Preterm Infants - Causes, Symptoms, Complications, and Treatment

What Is Preterm Birth?

The early birth of babies that is before 37 weeks of gestation is considered to be preterm birth. Premature infants born early often have medical complications. However, the severity of complications varies. Preterm infants require special care to grow and develop outside the mother’s womb.

Subcategories of Preterm Birth :

• Extremely Preterm Infants: Babies are born very early, before 28 weeks of gestation.

• Very Preterm Infants: Infants born between 28 to 32 weeks of gestation.

• Moderate to Late Preterm: Infants born between 32 to 37 weeks of gestation.

Why Does Preterm Birth Happen?

The actual cause of preterm birth is not known, but there are a few risk factors that cause preterm birth, including :

• When the mother has chronic health issues like diabetes and hypertension.

• Alcohol, cocaine consumption, and smoking during pregnancy.

• Stress during pregnancy.

• Pregnancy with twins or triplets or multiples.

• Conceiving through in-vitro fertilization.

• Any physical trauma during pregnancy.

• Some infections are amniotic and genital tract infections.

• Obesity.

• Multiple miscarriages.

• Any issues or problems with the uterus, cervix, or placenta.

• Extreme physical activity.

How to Stay Healthy During Pregnancy?

• Prenatal care has to be started once pregnancy is confirmed.

• Follow regular visits with a gynecologist.

• Eat a variety of healthy foods before and during pregnancy.

• An adequate amount of vitamins, minerals, and other nutrients are required to stay healthy.

• Take iron supplements, folic acid, and other vitamins during pregnancy.

• Try to get health issues under control before getting pregnant (like diabetes, hypertension, and depression). Talk to the doctor right away about a treatment plan.

• Stop smoking, drinking alcohol, or avoiding illegal drugs during pregnancy.

• Maintain at least 12 months in between the pregnancies.

• Mental and physical health is essential during pregnancy.

• Avoid vigorous exercises during pregnancy.

How to Prevent Preterm Births?

• Progesterone Supplements: Taking progesterone supplements in females with short cervix will reduce the risk of preterm delivery.

• Cervical Cerclage: This is performed in women with a short cervix or a history of preterm delivery.

What Are the Signs of a Premature Infant?

• Small body size with a large head.

• Lack of reflexes like sucking and swallowing causes feeding difficulties.

• Fine hair covers the body.

• Difficulty in breathing.

• Sharper-looking, less rounded features, unlike full-term babies due to lack of stored fat.

What Are the Complications of Preterm Birth?

Not all premature babies will have complications. However, babies born very soon may have few short-term and long-term complications.

Short-term complications include complications in the very first few weeks after birth. They are:

• Breathing Problems: The infant may have breathing problems soon after birth due to underdeveloped lungs. Some infants may develop respiratory distress syndrome because the lungs cannot expand and contract normally.

• Heart Problems: A few infants may have problems like patent ductus arteriosus (PDA) and low blood pressure.

• Brain Disorders: Some infants may have internal bleeding in the brain, which will resolve in a few weeks, but in a few infants where there is severe bleeding will cause permanent brain disorders.

• Temperature Control Problems: Premature babies can lose body heat rapidly. They do not have stored fat like full-term babies. Hypothermia in children leads to low sugar levels and breathing problems. Infants use all the energy gained through feeding to stay warm.

• Gastrointestinal Problems: Preterm infants will have many gastrointestinal problems like necrotizing colitis. However, preterm infants who take only breast milk will have less risk of developing necrotizing colitis.

• Immunity Problems: Preterm infants have deficient immunity, which results in many infections; these infections spread to the bloodstream and cause sepsis.

• Metabolic Problems: Premature babies will have poor metabolism. They will have a problem converting stored glucose into usable glucose.

Long-Term Complications :

• Cerebral Palsy: Premature babies have a higher risk of cerebral palsy due to inadequate blood flow to the brain, cognitive disability, and chances of seizures.

• Impaired Learning: Prematurely-born children have difficulty reaching their milestones and have chances of lagging in academics due to poor learning abilities. They have higher rates of developing autism spectrum disorders.

• Dental Problems: Premature kids are more prone to discolored teeth, delayed tooth eruption, and improperly aligned teeth.

• Vision Problems: Premature infants may develop various vision problems due to improper development of eye-leading retinopathy.

• Hearing Problems: Premature babies are at high risk of hearing loss. Therefore, all the babies are checked for hearing before going home.

• Behavioral and Psychological Problems: Many premature children exhibit various behavioral and emotional disorders, such as autism.

• Chronic Health Issues: Premature babies are prone to various health issues such as asthma, infections, and feeding problems. Sometimes, they require hospitalization, too. In addition, preterm infants have more risk of sudden infant death syndrome (SIDS).

What Are the Investigations to Be Done on Infants After Premature Birth?

The investigations done after the premature birth are:

• Breathing and heart rate monitoring.

• ECG (electrocardiogram).

• Blood investigations.

• Ultrasound scan.

• Fluid intake monitoring.

• Eye examination.

• Check for hearing.

How to Treat Preterm Birth Complications?

Preterm babies may need longer or more intense nursery care, and surgery may sometimes be required. Treatment consists of supportive care, medications, and surgery.

Supportive Care:

• Being placed in a NICU incubator.

• Providing oxygen therapy.

• Monitoring vital signs.

• Keep the baby warm.

• Having feeding tubes.

• Blood transfusions.

• Replenishing fluids.

• Spending time under bilirubin lights.

Medications :

The medications are:

• Drugs are used to treat respiratory conditions.

• Antibiotic Therapy: If an infection is present.

• Fine mist to increase breathing and heart rate.

• Diuretics: A medicine that manages urine output.

Surgery:

Sometimes, surgery is required to treat the conditions associated with prematurity.

When to Take the Baby Home?

• Can breathe without support.

• Can breastfeed or bottle feed.

• When there is steady weight gain.

• When the baby can maintain a stable body temperature.

What Special Care Needs to Be Taken for Preterm Infants?

When the mother gives birth to a preterm baby the baby should stay in a special nursery unit at the hospital. Some newborn should spend more time in the special nursery unit and their health need to be monitored day and night. This special care unit is called the neonatal intensive care unit (NICU). A step down from NICU is called an intermediate care unit where the newborn will be given a less intensive care unit. The baby will need extra care while feeding and adapting post-delivery.

What Are the Risk Factors Seen in Preterm Babies?

The exact cause of preterm baby is not known, but some can be risk factors; some are:

• Pregnancy with twins or triplets.

• A time span of less than six months between consecutive pregnancies.

• Pregnancy that is positive through treatment methods.

• More than one miscarriage.

• History of premature birth.

• Issues with cervix, placenta, or uterus.

• Infection that occurs in the amniotic fluid or low genital tract.

• Injury to the body.

• Being overweight or underweight.

Conclusion:

Infants born before 37 weeks of gestation are considered preterm infants. Premature birth is due to several risk factors during pregnancy. Premature birth leads to severe issues associated with a child's mental and physical well-being. So it is more important to take proper care than regretting later.