Immediate problems in Preterm newborn: Parents

Neonatology is a field of Pediatrics (Child Health) that deals with newborn babies till first 28 days of life. But the scope of the field is not limited to first month, there are premature babies who will be cared by a Neonatologist till fit for discharge and followed up till years later.

A Neonatologist is a child doctor who has specialized in the field of Neonatology (Trainings, Fellowships, Academic degrees), they should be the expert in care of sick and preterm neonates.

Neonatal Intensive care Unit:

Babies who are born prematurely, that is before the 37 completed weeks of gestation and those who are ill in early days of life are admitted in different levels of Neonatal Intensive Care Unit called NICU. Mostly NICUs are well equipped, temperature maintained, sound and light ambient settings. A good NICU is a team of good doctors, good nursing staff (very important) and good multispecialty supports like neuroimaging, cardiology, audiometry, pediatric surgery, neurosurgery, pediatric ophthalmology and physiotherapy units. A good NICU also has Mothers room, Kangaroo Mother Care chairs, one to one nursing support, psychological counseling for parents and Breast feeding counselor.

What to expect in a premature born baby

A baby who is destined to be born after 38-40 weeks by nature, may not easily adapt to external world when they are born before an expected time. The problems related to prematurity are multiple and depends upon many factors. But gestational age and weight are the most important predictors of severity of problems. The more premature or lesser the gestation age is, more are the diversity of problems.  Extreme preterm babies (less than 28 weeks) will likely have more problems and long stays in hospital. Late preterm infants born between 34 completed weeks to 37 weeks may have transition problems which include: respiratory problems, exaggerated jaundice, pulmonary hypertension, metabolic instabilities like low blood sugar, calcium and polycythemia (excess hemoglobin in blood leading to viscosity).

These are the commonly expected immediate problems and their expected remedies summarized:

1. Temperature instability:  predominantly hypothermia is immediate and serious problem unless preterm is taken care of in thermoneutral environment. A warm delivery room temperature, skin to skin contact when needed, warm clothes, proper drying, radiant warmer or incubator are used to maintain thermoneutral environment for the baby, meaning the temperature at which baby is most comfortable.  The hazards of hypothermia are depressed heart rates and circulatory problems, risk of infection, poor feeding, low sugars and in more severe cases can lead to bleeding problems, cardiac instabilty and death.  Very low birth weight babies can be cared under the care of incubators ( Device designed to house and keep preterms warm and peaceful) or open radiant warmer.

• Care of Skin: Babies born preterm have immature and incomplete skin layers. Extreme preterm babies may have thin and reddish shiny skin which are easily damaged by rough wiping and adhesives.  Antiseptics like Povidine iodine are excessively absorbed from immature skin and cause endocrine disturbances. So gently handly, using soft and gentle wipes, not using skicky adhesive instead using proper transparent semipermeable adhesive can lessen the skin injury. Proper checking of cannula sites is vital to prevent extravastation of fluids.

• Respiratory problems: The most significant problem in premature babies is Respiratory distress syndrome or Hyaline membrane disease, which occurs when immature lungs cannot produce adequate lubricating substance called Surfactant. It can be mild to very serious problem, requiring respiratory support like ventilators. If your preterm baby has respiratory issues at birth expect to see them on CPAP devices or ventilators. Surfactants which may be synthetic or human derived by recombinant technology are available and used for treatment of RDS. Other problems may be transient tachypnea in late preterm infants and few other rate causes.

• Metabolic issues: Sugar fluctuations, low calcium level in blood and low sodium levels may be other problems which needs to be monitored for and dealt with. You baby may be given calcium and glucose in drip via cannula along with sodium if baby is kept nil oral.

• Feeding issues: Premature babies are born with premature guts. So feeding may not be well tolerated and may need to be gradually started and advanced. So likely babies will be on Intravenous fluids in early days. Even as feeding is advanced babies may develop feed intolerance ( vomiting, aspirates, abdominal distension) and a serious condition called necrotizing enterocolitis ( Intestine gets inflamed and can perforate) can  arise . It may even need surgical management in most severe cases.

• Jaundice: Jaundice is an ominous problem in any preterm infant. Read about Neonatal jaundice.

• Infections: Preterm babies have immature immune system and are susceptible to infections. Infections can be local like eye infection, umbilical infection, skin infection to severe blood infections. Proper use of antibiotics can cure infections.

Stay: Usually as per individual protocols of NICUs and condition of baby, baby stay in hospital till babies have weight of 1800 grams, can maintain temperature without heat source, able to feed adequately, good growth for 3 days or more after being stable and when all pre-discharge investigations and assessments have been done.

Prematurity is now a manageable problem in Medical science. Every year hundreds of studies are published which have continually