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Premature Birth

  • Aspiring Doctors
  • Nov 20, 2020
  • 5 min read

Written by: Mahima Bharal | Edited by: Shelomith M.Hoy


Premature birth is one of the leading causes of death in children worldwide. Babies born much earlier than their expected due date have higher chances of risking health issues than those born within the expected due date range.



Top 10 countries with the highest number (thousands) of newborn deaths, 2019



Causes of Premature Birth

Premature birth occurs due to a variety of factors, such as early induction of labor, cesarean birth (delivery of a baby through an incision in the abdomen and uterus), multiple pregnancies, genetic influence, infections, or if the mother is younger than 17 or older than 35, but in most cases, the cause remains unknown.


To reduce the chances of premature birth, an expecting mother should maintain a healthy lifestyle by eating nutritious foods, avoiding nicotine and other illegal drugs, and overconsumption of alcohol. If the mother has had a premature birth in a previous pregnancy, she should take extra care of herself in her future pregnancy journey.


Short-term Effects

Respiratory Problems


Apnea

Apnea is a condition in which the baby stops breathing for 15-20 seconds or longer. This happens when the underdeveloped nervous system cannot communicate with the respiratory system, which may also result in a slow heart rate called Bradycardia. In such a case, doctors may start to mechanically ventilate the baby.


Bronchopulmonary dysplasia

In this condition, the baby requires help obtaining oxygen, so they rely on ventilators for several weeks to several months. Treatment for this condition requires time as doctors gradually reduce the babies’ dependence on ventilators until they can efficiently breathe on their own with functional respiratory systems.


Respiratory distress syndrome

Pulmonary surfactant is a mixture of lipids and proteins secreted by the alveoli (air-filled sacs in the lungs). Surfactant reduces surface tension in the alveoli, therefore preventing the lungs from collapsing. Respiratory distress syndrome occurs when the infant’s lungs are unable to produce enough pulmonary surfactant, thus causing difficulty in breathing. Respiratory distress syndrome is treated by supplementing extra oxygen with the help of a ventilator or through surfactant therapy.


Cardiological Problems




Patent ductus arteriosus (PDA)

Normally before birth, the lungs are non-functional. The baby receives oxygen from the placenta, which reaches the lungs through the blood vessel called ductus arteriosus. After birth, this blood vessel normally closes as the lungs become functional. In patent ductus arteriosus, the ductus arteriosus fails to close properly and causes increased blood flow into the lungs. This causes heart and breathing problems. If it remains untreated, it may cause heart murmur (sound of blood flow through the heart on passing through an abnormal heart valve or due to any other abnormality) and heart failure. PDA often closes on its own but if it doesn't, it can be treated with medicines or by surgically closing the ductus.


Neurological Problems


Intraventricular hemorrhage (IVH)

In this condition, blood fills the ventricles (fluid-filled spaces) of the brain due to the tearing of underdeveloped blood vessels. This leads to the accumulation of fluid around the brain thus putting pressure on the brain cells, increasing the likelihood of seizures, and causing permanent damage to the brain. It can be treated with surgical insertion of a shunt to release pressure in the brain.



Temperature Regulation Problems

Premature infants are unable to generate enough body heat as they do not have enough stored body fat in ratio to the heat lost through the surface of their body. If their body temperature dips too low, hypothermia will persist, leading to breathing problems and low blood sugar levels. Therefore, infants may require additional heat from an incubator until they are capable of maintaining their sufficient body temperature.


Gastrointestinal Problems


Necrotizing enterocolitis (NEC)

NEC occurs when the baby’s intestinal tissue is damaged, which can lead to perforation of the intestinal wall in some cases. The bacteria already present in the intestine may reach blood flow and cause infections. Common symptoms include bloody stools, vomits, and swelling of the abdomen. Treatment includes antibiotics and intravenous feeding.


Hematological (Blood) Problems


Anemia

Anemia is a condition where the baby is unable to get enough iron via the placenta due to its premature birth, leading to insufficient red blood cells in the body (iron deficiency reduces the synthesis of heme, which in turn reduces the synthesis of hemoglobin, consequently decreasing the production of red blood cells). Doctors may provide the infant with blood transfusions and iron supplements as part of treatment.


Newborn Jaundice

Bilirubin is a waste product of the natural breakdown of RBCs. Normally, the liver is effective in removing it, however, the liver of a premature infant is not fully developed to remove the toxic bilirubin. Since bilirubin is yellow in color, the skin and eyes of the infant appear yellow. It is treated light therapy which helps in lowering bilirubin levels by photooxidation.


Immune System Problems

Premature babies have yet to develop their immune systems and hence are very prone to infections. Sometimes, chemicals released in the blood to fight such infections lead to inflammation in the body, causing damage to the organs. This is called sepsis and it may be life-threatening in severe cases. It is treated with the help of antibiotics and intravenous fluids.


Vision Problems


Retinopathy of prematurity (ROP)

ROP occurs when the retina (nerve tissue at the back of the eye having light-sensitive cells) is damaged or underdeveloped. Most cases of ROP are mild and don’t require treatment, but severe cases may lead to vision impairment.


Long-term Effects


Premature Birth also causes Long term effects like Cerebral palsy (movement disorder affecting coordination, muscle tone, or posture that may occur due to abnormal brain development). Babies born prematurely may face a tough time learning at school and are more likely to face learning disabilities as well as behavioral and psychological issues like anxiety. Infants born with retinopathy of prematurity may sometimes have their retina pulled out of position (retinal detachment), which can lead to vision impairments and even blindness. Hearing loss may also arise due to underdeveloped inner ears or ear infections. Premature babies may have underdeveloped enamel (which protects the teeth from desiccation) which can lead to cavities, staining, delayed tooth eruptions, and decay. Premature infants are more likely to develop infections than full-term babies because of their underdeveloped immune system. They also have an increased risk of sudden infant death syndrome (SIDS).


Need for Awareness


World Prematurity Day, which falls on November 17th each year and is celebrated by wearing a

purple ribbon. Globally, 2.4 million children died in the first month of life in 2019, this day raises awareness of this serious health crisis

Improvement in technology and medical assistance has been able to increase infant survival since 1990, with the World Health Organisation and other organizations working together to further increase chances of survival. Thus, spreading awareness about such a critical issue has never been more necessary to provide premature babies with a brighter future.


 

Works Cited

Newborns: improving survival and well-being. (n.d.). Who. Int. Retrieved November 9, 2020, from https://www.who.int/en/news-room/fact-sheets/detail/newborns-reducing-mortality

Rice, S. C. (2016, November 7). Premature Infant. Healthline.Com. https://www.healthline.com/health/pregnancy/premature-infant

Young, R. (2013). PREMATURE BABIES. In Maternity and Infant Welfare (pp. 104–105). Elsevier.

Premature birth. (n.d.). Mayoclinic.Org. Retrieved November 9, 2020, from https://www.mayoclinic.org/diseases-conditions/premature-birth/symptoms-causes/syc-20376730

Nair, A. (2018, June 21). Premature baby health problems. Firstcry.Com. https://parenting.firstcry.com/articles/common-premature-baby-problems-that-you-must-aware-of/

National prematurity awareness month: Celebrating successes and taking action. (2019, February 4). Cdc.Gov. https://www.cdc.gov/media/releases/2016/s1103-prematurity-awareness.html

Preterm birth. (n.d.). Who. Int. Retrieved November 9, 2020, from https://www.who.int/news-room/fact-sheets/detail/preterm-birth


 
 
 

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