Dr Anushree Narayanan

According to the World Health Organization (WHO), an estimated 15 million babies are born too early (preterm) yearly, which is more than 1 in 10 babies around the globe.

Is this worrying? Absolutely!

Babies that are born preterm especially those born very early, often have complicated medical problems, while many survivors may face a lifetime of disability, including learning disabilities and visual and hearing problems.

To have better insight to this subject, we spoke to Dr Anushree Narayanan, Consultant Neonatologist & Paediatrician at Pantai Hospital Kuala Lumpur who pointed out that there isn’t enough awareness on preterm birth and babies, which is more common than we think.

CAUSE OF PRETERM DELIVERY

Preterm is defined as babies that are born before their 37th weeks of pregnancy is completed and can be categorized into 3 sub categories:

• extremely preterm (less than 28 weeks)
• early preterm (28 to 34 weeks)
• moderate to late preterm (34 to 37 weeks).

According to Dr Anushree, most of the time, there isn’t any specific cause for babies to be delivered prematurely. However, some risk factors of premature delivery include:

• Problems with the uterus, cervix or placenta
• Having chronic conditions, such as high blood pressure and diabetes
• Physical injury or trauma
• Being underweight or overweight before pregnancy
• Stressful life events, such as the death of a loved one or domestic violence
• Smoking cigarettes or using illicit drugs
• Pregnancy with twins, triplets or other multiples

COMMON COMPLICATIONS OF PRETERM BABIES

By 20-22 weeks of pregnancy, most baby’s bodily organs have been fully formed, but they are not fully functional yet.

Depending on the age of the baby at birth, some of the common complications of preterm babies may include:

• Trouble breathing due to an immature respiratory system.
• Temperature control problems, as they don’t have the stored body fat of a full-term infant.
• Complications such as necrotizing enterocolitis (NEC) due to an immature gastrointestinal system.
• Blood problems such as anemia and newborn jaundice.
• Problems with their metabolism
• An underdeveloped immune system that can lead to a higher risk of infections

The first 24-48 hours of a preterm baby’s life is the most critical in avoiding complications.

Dr Anushree mentions that “for babies born after 28 weeks, complication rate is low, which is less than 10%, but for babies that are born 26 weeks and below, there’s a 50% rate that the baby may have some permanent disabilities.”

The earlier a baby is born, the more has to be done to support the baby.

WHEN IS IT SAFE TO BRING BABY HOME?

For mums that deliver prematurely, it is an emotionally difficult time to not be able to bring Baby home right away.

So when is it safe to bring Baby home? According to Dr Anushree, Baby would need to be at least 2kg and 34-weeks-old, although most premature babies are discharged by 35-weeks-old.

He or she has to be able to breathe and feed on their own, and are in good health.

Prior to discharge, parents are encouraged to spend more time with their baby and to care for them under supervision of the nurses and doctors so they have an idea and understanding of the type of care that a preterm baby needs.

This will also help parents to be more confident when they’re at home without the security of the hospital.

CARING FOR A PRETERM BABY AT HOME

When it’s finally time to take Baby home, it can be both exciting and daunting at the same time.

You might be afraid to walk away from the security of a hospital but excited to finally kick start life at home. 

Dr Anushree says, “think of it as if you’re bringing home a newborn baby,” not a baby that has been delivered weeks or months ago.

One of the most important things to note is how to feed a preterm baby. “They don’t feed like a normal baby, they suck very slowly, so you’ll need to allow them to swallow before they take in more milk,” she says.

Premature babies are less vigorous when it comes to feeding. Parents need to be patient when feeding them to decrease the risk of choking.

 

Some of the other things that parents should take note on especially in the early days at home are:

• Limit visits- Although family members and friends might get a little excited that you’re finally bringing Baby home, it is best to limit visitors to your home to limit the risk of infection as their immune system is still not strong.
• No smoking- If anyone in your home is smoking, please get them to stop before Baby arrives home.
• Put  Baby to sleep on their back- Preemies have a slightly higher risk of sudden infant death syndrome (SIDS). Not just preemies, but all babies should be put to sleep on their backs to reduce the risk. You can expect your preemie to sleep more than a full-term baby, but for shorter periods of time.

You can expect to spend a huge amount of time caring for a preemie during the first few months at home, but you should also remember to be good to yourself and to accept offers of help from family and friends.

They can babysit your other children, run errands, or help you clean the house so you can focus on caring for Baby or rest.

And as with all women recovering from pregnancy, mothers of preemies may experience the hormonal shifts of baby blues or more serious postpartum depression.

Don’t forget to treat yourself well by getting enough rest, eating well, and exercising moderately. Should you need support, seek help from doctors, nurses, veteran parents, support groups, or online communities.

Can mothers breastfeed a preterm baby?

Breastfeeding is very important for preterm babies. Mothers who deliver a preterm baby produce milk that have different components to mothers who deliver at full term. Their breastmilk will help their preterm baby to fight off infection and help them grow, and hence it is crucial that mothers of preterm babies breastfeed their baby.