Dr Ravinder K Gupta, Dr Anmol Khajuria
World Prematurity Day is observed worldwide on 17th of November every year. The day was initiated in 2008 by EFCNI (European Foundation for the Care of Newborn Infants) and partnering European parent organizations during their first ever meeting and celebrated for the first time in 2009. 17thNovember was the day a founding member of EFCNI welcomed a daughter after having lost triplets due to preterm birth – the day signals hope and a new beginning. In 2010, the US organization “March of Dimes”, the African organization “LittleBigSouls”, the Australian “National Preemie Foundation”, and EFCNI joined forces across continents to make this special day truly global. They also initiated the purple lighting as a symbol to honor preterm babies and their families.” ?The color purple is the official color of world prematurity day and represents sensitivity and exceptionality. Its symbol is the socks line, which depicts a small pair of purple socks surrounded by nine full-size baby socks. This symbolizes that 1 in 10 babies are born prematurely worldwide.
Prematurity encompasses the category of infants born prior to 37 weeks of gestation. It is the leading cause of neonatal mortality and the most common reason for prenatal hospitalization. The primary causes of death among premature infants weighing less than 1000 grams include respiratory failure, infections, and congenital anomalies. There are various factors that can lead to preterm birth. While the majority of these births occur spontaneously, some are induced for medical reasons, such as infections or complications during pregnancy that require early labor induction or cesarean delivery. The various other causes of prematurity are teen mothers and women over age 35, underweight, women with low income, prior preterm birth Infection, previous history of abortion, carrying more than 1 baby (twins, triplets, or more), behavioral, tobacco use, substance use and stress.
These babies need immediate care after birth to prevent complications especially in the golden hour, which is the first 60 minutes after birth.
-Transport of these babies to neonatal intensive care units could be a major task as these babies are more fragile and at risk of developing major complications during this phase. Ambulance for the transport of preterm baby is different from the adult ambulance. the primary focus should be to establish the breathing of the child and provide the correct type of respiratory support.Often these premature babies need resuscitation at the time of delivery. The golden hour care includes neonatal resuscitation, along with post-resuscitation care. Transport of these babies to neonatal intensive care could be a major task as these babies are more fragile and at risk of developing major complications during this phase. Ambulance for the transport of preterm baby is different from the adult ambulance. It should contain a baby incubator and all the gadgets required for neonatal ventilator care and monitoring.
Giving premature baby breast milk benefits their health as well as to mothers’ health. Breast milk: it helps to protect baby from infections, particularly of their gut – premature babies are more likely to get infections contains hormones, nutrients and growth factors that help baby to grow and develop is easier for baby to digest than formula milk, because it’s human milk specially designed by mothers’ body for baby. If baby is very small or sick, they may not be able to breastfeed from your breast at first. But can start regularly collecting breast milk (called expressing) as soon as possible after baby is born. There is no role of giving formula feeding routinely for any baby. Commercially prepared infant formulas are alternatives to breast milk. They are to be used if the mother has no milk, or inadequate milk or has a medical illness or drug treatment which makes mothers milk not a choice for feeding. Use of formula milk should be only on advice of the doctor. With support and counseling almost, all moms are able to exclusively breastfeed their baby. Expressing milk if your baby is premature. It’s recommended express often, ideally at least 8 times a day to begin with – including at least once at night – to keep your milk supply up.Babies do not normally learn to co-ordinate the sucking, swallowing and breathing needed for feeding until about 34 to 36 weeks of pregnancy. If baby is born before this time, they may need to have breast milk through a feeding tube to begin with. This goes through their nose or mouth into their stomach. The staff in the neonatal unit can show you how to feed your baby this way.
Vaccination: Small and preterm vaccines must receive the birth vaccines. Generally, hepatitis B vaccine is given to a baby once it crosses 2 kg. However, if the mother has hepatitis B infection, even babies with weight <2 kg is given the hepatitis B vaccine (along with the hepatitis B immunoglobulin) at birth.
The various complications include respiratory issues. These premature babies may have trouble breathing due to an immature respiratory center in the brain. This can lead to apnea, which is when the baby stops breathing for a short period of time. Premature babies may also have respiratory distress syndrome (RDS) or bronchopulmonary dysplasia (BPD), Feeding difficulties: Premature babies may not be able to suck and may need to be fed through a tube, Temperature control issues:
Premature babies have an immature temperature control center in their brain, so they may need to be kept in an incubator or under special heaters.
Anemia is a lack of red blood cells, which can lead to weakness, lethargy, breathing problems, and heart dysfunction, Retinopathy of prematurity: This disorder can occur after birth when the blood vessels in the retina grow abnormally. This can lead to bleeding or scar tissue, which can pull on the retina and cause blindness in severe cases, Hearing disorder, Premature babies may have hearing disorders due to heredity or in utero and neonatal complications.
Premature babies may also have other complications, such as cardiovascular disorders, intraventricular hemorrhage, necrotizing enterocolitis, and glucose, Feeding Issues: Because they are born early, some babies cannot suck or swallow well and may need to be fed through a tube until they get stronger,
Premature babies can have difficulty staying warm because their bodies aren’t good at controlling temperature yet. They might need to be placed in an incubator or under special heaters to keep their body temperature stable,Anemia is when a baby doesn’t have enough red blood cells to carry oxygen throughout the body. It can cause weakness, tiredness, breathing difficulties, and even problems with the heart. Some premature babies may have a condition called retinopathy of prematurity, which affects the eyes. Abnormal growth of blood vessels in the eye can lead to bleeding or scarring and, in severe cases, blindness. Premature babies are more at risk of getting infections because their immune systems aren’t strong yet. Infections can be serious and might require treatment with antibiotics, fluids through an intravenous route, or help with breathing. Some premature babies may have hearing issues, which could be due to genetic factors or complications before or after birth.
Premature babies may also face issues with their heart, bleeding in the brain (intraventricular hemorrhage), severe intestinal problems (necrotizing enterocolitis), or blood sugar imbalances.
Thankfully, medical advancements have made it possible for most premature babies to overcome these challenges and grow into healthy children.
Government initiatives: Over the past years, the Ministry of Health has accorded priority to improve quality of newborn health in the country. Some of the important initiatives undertaken include implementation of Newborn Action Plan (2016-2023) with a focus on quality improvement around childbirth, Kangaroo Mother Care for preterm management among others. Further, prevention efforts such as the implementation of preconception care package have been expanded to improve experience during pregnancy and outcomes.
Prevention of prematurity includes adequate Prenatal care: Start prenatal care early and attend all appointments. Adoption of Healthy habits: Eat a healthy diet, maintain a healthy weight, and avoid smoking, alcohol, and drugs.Take care of any health problems, like diabetes, high blood pressure, or depression. Try to reduce stress in life. Wait at least 12-18 months between pregnancies, especially if there hadbeen a previous preterm birth, Wash hands often, don’t eat raw meat or fish, use condoms, and don’t change cat litter for protection from infections: Seek medical attention for any signs or symptoms of preterm labor.
This year, the World Prematurity Day theme is “Over 130 lakhs babies born too soon every year. Access to quality care everywhere.”
The theme raises awareness about the challenges and risks associated with preterm birth (babies born less than 37 weeks gestation),which is leading cause of death among children under five years old and the number one cause of childhood disability. It highlights the urgent need for better healthcare, policies, and support systems for premature babies and their families.
The authors are from Department of Pediatrics , Acharya Shri Chander College of Medical Sciences (ASCOMS) , Jammu }
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