The Continuum of Late Preterm and Early Term Births

Introduction:

The context around preterm births (premature births) is complicated and extensive. However, during a woman's reproductive life, there are several times when specific services can lower her risk for preterm birth (before pregnancy and during pregnancy), respond to an approaching early birth while protecting both the mother and the newborn (during labor and delivery), increase the chances that early and small newborns will survive (during the immediate postnatal period), and once again lower the mother's risk for future preterm births (later postpartum period).

What Is Preterm Birth?

A preterm birth occurs when a baby is born before 37 weeks. Babies that are born prematurely may have significant health issues. Some medical conditions, such as cerebral palsy, might last a lifetime. Learning difficulties are one issue that might develop later in childhood or even as an adult. Depending on how early a baby is born, preterm infants can be classified into:

• Late Preterm - Born between 34 and 36, completed weeks of pregnancy.

• Moderately Preterm - 32 to 34 weeks of pregnancy at birth.

• Very Preterm - Born at less than 32 weeks of pregnancy.

• Extremely Preterm - Born at 25 weeks of pregnancy or earlier.

The majority of preterm deliveries happen in the late preterm stage.

What Are the Signs of Preterm Birth?

Some signs of a premature baby are

• Small in size and has an oversized head.

• Due to a lack of fat reserves, the features are sharper and less rounded than those of a full-term baby.

• Lanugo (fine hair) covers a large portion of the body.

• Low body temperature due to insufficient body fat reserves, particularly immediately after birth in the delivery room.

• Breathing difficulty or respiratory distress.

• Feeding problems are caused by a lack of swallowing and sucking reflexes.

What Are the Risk Factors of Premature Birth?

There are numerous preterm births in women with no identified risk factors. Some of the risk factors are as follows:

1. Medical History

   1. Past preterm birth.

   2. Short Cervix - Measured during a transvaginal ultrasound exam (type of ultrasound device placed in the vagina).

   3. Early Cervical Dilation - Measured during a pelvic examination (a physical examination of women’s pelvic organs).

   4. Past procedures on the cervix.

   5. Injury during a past delivery.

2. Pregnancy Complications

   1. Vaginal bleeding during pregnancy.

   2. Infections during pregnancy.

   3. Carrying more than one fetus.

3. Lifestyle Factors

   1. Dietary deficiencies.

   2. Smoking during pregnancy.

   3. Low weight before pregnancy.

4. Age

   1. Younger than 17 years and older than 35 years.

What Are the Complications of Preterm Birth?

Although not all premature infants encounter challenges, giving birth too soon can result in immediate and long-term health issues. In general, the risk of problems increases with the time of birth. Furthermore, birth weight is significant. While specific issues may be present from birth, others might not emerge instantly.

1. Short-Term Complications - Arises in the first week of life.

   1. Breathing Problems - A premature baby's undeveloped respiratory system may cause breathing difficulties. A newborn with an inadequate surfactant in their lungs, which prevents the lungs from expanding and contracting appropriately, may experience respiratory distress syndrome. Bronchopulmonary dysplasia is a lung condition that can affect premature infants. Additionally, some preterm infants may develop apnea or extended breathing pauses.

   2. Heart Problems - Low blood pressure (low blood pressure) and patent ductus arteriosus (PDA) are the two most typical heart issues that preterm babies encounter (hypotension). A persistent gap between the aorta and the pulmonary artery is known as a PDA. Even though this heart condition frequently resolves on its own, if left untreated, it can result in heart failure, a murmur in the heart, and other consequences. Adjustments to intravenous fluids, medications, and even blood transfusions may be necessary for those with low blood pressure.

   3. Neurological (Brain) Problems - An intraventricular hemorrhage (brain bleeding) is more likely to occur the earlier a baby is born. The majority of hemorrhages are minor and have minimal immediate consequences. However, some infants may experience more severe brain bleeding that results in lifelong brain damage.

   4. Temperature Control Problems - Premature babies can quickly lose body heat. They lack the bodily fat reserves of a fully developed child and cannot produce enough heat to offset the heat lost through their skin. An unusually low core body temperature (hypothermia) can occur if the body temperature falls too low. A premature newborn with hypothermia may experience respiratory difficulties and low blood sugar. Additionally, a premature baby can expend all the energy from feedings to stay warm. Because of this, smaller premature infants need supplemental heat from an incubator or warmer until they are big enough to regulate their body temperatures on their own.

   5. Gastrointestinal Problems - Premature newborns are more susceptible to complications like necrotizing enterocolitis (NEC) due to their undeveloped digestive systems. After premature newborns begin feeding, this potentially dangerous disorder, in which the cells lining the intestinal wall are damaged, might develop. Infants who are exclusively breastfed have a significantly lower risk of having NEC.

   6. Hematological (Blood) Problems - Premature infants are more likely to experience blood issues such as anemia and neonatal jaundice. The lack of sufficient red blood cells in the body is known as anemia. All newborns gradually lose red blood cells over the first several months of life; however, premature infants may have a more extensive loss. A newborn's skin and eyes turn yellow due to newborn jaundice, which is caused by an excess of the yellow pigment bilirubin produced by the liver or red blood cells in the newborn's blood. Jaundice can have a variety of causes, but preterm infants are more likely to get it.

   7. Metabolism Problems - Babies that are born prematurely frequently experience metabolic issues. Some premature infants may experience abnormally low blood sugar levels (hypoglycemia). This is possible because full-term neonates often have larger amounts of stored glucose than preterm infants. Additionally, it is more difficult for premature neonates to convert their stored glucose into more useful, active types of glucose.

   8. Immune System Problems - Premature babies frequently have weak immune systems, which increases their risk of infection. A prematurely infected newborn can quickly develop sepsis, a bloodstream infection.

2. Long-Term Complications - The following complications may occur in the long term.

   1. Cerebral Palsy - Cerebral palsy is a movement, muscle tone, or posture disorder brought on by an infection, poor blood supply, or trauma to a newborn's developing brain, either early in pregnancy or when the child is still young and immature.

   2. Impaired Learning - Premature infants are likelier to miss out on developmental milestones than their full-term peers. Premature birth may increase children's likelihood of learning problems when they reach school age.

   3. Vision Problems - Premature babies may experience retinopathy of prematurity, a disorder where blood vessels enlarge and protrude in the light-sensitive layer of nerves at the back of the eye (retina). The retina may occasionally sustain damage from the faulty retinal arteries over time, shifting it out of position. When the retina peels away from the back of the eye, it results in retinal detachment. This disorder has the potential to impair eyesight and cause blindness if untreated.

   4. Hearing Problems - Premature infants are more likely to experience hearing loss. Before going home, all newborns will have their hearing tested.

   5. Dental problems - Critically unwell premature infants are more likely to experience dental issues, including delayed tooth eruption, tooth discoloration, and misaligned teeth.

   6. Behavioral and Psychological Problems - Premature babies may be more prone to certain behavioral or psychiatric issues and developmental delays than full-term babies.

   7. Chronic Health Issues - Compared to full-term infants, premature babies are more likely to suffer chronic health conditions, some of which may require hospital treatment. The likelihood of developing an infection, asthma, or feeding issues is higher. Additionally, premature babies are more likely to experience sudden infant death syndrome (SIDS).

How Can Preterm Birth Be Prevented?

Although the exact reason for preterm birth is frequently unknown, some things can be done to assist women - particularly those who have an elevated risk - in lowering their risk, including

• Progesterone Supplements - Progesterone supplementation may lower the risk of preterm delivery in women with a history of preterm birth, short cervixes, or both.

• Cervical Cerclage - Pregnant women with a short cervix or a history of cervical shortening resulting in a preterm birth undergo this surgical procedure. Strong sutures seal the cervix during this treatment, which could give the uterus additional stability. At the time of delivery, the sutures are removed.

What Are the Tests Performed on Preterm Babies After Delivery?

After delivery, the baby is moved to the neonatal intensive care unit (NICU); some tests are regular additional tests that may be required if the doctors suspect any complications. Some tests performed on a premature baby in NICU include

• Breathing and Heart Rate Monitor - The baby’s heart rate and breathing are monitored continuously, along with frequent blood pressure measurements.

• Fluid Input and Output - The NICU staff closely checks the amount of fluid the baby consumes through feedings and intravenous (IV) fluids, as well as the amount of fluid the baby loses through soiled or wet diapers.

• Blood Tests - The baby's blood is sampled using a heel stick or a needle placed into a vein to check the levels of several essential chemicals, including calcium, glucose, and bilirubin. A blood sample may also be examined to count the red blood cells, check for anemia, or determine whether an infection is present. The NICU team may place a central umbilical intravenous (IV) line if the baby's doctor expects the need for multiple blood samples to save the parent from having to poke the baby with a needle every time blood is required.

• Echocardiogram - A heart ultrasound is performed during this exam to look for issues with the baby's heart function. Echocardiography employs sound waves to create moving images on a display monitor, similar to prenatal ultrasound.

• Ultrasound Scan - Ultrasound scans can be carried out to look for bleeding or fluid accumulation in the brain or to check the abdominal organs for issues with the digestive system, liver, or kidneys.

• Eye Tests - To check for retinal issues, an ophthalmologist (eye specialist) may evaluate the infant's eyes and vision (retinopathy of prematurity).

How Are the Complications Treated in Preterm Babies?

The premature baby receives round-the-clock care in the special care nursery or neonatal intensive care unit (NICU).

1. Supportive Care - The specialized supportive care provided to the premature baby in the NICU includes

   1. Incubator - The infant will likely spend the night in an enclosed plastic bassinet (incubator) that is heated to support the maintenance of the infant's average body temperature. Later, NICU professionals may demonstrate how to hold the baby in a specific method with close skin-to-skin contact or "kangaroo" care.

   2. Vital Signs - The baby's body may have sensors attached to it to track temperature, respiration, heart rate, and blood pressure. A ventilator might assist the infant's breathing.

   3. Feeding Tube - Initially, an intravenous (IV) tube may be used to administer fluids and nutrition to the infant. A tube inserted through the baby's nose and into their stomach can later be used to administer breast milk. Breastfeeding or bottle-feed the baby after they are strong enough to suck is frequently feasible.

   4. Replenishing Fluids - Depending on their age and any underlying health issues, the kid requires a particular amount of fluids daily. To ensure that the baby's fluid levels remain within normal range, the NICU team will monitor fluid, salt, and potassium levels regularly. If liquids are required, they will be administered via an IV line.

   5. Bilirubin Lights - The baby might spend some time in front of a pair of bilirubin lights to treat infant jaundice. The extra bilirubin that accumulates in the baby's system because the liver cannot handle it all can be broken down by the lights. The kid will wear a protective eye mask to relax more easily while exposed to the bilirubin lights.

   6. Blood Transfusion - If the kid has had numerous blood samples taken for various testing, they may need a blood transfusion to increase blood volume.

2. Medications - Medications are given to encourage maturation and to stimulate the stable functioning of the heart, lungs, and circulatory system. Depending on the baby's condition, medications may consist of the following:

   1. Treatment for respiratory distress syndrome with surfactant.

   2. IV or fine-mist (aerosolized) medicine to improve heart rate and breathing.

   3. Medicine is injected into the eye to prevent the development of new blood vessels that might result in retinopathy of prematurity.

   4. Medication that aids in treating the patent ductus arteriosus heart defect.

   5. Antibiotics (if an infection is present or if there's a risk of possible disease).

   6. Medicines (diuretics - increase urine output to manage excess fluid).

3. Surgery - Several conditions related to preterm may occasionally require surgery.

Conclusion

A baby's health may suffer significantly from premature birth. Important organs might not fully develop in a baby without enough time to grow in the uterus. Nevertheless, neonatal care improvements are aiding many preterm infants in developing into strong, healthy kids. Maintaining good health during pregnancy is the best defense against having a child too soon.