Preparation for New Parents if the Baby is at Risk of Preterm Birth
When a mother is pregnant and has registered for prenatal care with an obstetrician, attending scheduled check-ups or promptly consulting a doctor when noticing any abnormalities in the pregnancy is important. Pregnancy care and preparation for parents also include having knowledge to cope with the possibility of preterm birth. Knowing in advance “what problems preterm babies often face” helps in better handling the situation. If the baby is under medical care from birth, it will help ensure the baby receives the fastest and best care.
What Does Preterm Birth Mean?
Preterm birth means a baby born before 37 weeks of gestation. Although these babies have all organs, their development is not yet complete, which can lead to problems or illnesses after birth, including many complications. These babies require special care and often need to stay in the hospital for a long time, depending on gestational age, birth weight, and the problems or illnesses found.
Common Problems and Illnesses in Preterm Babies
The younger the gestational age and the lower the birth weight of a preterm baby, the more problems they may face, and symptoms can change rapidly, requiring close monitoring and treatment. Common problems and illnesses include:
Respiratory Problems
- Surfactant Deficiency
Surfactant coats the alveoli in the lungs and helps the lungs expand properly. Preterm babies cannot produce enough surfactant, causing alveoli to collapse. These babies may breathe rapidly and may need a ventilator. In cases of respiratory failure, doctors may consider administering surfactant replacement through an endotracheal tube to help the lungs expand better.
- Apnea
The respiratory control center in preterm newborns is not fully developed, leading to irregular breathing pauses. If frequent, the baby may need respiratory stimulants or ventilator support.
- Chronic Lung Disease
Due to immature lungs, preterm babies often require ventilators or oxygen for several weeks and are prone to inflammation and infections, increasing the risk of chronic lung disease, which prolongs the need for respiratory support.
Heart Problems
- Patent Ductus Arteriosus (PDA)
In full-term babies, the ductus arteriosus, a blood vessel connecting the aorta and pulmonary artery, closes after birth. In preterm babies, this vessel may remain open, causing excess blood flow to the lungs, leading to rapid breathing and heart failure. Treatment includes medication to close the vessel, but some cases require surgery.
Gastrointestinal Problems
- Necrotizing Enterocolitis (NEC)
Digestive and absorption functions are immature, so preterm babies must be fed small amounts of milk gradually, often taking weeks to tolerate full feeds. During this time, they receive nutrients intravenously, and some may need a central venous line for nutrition.
Severe intestinal infection causing necrosis is a problem in preterm babies, requiring treatment by withholding milk, administering antibiotics, and sometimes surgery, depending on severity.
Gastroesophageal Reflux Disease (GERD)
The lower esophageal sphincter in preterm babies is immature and often loose, allowing milk and stomach acid to reflux. This can cause apnea and cyanosis episodes, usually treated with medication. Severe cases may require surgery.
Kidney Problems
Preterm babies with chronic lung disease may receive diuretics for a long time, which can cause calcium accumulation and kidney stones, requiring long-term treatment.
Brain Problems
Preterm babies are at risk of brain hemorrhage due to fragile blood vessels. The risk is higher in babies with lower gestational age and birth weight. These babies undergo brain ultrasound screening.
Infections
Preterm babies have immature immune systems, making them prone to severe infections. They often require antibiotics.
Jaundice
The liver’s ability to process bilirubin is immature, and combined with various illnesses, jaundice commonly occurs in the first week after birth and requires phototherapy.
Anemia
Red blood cell production is immature, and frequent blood tests in sick babies increase the risk of anemia. Some may need blood transfusions.
Eye / Vision Problems
The retina of preterm babies is not fully developed. Abnormal blood vessel growth after birth can affect vision or cause blindness. Babies born before 32 weeks gestation receive eye exams by an ophthalmologist to monitor this condition and may require laser treatment.
Hearing Problems
Preterm babies are at risk of hearing impairment, especially those with multiple health issues, which may affect the auditory nerve. Hearing tests are performed before discharge.
Growth and Development Problems
Preterm babies have low birth weight and multiple illnesses, which may cause slower growth and development compared to normal children. After discharge, ongoing monitoring of growth, vision, hearing, and overall development is necessary.
Care of Preterm Babies
Due to multiple problems and illnesses, preterm babies require care in the Neonatal Intensive Care Unit (NICU) by specialized doctors and nurses. Critically ill babies may need various equipment such as ventilators, incubators/warmers, vital sign and oxygen monitors, and intravenous fluid controllers. They may also have umbilical venous lines for fluids, medications, nutrition, and blood tests to minimize discomfort and disturbance.
Babies receive treatment for all problems or illnesses until they pass the critical phase and can regulate their body temperature independently, allowing them to leave the incubator.
When Can the Baby Go Home?
The baby can go home when weighing at least 2,000 grams, maintaining normal body temperature outside the incubator, no apnea, feeding well, gaining weight, and when caregivers can properly care for the baby. After discharge, the baby must attend regular follow-up appointments to monitor growth and development.
