Tuesday January 3 2017

What you need to know about premature infants

 

By Dr Waceke Nganga Kombe

Premature infants, also known as ‘preemies’ come weeks earlier than the expected date of delivery. This can be distressing for parents and close family members.
The birth of a baby brings joy and excitement for most people, but that of a preemie, infant born before 36 weeks, causes mixed reactions and in some cases disillusionment. The parents suffer shock because they did not expect their infant to be delivered long before the expected due date. In addition, high expectations from family, friends and relatives and the task of explaining the delay of a newborn coming home because they are admitted in hospital can be burdening. The common causes of preterm deliveries are maternal conditions such as pre-eclampsia, infections and ante-partum haemorrhage; among others.

Once a preterm baby has been delivered either normally, or through caesarean section they require critical care which can be provided in a neonatal high dependency unit (NHDU, or neonatal intensive care unit (NICU) depending on the baby’s condition. The NICU is designed to meet premature infants’ needs of warmth, nutrition and protection to assure proper growth and development. Premature babies lack the body fat necessary to maintain their temperature even when swaddled with blankets hence incubators are used to keep them warm.
Preemies have special nutritional needs. They have higher caloric and protein requirements than term babies. Depending on the baby’s weight and gestation, they may be started on feeding through a vein or through the digestive system. The babies receive carbohydrates, fats, vitamins and minerals through this route. At the same time, a small amount of milk which is insignificant nutritionally is given to the baby to keep the digestive system working well and avoid further complications.

Generally, preterm infants are at risk of health problems because of their weak immunity and prolonged hospitalisation. These complications include infections, chronic lung disease, anaemia and, hyperbilirubinemia. This is a condition whereby there are high levels of bilirubin, a compound that results from the natural breakdown of blood which causes jaundice, a yellow discoloration of the skin and whitening of the eyes.

Apnea of prematurity, a condition whereby a baby stops breathing may occur in preterms. When this occurs, the baby’s heart rate may go down and the skin may turn dusky. It is usually caused by immaturity in the area of the brain that controls the drive to breathe.
All preterm babies who are not on any machine to support breathing receive some medication to avoid this complication. This would occur in babies born before 32 weeks gestation.

- Dr Waceke Nganga Kombe,
Paediatrician at Aga Khan University Hospital, Nairobi

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