A premature birth can be described as an emotional rollercoaster ride and, simultaneously, a time of witnessing the miraculous, as a “preemie” fights to gain strength and keep growing. Kim Jansen explores premature or preterm births and how these warrior-like little ones develop.
“When a baby born too soon grasps onto your finger, it is a tiny glimpse, a little flicker of hope and encouragement into understanding the strength of their fighting spirit,” says Julia Toivonen of L’il Aussie Prems Foundation.
How early is “premature”?
While the normal gestational age for a human baby would be 38 – 42 weeks, a preterm or premature birth describes a baby born earlier than 37 weeks. Professor Michael Harrison of the Department of Neonatal Medicine at Groote Schuur Hospital highlights that there are in fact various levels of prematurity: “At the far end, we have extremely preterm infants – those born between 24 and 27 weeks, and at the other end we have late preterm babies that include those born between 34 and 36 weeks.” One only has to realise that 24 weeks into gestation is just over halfway through a pregnancy, which raises the question of what the chances of survival are for preemies. “Today, more and more premature babies all over the world are surviving without disability; babies who wouldn’t have had a chance even 50 years ago,” says Professor Harrison.
The differences in medical care between the developed and developing world are stark. The medical advances in the developed world are such that babies born now at only 26 weeks’ gestation have a 90% chance of survival. Contrast this with the 50% chance of survival at 32 weeks (a full six weeks later) in the developing world. “Many of these moderately premature infants could be saved with relatively simple, cost-effective interventions such as providing warmth, nutrition and infection prevention,” says Professor Harrison.
What causes preterm birth?
“The causes of preterm birth are many and complex,” says Dr Lloyd Tooke of the Department of Neonatal Medicine at Groote Schuur Hospital. “There are two broad categories, provider initiated and spontaneous. Provider initiated is when the baby is actively delivered early due to foetal or maternal health reasons, such as maternal pre-eclampsia. Of the spontaneous preterm births, which is when the mother goes into labour unexpectedly, over 50% of the time the cause is not known,” says Dr Tooke. “Preterm labour on its own is not dangerous for mothers; however, the danger for the baby is determined by how premature he or she is and, as already established, the earlier the stage of pregnancy, the more dangerous for the baby.”
Risks for preterm birth
The Groote Schuur Neonatal team reveal that other risk factors that could possibly cause preterm birth include:
- medical problems such as hypertension, diabetes, infectious illnesses, vaginal infections and STDs, asthma, thyroid problems, heart disease, etc.
- pregnancy disorders such as pre-eclampsia
- current or historical problems with the uterus or cervix
- multiple pregnancies or birth defects, like congenital heart disease or spina bifida
- age – mothers younger than 17 or older than 35 years of age
- previous preterm birth, or a family history of preterm births
- being overweight (obese) or underweight
- low weight gain during pregnancy
- substance abuse – drugs, smoking, alcohol
- uterine or placental abnormalities
- domestic violence and abuse
- working long hours
- short intervals between pregnancies
- history of miscarriage or abortions
- untreated gum disease (periodontitis)
- late or no antenatal care
Developmental risks for preterm babies
Unfortunately, preterm births are made even more stressful for parents by the possible short and long-term effects that the premature babies are at risk of developing. Short-term risks include problems with breathing, the heart and brain, gastrointestinal tract, immune system, blood circulation and the baby’s ability to control her body temperature. Long-term risks include vision or hearing problems, cerebral palsy, renal problems, behavioural, cognitive or psychological problems, or chronic health issues. These possible complications would make any parent’s heart sink, with any preemie mum asking, “Is there anything I could have done to prevent this?”
The team at the Department of Neonatal Medicine at Groote Schuur Hospital note that “Regular antenatal visits by the mother reduce the incidence of preterm labour.” However, they also emphasise that premature labour cannot be prevented, but in some cases it can be delayed through the hospitalisation of the mother and the administration of medicines to delay labour and help the baby develop as far as possible.
Actual age vs corrected age
Dr Tooke says that a preterm baby’s developmental age should be corrected based on when they were due according to full gestation. Parents should also be aware that there will be developmental and milestone differences in preemies because at birth, their organs aren’t as mature as those of full-term babies.
In other words, a baby born six weeks early would be expected to achieve milestones of a full-term baby when they are six weeks of their corrected age, not their birth age. For example, if a full-term baby is expected to sit at between four and seven months old, a premature baby born two months early should be expected to sit at six to nine months of age.
Potential missed milestones for preemies
The Neonatal team at Groote Schuur Hospital remind us that there may of course be a few red flags that parents of premature babies need to watch for.
“Some preemie babies may have developmental issues. Parents and healthcare workers should be aware of age intervals at which certain milestones like sitting, crawling and walking should be reached (taking into account the adjusted ages) and if this does not occur, they should seek professional advice.” The Groote Schuur team give mums and dads the good news: “With modern neonatal and obstetric care, the vast majority of prematurely born babies that have access to these services can lead completely normal, healthy and productive lives.”
To the preemie parents out there, Alvaretta Roberts of Precious Preemies says this, “Of all your precious efforts, love tops them all.”
World Prematurity Day is on 17 November. Turn to page 75-79 to find out how you can help support the Newborns Trust Wear Purple for Preemies fundraising and awareness campaign.