A baby that is born before 37 weeks of gestation, is a premature baby (preemie) and such a labor is known as preterm labor. Various causes can contribute to a preterm labor. Premature babies may have health issues since their organs did not have sufficient time to develop and grow. They normally weigh less than a full term baby. Preemies need special care in a NICU- neonatal intensive care unit. NICU is equipped to provide basic needs of a premature baby. It ensures that the preemie has proper growth and development. They continue to be on support until such a time that their organs can work independently.
1. Anemia
A baby stores iron to produce enough red blood cells. This happens during later stages of pregnancy and after the birth. However, since a preemie has had less time to store iron, he has limited production of red blood cells in the first weeks of his life. These cells also have a shorter span of life than an adult’s. This is one of the reasons that causes anemia in premature infants. Babies with this condition can develop breathing and feeding problems. Such babies are given dietary iron supplements which boosts the growth of red blood cell count in the body of the infant. In extreme cases, babies may require blood transfusions.
2. Apnea
Apnea is a condition when the baby stops breathing for twenty seconds or more. The heart rate may decrease and the skin may turn pale due to lack of oxygen in the body. This is caused due to the immaturity in the brain that controls the drive to breathe. Most of the preemies experience this condition and it decreases as the infant grows. The heart rate, oxygen saturation, breathing level of the baby is constantly monitored in the NICU for eight to twelve hours. Doctor or the nurse stimulates such a baby to breathe by touching the soles of his feet or rubbing his back. When this happens repeatedly, a nasal device is required which blows air constantly to keep the baby’s airways open.
3. Respiratory distress syndrome (RDS)
Surfactants are important substance in the lungs that keep the tiny air sacs in the lungs from breaking down. The preemie’s immature lungs fail to produce sufficient surfactants that help the lungs to expand properly to facilitate breathing. This causes breathing difficulties in preemies which is called respiratory distress syndrome. Babies suffering from this condition are administered with artificial surfactants through a breathing tube. They may also receive CPAP – continuous positive airway pressure, that pushes pressurized air into the baby’s lungs via small tubes in the baby’s nose or through a tube inserted in the windpipe. This support continues until the baby’s lungs mature.
4. Intra-ventricular hemorrhage (IVH)
The blood vessels in a preemie’s brain are weak and fragile. They rupture and cause bleeding (hemorrhage) in the brain. Hemorrhage normally occurs during the first three days of life and is diagnosed with an ultrasound. Minor bleeds can be resolved using medicines while major ones cause expansion of the brain. This puts pressure on the brain causing damage such as cerebral palsy. In such cases, tubes are inserted in the brain to drain the excess fluid to prevent brain damage.
5. Jaundice
Jaundice is a condition when there is a high level of bilirubin in the blood. One of the main functions of liver is to remove the toxic products from the blood, with bilirubin being one of them. In preemies, liver is unable to remove the extra amount of toxins from the blood. Since the lungs are immature in preemies, they are prone to get jaundice. It makes the skin look yellow or brown depending on the severity of the condition. High levels of bilirubin can cause brain damage in the infant. It is often treated by exposing the child to blue light therapy (photo therapy). Severe cases of jaundice may require blood transfusion.
6. Necrotizing enterocolitis (NEC)
Necrotizing enterocolitis affects the intestinal tract causing abdomen tenderness, feeding intolerance and sometimes leads to deterioration of multiple organs. This generally occurs in low birth weight babies and preemies. Risk is high in premature babies since they have under developed intestines that are unable to handle digestion. Babies are switched to IV while all the other types of feeding are stopped. Antibiotics are administered and the baby’s bowels are drained. Surgery is performed in severe cases wherein it is required to remove the damaged sections of the intestine.
7. Patent ductus arteriosus (PDA)
This is a heart condition that occurs in premature babies. The aorta and the pulmonary artery are connected through a blood vessel known as Ductus Arteriosus. This plays an important part in fetal blood circulation. This blood vessel closes soon after birth (within minutes or a few days) as part of changes that occur in the baby for normal blood circulation. However, in some babies, this vessel remains open and leads to mixing of oxygen rich blood with the oxygen deficient blood. This causes respiratory problems in the infant. Medicines are administered to rectify the condition. Some babies may also need surgery to close the vessel.
8. Bronchopulmonary dysplasia (BPD)
Babies who require ongoing oxygen supplement at four weeks before their original due date are diagnosed with Bronchopulmonary Dysplasia (BPD). It is a serious lung condition and mostly affects premature infants. Undeveloped lungs in preemies with the combination of respiratory treatments given to the infant to help him breathe, can cause damage to the lungs of the infant. Respiratory infections such as pneumonia can also lead to this condition. BPD develops fluid in the lungs, scarring and lung damage. Such babies are treated with medicines and are put on ventilator that eases breathing.
9. Peri-ventricular leukomalacia (PVL)
Lack of blood flow or oxygen to the peri-ventricular area of the brain causes loss of brain tissue. Ventricles are the areas around the spaces within the brain. These contain nerve fibers that carry brain messages to other parts of the body. Loss of this tissue may lead to co-ordination problems, hearing and vision impairments, delayed motor and mental development. Premature infants are at highest risk of this disorder. There is no specific treatment for this disorder. Appropriate therapy and regular monitoring is required for such babies.
10. Retinopathy of prematurity (ROP)
Fragile abnormal blood vessels can bleed scarring the retina. This pushes the tissue out of position, thus detaching the retina. This detachment causes blindness and visual impairment. Premature and small weighing babies at birth, are at higher risk of developing this disorder. Oxygen level in the baby is one of the factors contributing to this disorder. Mild cases do not result in vision loss. In severe cases, babies are treated with laser treatment to rectify the abnormal blood vessels (cryo therapy) which prevents vision loss.
11. Other complications
Other than the above, preemies can experience other problems as well. Premature babies are unable to regulate their body temperature as they lack the fat reserves to maintain body temperature. Such babies are kept in isolettes or warmers. Under-developed blood vessels in preemies can cause either high or low blood pressure. This fluctuation can put the blood vessels under stress.
Severe bacterial infection in the bloodstream causes sepsis. This impairs the functioning of all the major organs of the body including, brain, lungs, skin, kidneys, bowels. Bacterial infection can spread through IV lines, close contact with an infectious person (carrier of bacteria), and through delivery from the
mother during labor. Babies with sepsis are treated with antibiotics and require close monitoring up to 14 days
Premature infants are also prone to various infections. Since their defense mechanism is poorly developed, babies easily catch infections such as meningitis, pneumonia and other skin infections. These are contracted from the mother, nurse handling multiple babies in NICU. These infections can be treated with antibiotics.
