In Summary

While not all premature babies experience complications, being born too early can cause short-term and long-term health problems for prematures.

A pregnancy is supposed to last about 40 weeks. However, there are some babies who are born earlier. According to the World Health Organisation, (WHO) babies born before 37 weeks are defined as ‘preterm babies’.

Globally, 15 million babies are born too soon annually. About 210,000 babies are born too soon every year in Uganda according to Dr Gelasius Mukasa, the chairman of the national newborn steering committee.

Since a preterm baby may not be fully developed, some have health problems at birth and might die, especially the very pre-term (born at less than 28 weeks of pregnancy), or develop complications that can last a lifetime. The risk of health problems is greatest for babies born before 34 weeks of pregnancy.

In developed countries, such babies have a very high chance for survival - about 90 per cent - although they might suffer life-long physical, neurological, and learning disabilities. In low-income countries however, only 10 per cent survive.

According to Florence Nightingale Munaaba, a midwife at Mubende Hospital, heavy chores women do such as digging, fetching water and little rest are the leading causes of preterm.

“Most women in the villages complain that at night, after a hard day’s work, men pounce on them and demand for sex even when they are pregnant,” Munaaba says.

Faridah Nagawa, a midwife at Rakai Regional Referral Hospital says about six mothers give birth to preterm babies every month at the facility.

“The most common cause of preterm births, include infections such as malaria, Urinary Tract Infections; Sexually Transmitted Infections; foetal abnormalities; abnormalities in the uterus,” she says.

Complications
While not all premature babies experience complications, being born too early can cause short-term and long-term health problems for prematures. Birth weight plays an important role, too.

“A premature baby may have trouble breathing due to an immature respiratory system. The baby may develop respiratory distress syndrome because the lungs can’t expand and contract normally,” says Dr Harriet Ajilong, a pediatrician at International Hospital of Kampala .

They may also develop chronic lung disease known as bronchopulmonary dysplasia and apnea (prolonged pauses while breathing).

“Premature babies experience Patent Ductus Arteriosus (PDA), a persistent opening between two major blood vessels leading from the heart and low blood pressure, Dr Ajilong says.

While the PDA heart defect often heals on its own, if left untreated can cause too much blood to flow through the heart leading to heart failure. Low blood pressure may require adjustments in intravenous fluids, medicines and sometimes blood transfusions.”

The earlier a baby is born, the greater the risk of bleeding in the brain, which may lead to permanent brain injury. Larger brain bleeds may lead to fluid accumulation in the brain (hydrocephalus). Some babies who develop hydrocephalus will require an operation to relieve the fluid accumulation.

Munaaba says, “Premature babies lose body heat rapidly; because they do not have the stored body fat of a full-term infant so they cannot generate enough heat to counteract what is lost through the surface of their bodies. If body temperature dips too low, hypothermia can result.”

Gastrointestinal problems such as necrotising enterocolitis in which the cells lining the bowel wall are injured. Premature babies who receive only breast milk have a much lower risk of developing the disorder.

Prematures are at risk of blood problems such as anemia a common condition where the body does not have enough red blood cells.

“They may develop an abnormally low level of blood sugar (hypoglycemia) because they have smaller stores of glucose than full-term babies. Such babies also have an underdeveloped immune system, leading to infection. The infection can quickly spread to the bloodstream causing sepsis, a life-threatening complication,” says Ajilong.

The long term complications to premature babies may include Cerebral palsy, a neurological disorder of movement, visual impairments, hearing problems and dental problems such as delayed tooth eruption, tooth discoloration and improperly aligned teeth. The risks are greater the earlier a baby is born.

caring for premature babies

Neonatal survival largely depends on how they are handled and cared for after birth.

A premature is the most delicate and hardest baby to look after. If the baby is less than 1.4kg, the chances of it dying is at 30 per cent.

Dr Harriet Ajilong says, “The more preterm the baby is, the longer it is likely to stay in the incubator. When the baby makes the appropriate weight (2.5kg), able to feed, can breathe without support and its mother has mastered the kangaroo mother care skill, they can be discharged but monitored weekly.”

Kangaroo mother care (KMC) has been recommended as the cheapest and effective technique a mother should use on their premature child. The technique enables the baby to get heat from the mother to keep it warm. In Kangaroo mother care, the infant is held skin-to-skin with his mother, father, or substitute caregiver.

Dr Ajilong warns that it is very dangerous to bathe preterm babies. Wait until they are stable and have a weight of 2.5kg. “The mother should not bathe the baby because such babies are at risk of developing hypothermia (the condition of having an abnormally low body temperature). The mother can instead wipe the baby with a warm towel,” she says.

Preterm babies are usually monitored to enable the doctors detect any sight or hearing problems that may occur. This is managed through constant eye and ear tests as well as neurological examination.

KMC may be restricted to a few hours per day, but if the baby is medically stable, the time may be extended. Named after the similarity of how the kangaroo carries her young one, KMC was developed to care for preterm infants in areas where incubators may be unavailable or not reliable.

“I gave birth to my baby at eight months of pregnancy. I was very sick with malaria. My baby was kept in an incubator because his weight was very low. After two weeks in hospital the bill was too high and I asked the doctor for an alternative care method because I would not manage the bill. I was told about the KMC and it helped my child keep the heat. He is now six years and very healthy. He does not have any health problem because I followed the instructions of frequent review,” says Annet Kalungi, a mother of four.

According to Dr Ajilong, KMC is beneficial for parents because it promotes attachment and bonding and helps to stimulate milk production and breastfeeding success. If the infant’s mother had a caesarean birth, the father can hold their baby in skin-to-skin contact while the mother recovers from the anesthesia.

“KMC helps the preterm child to have a more normalised temperature, heart and respiratory rate, increased weight gain, fewer infections and reduced incidence of respiratory tract diseases, improved cognitive development, decreased stress levels, normalized growth and helps to improve sleep patterns of infants.”

For preterms that are unable to suckle, Dr Ajilong says they are fed through a plastic tube that goes through the nose, past the throat, and down into the stomach. She says, “Breast feeding pre term babies is very important to boost their immunity.”

bnakibuuka@ug.nationmedia.com