Prematurity for child
When a baby is born after being in the womb for less than 38 weeks it is termed premature, or, as it is more usually called today, preterm. Between 38 and 42 weeks newborns are regarded as being fullterm, and after 42 weeks, postmature.
Up to 20 per cent of babies born in poor areas are preterm, while the incidence is around six per cent in more affluent areas. Although there are a number of reasons why babies are born before their time, doctors are not able to pin-point the exact cause in up to half the cases. Certain factors are known to cause early labour. One of these is poor nutrition. Even mothers in high income groups are susceptible if they do not eat properly during pregnancy. The new approach is not to limit a woman’s mass gain in pregnancy. A gain of between 11,25 kg to 13,5 kg is now considered best. Other important causes of premature birth are placenta praevia and abruptio placenta, when the placenta is placed over the mouth of the womb or starts to come away from the womb. With good antenatal care and new diagnostic techniques such as ultrasound, doctors can tell if a woman has any of these conditions and can treat her (usually with bed rest) so that her baby is able to stay in the womb much longer.
Maternal illness such as diabetes, heart or kidney disease, infections, and toxaemia can also bring on early labour. But with good antenatal cam these conditions can be treated so that the baby is not affected.
Twins are often born early due to the size of the uterus, and if the babies have certain abnormalities, premature labour can also result.
In the 50 per cent where the causes of early labour are not known, factors such as smoking, lack of vitamins and minerals, and taking certain drugs are implicated. With modern techniques, smaller and younger babies are surviving with a good chance of growing up normally. Babies born at only 26 weeks have done well with specialised care.
Hyaline membrane disease, until recently one of the main reasons why preterm babies died, is treatable. Continuous positive airway pressure (CPAP) is a new way of keeping the baby’s lungs expanded. Amniocentesis (in which a sample of the fluid surrounding the baby is removed with a needle) can show if the baby’s lungs have produced surfactant, a substance that prepares it for
breathing outside the womb. If the substance is lacking and labour can be delayed for 24 to 48 hours, the mother can be given certain drugs to help the baby’s lungs manufacture surfactant so that the infant can be born safely.
The old tale that babies born at seven months do better than those born at eight months is not true and the nearer to term the baby is born, provided there are no complications, the better. More important than the gestational age of the baby is the child’s mass. Babies with a low birth mass are usually at greater risk than heavier infants. For the parents, premature birth is always a shock. They feel cheated of the last few months of pregnancy, the time in which the mother prepares herself and her home for the arrival of the baby. Instead of ready love and acceptance there is the fear of getting too close to the baby in case the child does not survive. Parents should be kept fully informed about the condition of their baby and, most importantly, helped to bond with their baby. Both mother and father should handle the child in and out of the incubator as soon and as often as possible.
Too often parents feel that their baby ‹“belongs’ to the doctors and nurses and they are strangers looking on.
Some mothers are able to produce breast milk and can express it so that it can be given to their babies in the incubator, and even keep the milk supply going until the baby is strong enough to suck. This can give great satisfaction and alleviate some of the feelings of failure that plague many mothers who have given birth prematurely. Breast milk from a mother who has given birth prematurely appears to be richer so that it supplies the extra protein needed to produce satisfactory growth in babies under 1 200 g who need extra kilojoules. Experiments are also being conducted to try and concentrate breast milk from milk banks so that it can be given to premature babies under 1 200 g if the natural mother cannot breast feed.
For the premature baby of more than 1 200 g, breast milk, even if it is not from the natural mother, is perfect. Preterm babies need extra iron from birth since they have not had time to store it while still in the womb. Although they gain mass rapidly they may not catch up in growth to other babies until they are three or four years old. When judging a preterm baby’s progress and milestones you should keep in mind the date on which the baby should have been born. For example, if she was six weeks preterm she will behave like a six week old baby when she is three months. Nevertheless, preterm babies do catch up develop-mentally as well, and there should be no difference after the first few years.
By the time the child is ready for nursery school there should be no lag. If there do appear to be learning problems they should be investigated (198) and it should not be presumed that the child will ‹“catch up’.