Understanding Premature Birth and Its Effects on Babies

Premature birth, occurring before the due date, is an unexpected event during pregnancy that presents numerous health challenges for newborns, necessitating extended hospital stays and vigilant monitoring. In this article, we will delve into the definition of premature birth, its classification, the causes behind it, and the characteristics of premature infants. Additionally, we'll explore the crucial aspects of caring for and nourishing these vulnerable infants.

1. What Constitutes a Premature Baby?

Previously, a simple definition of premature babies relied on a birth weight of less than 2,500 grams. However, this definition proved inaccurate and often led to confusion with low birth weight infants and those with fetal growth issues. Consequently, the World Health Organization (WHO) revised the definition, categorizing babies born before the 37th week of gestation (calculated from the first day of the last menstrual period) as premature.

The classification of premature infants is as follows:

• Late preterm birth: Occurring between 34 and 36 weeks and 6 days.
• Moderate preterm birth: Taking place between 32 and less than 34 weeks.
• Very premature birth: At 32 weeks or less.
• Extremely premature birth: Born before 28 weeks.

Premature birth poses a myriad of risks, with the level of risk increasing as gestational age decreases. Potential post-birth risks include respiratory failure, hypothermia, issues with the closure of the ductus arteriosus, blood sugar instability, electrolyte imbalances, pathological jaundice, anemia, malnutrition, infections, cerebral-meningeal hemorrhage, hearing loss, retinal disease, and even sudden death.

The primary objective in treating and caring for premature infants is to provide adequate respiratory, circulatory, and systemic support to minimize postpartum complications. Additionally, these infants require nutrition and energy support to help them adapt to life outside the womb.
Caring for premature infants is costly due to their extended stay in neonatal intensive care units. Furthermore, premature and extremely premature infants may experience long-term sequelae, including neurological issues, intellectual challenges, impaired vision and hearing, which can impose a lifelong psychological and financial burden on parents.

2. Understanding the Causes of Premature Birth

In more than 50% of cases of premature labor, the exact cause remains unknown. However, various factors can contribute to premature birth, which can be categorized into the following groups:

2.1. Due to Pregnancy

• Premature rupture of membranes can stimulate uterine contractions, leading to premature labor.
• Multiple pregnancies tend to have shorter average gestation periods compared to singleton pregnancies.
• Polyhydramnios, particularly when combined with fetal malformations, is often linked to premature labor.
• Infectious chorioamnionitis can induce uterine contractions.

2.2. Placental and Fetal Factors

• Placenta previa and placental abruption can cause bleeding before birth.
• Placental insufficiency can result in inadequate fetal nutrition, often leading to premature labor.

2.3. Maternal Factors

• Inflammatory diseases such as pyelonephritis and appendicitis, especially when accompanied by fever, can increase the risk of premature labor.
• Uterine malformations, an underdeveloped uterus, or uterine clefts create favorable conditions for premature birth.
• A history of previous premature births, abortions, or miscarriages can elevate the risk.
• Habits like smoking, alcohol consumption, or low socio-economic status can also contribute to premature labor.

3. Characteristics of Premature Babies

• Determining the gestational age of a newborn can be challenging, especially when the exact date of the last menstrual period is unknown. However, external characteristics and neurological manifestations can provide a relatively accurate estimation of gestational age. Some key characteristics include:
• Premature babies often have hydrated, reddish skin with visible blood vessels.
• Their ear cartilage is soft, and their skulls are flexible and easily deformable.
• Muscle tone is underdeveloped, and primitive reflexes like grasping and sucking may not be fully developed.
• Premature infants may have weak chest muscles, underdeveloped lungs, and difficulty regulating their body temperature.
• They are susceptible to respiratory issues, hypothermia, bleeding, digestive problems, and infections due to weak immune systems.

4. Caring for and Nourishing Premature Infants

Immediate post-birth care for premature infants includes providing warmth, respiratory support, lung-expanding medications, and oxygen if necessary. Feeding should commence as early as possible, ideally with breast milk, carefully tailored to the infant's weight, gestational age, and postnatal age. Feeding methods may include breastfeeding or nasogastric tube feeding. In extremely premature babies, high-energy feeding fluids may be necessary to support rapid growth.

Sterility is crucial when caring for premature infants, including all equipment. Proper temperature and humidity regulation in incubators, combined with skin-to-skin contact with the mother, can aid in the infant's development.

Continuous monitoring devices are essential to promptly address any respiratory, heart rate, or oxygen saturation abnormalities.

Despite the challenges and expenses associated with caring for premature infants, some can grow up healthy and develop similarly to full-term babies if they receive timely and appropriate postpartum support. Parents should receive counseling on breastfeeding, alternative feeding methods, and how to monitor their child's health. Additionally, they must understand the vaccination schedule and be vigilant in monitoring their child's physical and psychological development, promptly addressing any issues that arise.