An estimated 15 million babies are born too early every year. That is more than 1 in 10 babies. Approximately 1 million children die each year due to complications of preterm birth. Many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems.
In low-income settings, half of the babies born at or below 32 weeks (2 months early) die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and primary care for infections and breathing difficulties.
In high-income countries, almost all of these babies survive. Suboptimal use of technology in middle-income settings is causing an increased burden of disability among preterm babies who survive the neonatal period. Black and Africans are more susceptible to having preterm babies. Although, appropriate research is lacking to back this claim.
What is a preterm baby?
A preterm baby is born too early or before 40 weeks of pregnancy. Most times, these babies are born before the 37th week of pregnancy.
Most preterm babies have various complications at birth or later in life. These problems vary for all babies. Some might be mild; others might be severe. Preterm babies can be classified into four groups:
- Late preterm: Babies are born between 34 and 36 weeks of pregnancy.
- Moderately preterm: Babies born between 32 and 34 weeks of pregnancy.
- Very preterm: Born between 28 and 32 weeks of pregnancy.
- Extremely preterm: Such babies are born before 28 weeks of pregnancy.
Some babies might have severe complications, while others may have mild symptoms. Some common symptoms include:
- Difficulty in feeding
- Breathing problems
- Hypothermia (Low body temperature)
- A large head to small body
- Thinner features than other babies due to less deposit of fats
Certain things increase the risk of preterm birth; some of them include:
- Smoking during pregnancy
- High blood pressure
- Cervical or vaginal problems
- Multiple miscarriages or abortions
- Previous preterm birth
- Assisted pregnancies like IVF
- Pregnancy with twins and other multiple
- Getting pregnant immediately after birth
Neonatal nutrition for preterm babies
Preterm babies need good nutrition, so they grow at a rate close to that of babies still inside the womb. They will often stay in the neonatal intensive care unit. The professionals will watch them closely to ensure they get the right balance of fluids and nutrition.
Incubators or unique warmers help babies maintain their body temperature. This incubator reduces the energy the babies have to use to stay warm. Moist air helps them maintain body temperature and avoid fluid loss.
Babies born before 34 to 37 weeks often have problems feeding from a bottle or a breast. They are not yet mature enough to coordinate sucking, breathing, and swallowing.
Breathing problems, low oxygen levels, circulation problems, and blood infection can also affect their feeding, and most of the time, they may need to get nutrition and fluids through a vein (IV).
As they get stronger, they can get milk or formula through a tube that goes into the stomach through the nose or mouth. This is called gavage feeding. The amount of milk or formula increases slowly to reduce the risk of an intestinal infection called necrotising enterocolitis (NEC).
Nutritional needs for preterm babies
Preterm babies have a more challenging time maintaining the proper water balance in their bodies. These babies can become dehydrated or over-hydrated.
They also need human milk from their mother's breast; this is the best for babies born early and at very low birth weights. Human milk can protect babies against infections and sudden infant death syndrome (SIDS) as well as NEC, and in cases where the mothers cannot feed, use special preterm formulas.
A supplement called human milk fortifier is mixed into their feedings. This supplement gives them extra protein, calories, iron, calcium, and vitamins. Babies fed formula may need supplements of certain nutrients, including vitamins A, C, and D, and folic acid.
Methods of feeding a preterm baby
Intravenous lines: These lines carry nutrition directly into the baby's bloodstream. They are used for premature babies with immature digestive systems and cannot suck, swallow and breathe normally. This method is sometimes used when treatment for other health complications is implemented. This approach utilises an IV that may be placed in their scalp, arm or leg.
Umbilical catheter: This painless method involves a tube surgically placed into an umbilical cord vessel. However, there are risks associated with this method that includes infection and blood clots. Therefore, the method is used only in the most critical cases and when the baby might need this feeding for several weeks. It is the safest and most effective way to receive nutrients for these babies.
Oral and nasal feeding: This method utilises a narrow flexible tube threaded through the nose (nasogastric tube) or mouth (orogastric tube). It is a solution for babies who are ready to digest breast milk or formula but cannot yet suck, swallow and breathe in a coordinated manner.
Central line (sometimes referred to as a PICC line) – This is an intravenous line inserted into a vein, often in the arm, that allows the use of a more prominent vein. This method delivers nutrients and medicines that might otherwise irritate smaller veins.
Weight gain for preterm babies
Weight gain is monitored closely for preterm babies because if their growth is too slow, they might have more delays in their development. It is usual for babies to lose weight in the first few days of life, but they should start gaining weight within a few days of birth.
Why do premature newborns need special care?
Premature babies aren't able to deal with our environment. Their little bodies still have underdeveloped parts, including the lungs, digestive system, immune system and skin. Thankfully, medical technology has enabled preterm babies to survive the first few days, weeks or months of life until they are strong enough to make it on their own.
The cause of birthing preterm babies is unknown. However, certain things lower your risk of preterm birth. They include:
- Progesterone hormone: You can buy chemically made ones. They help lower your risk of preterm birth, even if you've had one before. They are also great for women with short cervix. The cervix is the lower end of your vagina that expels your baby during childbirth.
- Cervical cerclage: This is a short surgery during pregnancy to prevent preterm birth. For the procedure, the cervix is closed with a suture till labour. Check with your doctor if you need to stay away from certain activities.
Will my baby have complications in future?
Not all preterm babies may have complications in future. However, such babies may have long and short-term complications. This depends on their weight at birth.
Short-term complications are digestive issues, breathing problems, temperature imbalance, weak immune system, blood problems, and brain, heart and metabolism problems.
Some long-term complications include; Visual impairment, learning problems, dental problems and auditory (ear) problems.
Another risk factor of preterm birth is living a sedentary lifestyle. Staying in bed all day weakens your muscles and bones, increases blood clots and makes you susceptible to preterm birth. Ensure you perform regular and light exercises like walking if you've never had a preterm birth.