Premature baby | Afrilatest.be

An estimated 7% of pregnancies result in premature birth. But when does a premature birth occur? And what physical challenges do premature babies have to overcome to gain strength?

When is a baby premature?

What are the causes of premature birth?

In many cases, the exact cause is unclear. However, certain risk factors are known. Here are some examples:

• Maternal infections or illnesses: Certain infections, such as urinary tract infections and cervical infections, can cause premature birth. Chronic illnesses such as diabetes and high blood pressure can also play a role.
• Cervical insufficiency (premature opening of the cervix): A weak cervix or a cervix damaged by previous surgery cannot support the baby's increasing weight, leading to premature birth.
• Multiple pregnancies: Multiple pregnancies (twins, triplets, etc.) carry an increased risk of preterm birth, partly due to the extra weight on the uterus.
• Placental problems: Placental abruption or placenta previa can lead to premature birth.
• Lifestyle factors: Smoking, alcohol and drug use are all associated with an increased risk of preterm birth. Intense stress or strenuous physical work can also be risk factors.
• Pregnancy-related complications: Certain complications, such as preeclampsia (high blood pressure during pregnancy), can lead to premature birth.
  History: Women who have already had a preterm birth have an increased risk of having another preterm birth.
• Problems with the amniotic fluid: Especially premature rupture of the membranes.

What are the physical characteristics of a premature baby?

• A premature baby is well-proportioned and well-formed (fingers and toes, for example). What is most noticeable about their appearance is their size and weight (determined by the length of the pregnancy and growth within the womb). Premature babies usually weigh less than 2.5 kg. Some weigh as little as 500 grams.
• The skin is thin (the subcutaneous blood vessels are clearly visible), reddish (but also blue, yellow and greyish) and has a slightly gelatinous consistency (it is covered with vernix caseosa, the waxy substance that protects the fetal skin from the amniotic fluid). Subcutaneous fat reserves are low.
• The shoulders and back are covered with down, called lanugo.
• The genitals (testicles, labia majora) and breasts (nipple, areola) may not yet be fully developed.
• The auricle is somewhat soft and has little relief, but this does not hinder hearing. Premature babies are very receptive to sound.
• The child cannot suck before an age corresponding to 32 weeks of pregnancy. The sucking reflex must be stimulated (special teats are available).
• Premature babies breathe rapidly, with pauses that can last more than 20 seconds.
• Premature babies have reduced physical activity and low muscle tone.

Also read: Congenital heart defects

What are the risks for premature babies?

Premature babies require specialized medical care and close monitoring during their hospital stay. The more premature the baby, the greater the health risks (the risk of neonatal death is real). However, recent developments in neonatal units have significantly improved the survival and development of these babies.

What problems do premature babies face?

Difficulty breathing

• Premature babies often breathe faster, more abruptly and irregularly. In addition to immature airways, premature babies may also lack surfactant, a fluid that lines the alveoli (small cavities where gas exchange takes place). This substance changes the elasticity and retraction of the lungs. This explains cases of respiratory distress syndrome (RDS), with difficulty taking in oxygen and removing CO2.
• Apnea is common in premature babies and it is important to stimulate and monitor the respiratory reflex (by cardiorespiratory monitoring, with an alarm sounding in case of prolonged apnea).
• Supplemental oxygen may also be necessary in the incubator.

Cardiac problems

The transition from fetal circulation to normal circulation can cause problems for premature babies. This is known as patent ductus arteriosus, a pathological condition that occurs when the ductus arteriosus does not close at birth. The ductus arteriosus is one of the components of the fetal circulation: it connects the aorta to the pulmonary artery. Treatment consists of oxygen therapy, medication and, if necessary, surgery.

Cardiac arrhythmias (arrhythmia or bradycardia) are common and explain the importance of cardiorespiratory monitoring. Manual pacing is usually sufficient to restore a satisfactory heart rhythm.

Gastrointestinal problems

Premature babies have poorer peristalsis than full-term babies, meaning that their digestive tract contractions are less efficient, making it harder to process food. Their stools are more irregular and bloating is common. Feeding is adjusted according to the degree of prematurity, with feeding being given parenterally (intravenously), by tube or by bottle. In the latter two cases, breast milk is very suitable.

Liver problems

Physiological jaundice (hyperbilirubinemia) is common. Treatment consists of phototherapy (the baby is placed under a lamp). Bilirubin is a yellow pigment, a breakdown product of red blood cells, the abnormal accumulation of which in the blood and tissues causes jaundice. Bilirubin is absorbed through the skin instead of being excreted in the feces, which causes the yellowish skin color.

Immaturity of the immune system

Premature babies have poor immunity and are therefore very vulnerable to infections. This requires constant vigilance and, if necessary, a rapid response.

Difficulty regulating body temperature

In premature babies, the regulation of body temperature requires special attention, due to a modest amount of adipose tissue and a thermoregulatory system that does not function optimally. To avoid very serious problems (such as hypothermia), it is vital to ensure that the environmental temperature is constant and perfectly adapted, and this is one of the reasons why babies are placed in incubators from birth.

Sources:
https://www.msdmanuals.com
https://www.inserm.fr
https://emedicine.medscape.com