stronger, chances of a birth condition reoccurring during the child’s early years decreases. However, premature birth complications can be long-term.
This means, while they may not necessarily show any symptoms during early childhood, complications can impact the child’s life later.
To shed more light on this, we spoke exclusively with Dr Natalie Ann Epton, paediatric neonatologist at Mount Elizabeth Hospital, Singapore. She explained the long-term effects of premature birth complications in depth.
Dr Epton lists five long-term premature birth complications. These are as follows:
“Many babies born prematurely fail to grow at the same rate as they would have done had they remained inside the womb until full term. This slow growth may even continue throughout infancy and early childhood,” explains Dr Epton.
She adds that there is an increasing understanding of how important early weight gain is. It is especially important to ensure that babies receive enough protein in the first few days and weeks of life.
If a premature baby’s growth and nutrition improve, they can positively impact his neurological outcomes and later academic performance, notes Dr Epton.
Babies born prematurely may have an increased risk of damage to the very fragile premature brain.
“Damage can include bleeding from tiny blood vessels, or reduced oxygen to vulnerable parts of the brain. It is important that babies born prematurely are offered the opportunity of early intervention therapies such as physiotherapy and occupational therapy to optimise their outcomes,” advises Dr Epton.
If you initiate these interventions even before the diagnosis of a developmental delay, it can significantly improve outcomes. This includes minimising disability and improving neurological development.
Dr Epton shares that potential for hearing loss or visual disabilities can arise. This is possible due to various NICU based therapies and medications.
Some premature babies may have vision problems such as retinopathy of prematurity (ROP). These can lead to lifelong vision impairment or loss.
“We recommend that all babies less than 34 weeks at birth, and all premature babies who received ventilation have an eye screening examination,”advises Dr Epton.
“Babies requiring certain modes of ventilation such as high frequency oscillatory ventilation may require high risk hearing screening, as do babies who were noted to have high levels of medications known to be potentially toxic to the developing auditory nerves,” she adds.
This happens due to artificial ventilation and oxygen therapy.
“The more premature a baby is, the more likely this is to occur. Although this may happen to a more mature baby if the stay is complicated by other factors such as infections or congenital malformations,” explains Dr Epton.
Babies who require longer durations of artificial ventilation are more likely to have chronic lung issues. “These may manifest as childhood asthma-type symptoms or a tendency to recurrent lung infections,” warns Dr Epton.
As mentioned in our previous article, a premature baby is susceptible to respiratory distress syndrome. This is a condition in which the baby has difficulty breathing due to the lack of elasticity in her lungs. Preemies may also develop a chronic lung disease known as bronchopulmonary dysplasia, which causes the lungs to grow abnormally or to be inflamed.
Some preemies may also experience prolonged pauses in their breathing, known as apnea. They are often at an increased risk of sudden infant death syndrome (SIDS).
Premature birth can lead to long-term brain developmental and intellectual disabilities.
“It depends on how premature the baby is, and how healthy the baby is after delivery. Over the past several years, advances in neonatal intensive care have improved not only survival but survival without disability, known as intact survival. However, even borderline premature babies may be at risk of some neurodevelopmental delay, and slow acquisition of developmental milestones,” explains Dr Epton.
Even if there is no obvious damage to the brain, it is important to continue early intervention physiotherapy.
In addition, parents should follow up on appointments with a neurodevelopmental paediatrician or neonatologist to assess for any potential neurodevelopmental delays. This helps in devising appropriate therapy.
For the parents, worries about how to manage the financial implications of a long-term stay in the NICU can be a source of stress. But this is only the beginning.
Parents may even experience the same feeling as ‘bereaved’ parents, feeling the loss of a perfect, or normal, baby.
“These feelings of bereavement may manifest in feelings of anger, guilt, or wanting to find someone or something to blame,”explains Dr Epton.
Parents have to deal with a host of health problems in their preemie. Basically, premature birth complications mean that there is potential for damage to the premature lungs and eyes due to ventilation and oxygen therapy.
Hearing damage may occur due to certain medications used in the NICU, such as antibiotics. Also, poor growth may affect all the organs, and insufficient protein may influence muscle mass and height gain.
Premature birth complications can also lead to a few other health issues.
• Necrotizing enterocolitis. Some premature babies are affected by necrotizing enterocolitis (NEC). This is a disease of the intestines. While most premies get over it after being discharged from the NICU, some may feel its effects later in life.
In rare cases, doctor’s may surgically remove a part of baby’s intestines. Due to this, they may be unable to get all the nutrients they need to grow.
• Infections. Some preemies may also suffer from meningitis (infection of the brain) and pneumonia (infection of the lungs).
• Dental problems. Due to slower growth, premature babies face difficulties with their dental health. Their gums might be weak and their teeth might come out crooked. They may even notice a change in the colour of their teeth, and they might need braces in the future.
• Bone defects. A study by Norwegian University of Science and Technology reveals that “Low birth weight babies are at higher risk of osteoporosis later in life, especially if they are born prematurely, say researchers. Targeting these children with the appropriate diet and weight-bearing exercise can help improve the problem.”
Chandima Balasuriya, co-author of the study told media, “Those born prematurely with a very low birth weight and those who were born full term, but small for their gestational age, had lower bone mass than the control group, who were born full term with normal weights.”
The first thing you must do is to speak with your health care provider. Based on your baby’s condition, he/she may be admitted to the NICU and given assistance and care.
Dr Epton advises, “It is important to support one another through what will likely be a long and stressful journey. Try not to blame one another or find reasons why it may be someone’s fault. It is rarely helpful to try to find someone or something to blame, and feelings of anger or resentment will not help you and your loved ones come to terms with the situation.”
Instead, you should look for ways to support one another, offering each other the chance to talk through their emotions, and providing encouragement.
“Allow friends and other family members to support where they can, whether it is with child care for older siblings, making a meal, or even taking you out for coffee,” shares the expert.
As far as mothers are concerned, stress, anxiety and depression are real concerns for them, as are feelings of self-blame.
“The vast majority of premature deliveries occur due to factors outside parental control. Most occur due to unknown causes,” says Dr Epton.
In such cases, here’s what mothers of premature babies can do.
- New mums of premature babies should try not to blame themselves.
- You should not isolate yourself either. It is possible to cut yourself off from the support network you most need when you are either at home pumping expressed breast milk or in the NICU.
- It is important to make time for rest.
- Meet up with friends and family to reconnect with the people who can support you through this time
At this stage, breastfeeding your premature baby will hold its special place. As mentioned previously, in a premature birth, your breastmilk takes over the job of the placenta and continues to help in the baby’s growth and development. That’s because your hormones naturally help you produce breast milk that has essential nutrients, vitamins, minerals and proteins that can nourish the preemie.
In fact, the milk produced by your body for your preemie also contains high concentrations of sodium, phosphorus, chloride, protein, iron, fat calories as well as magnesium. All of these are essential for optimal growth and development of a premature baby.
Try different methods to increase your milk supply. You can try adding galactagogues (foods and herbs that help increase milk supply) to your diet. You can also try hand compression when pumping.
Most importantly, be patient and give your baby as much skin-to-skin contact as you can. This is the best therapy to help your premature baby overcome birth complications, and get stronger.