Dealing with babies born prematurely

photo

A nurse attends to a premature. Constant monitoring is essential. (Solomon Asaba)

Dr Tharcisse Ngambe is a pediatrician at King Faisal Hospital. Along side other medics he is part of the team, which oversees quality assurance at the hospital. Seven months ago, a premature was delivered from the hospital but this time round there were issues.

His skin was blue and constantly struggled with gasping respiration.The baby who seemed to be under severe distress was then taken for an X-ray to determine the exact problem.

Results from the X-ray, showed that all his lungs were white, an indication that they were filled with fluid.So there was an option, to drain the fluid and maintain balance.The first side of the lungs was drained; a second x-ray was taken only to find out more fluid surrounded the heart. Ngambe says that further procedures were taken and the baby was placed under artificial ventilation.

‘We would drain the fluids but in moderation, you don’t want to offset the stability to cause complications,” says Dr Ngambe.

Handling premature babies is unavoidable for people like Ngambe and being part of the team dealing in children health, he admits that premature babies are more delicate.

The term preterm is also used to refer to these fragile babies born before completing the nine months of the pregnancy cycle.

Because they don’t complete the fully growth cycle, they are liable to all sorts of complications and some cases can be rare. For example the pediatrician points out that one time another preterm baby was born with an abnormal heart.

“The whole structure was transposed. The left side was on the right side, oxygenate blood instead flew within the pulmonary artery while the main artery that was supposed to carry it‘the aorta’ instead carried deoxygenated blood’’.

This was more of a reverse anomaly. Several procedures had to be carried out. Cardiologists were called in and ultrasound echoes made to reveal the exact structure. Surgical transposition followed and an arterial switch was made. After such a procedure, it is believed that vessels develop and grow normally.

Dr Ngambe says that prematures usually have underdeveloped organs. For example their gastro intestinal tract is immature and their ability to generate body temperature is very limited. It is because of this that they are incubated.

Then there is another procedure that is usually carried out on neonates who cannot breath well, neonatal resuscitation. Such maneuvers are expected to stabilize the body’s breathing and circulation.

“It is a form of rescued breathing that includes efforts to open airways. Ordinarily babies are supposed to cry at birth but for ‘preterm babies’ it may be different. This crying stimulates the opening of the airways to the outside environment. In case that does not happen we do resuscitate’’.

Watch out for infections and blood pressure

Claudine Umupfasoni, a nurse at the hospital neonatal clinic has served more than six years dealing with preterm babies. She explains that several things may go wrong during delivery especially when the expectant mother has underlying infections, or complications like preeclampsia or high albumin levels.

“A baby about to be delivered may force preeclampsia, a condition during pregnancy characterized by high blood pressure, sometimes with fluid retention and proteinuria,” she explains.

Sometimes it may even be worse if eclampsia occurs. In such a situation one or more convulsions occurs in a pregnant woman suffering from high blood pressure, often followed by coma and posing a threat to the health of mother and baby.

Umupfasoni adds that medical records are very useful in situations when preterm babies are expected. As a must, beds are prepared and maintained warm and in case of any bacterial infections, admission of antibiotics may be considered.

“It depends on the tests, if our tests confirm that the mother had the infection but the baby does not, then we can decide to leave the baby without the antibiotics,” she adds.

Caring for a premature has always been misunderstood and as early as 1960, there were concerns about the health issues which preterm babies posses in addition to ways of keeping them alive.

For example in an online article by Dr William Silverman, the premature nursery then was a backwater of the hospital where physicians weren’t much interested because they had so little to offer and nurses were all powerful, and it was primarily nursing techniques that sustained the infants, gavage feedings, maintaining warmth and watching for apnea because there were no monitors.

Regularly, parents were barred from the nurseries but physicians too were discouraged from going in and handling the babies. There were a few procedures performed especially transfusions for anemia cases. Other crude and rather ineffective ways of administering fluid to the baby by injecting it in small bubbles under the skin were also common. But essentially there was almost nothing for doctors to do.

However, the times have changed with parents having even a lot to offer to the preterm babies.

Kangaroo mother care

The world health organization points out that the technique is important when stabilizing temperature in the pre-terms. Under the practice, the baby is held on an adult’s chest usually the mother with skin-to-skin contact, for extended periods of time. However full term babies are also not bared from this method especially those born with less than 2kg or with health problems such as poor heart rate and bad breathing.

The baby can also be placed on the parents’ chest and stays there, day and night, held in place by a cloth that is wrapped and tied at the mother’s back.

According to WHO, the Kangaroo Mother Care could save an estimated 450 000 preterm newborns a year on top of improving bonding between the mother and the child.

Nutritional requirements

Unlike full term babies who are born at a length of 38 weeks, premature babies are born in less the 37 weeks, which makes their nutritional requirements, complicated. In addition they need close monitoring and a right balance of fluids. And it is a testing period for every new mother.

For instance after Claudine Mugwaneza delivered a baby at 8 months, she was advised to provide breast milk which she had difficulty collecting.

“Whenever I would try to express my breasts to release the milk, I felt pain. It took me some time to generate enough milk for my baby,” she explains.

Isaac Bikorimana, a nutritionist at Kibagabaga hospital also points out that the babies too have problems feeding from bottles or directly on the breasts.

“They are not yet mature enough to coordinate sucking, breathing, and swallowing besides they are very small and require aided feeding in most cases,” says Bikorimana.

He however maintains that breast milk remains crucial for appropriate nutrient provision.

“Breast milk has its advantages, on top of being rich in nutrients, it provides that natural immunity which the baby has to acquire from the first milk the mother produces,” he adds.

Umupfasoni echoes the nutritionists’ views emphasizing that the role of mothers in preterm baby care is very crucial and in case they cannot feed interventions should be taken. For example feeds can be directed through IV tubes placed in the veins.

“As they develop a tube can be placed through the mouth and formula milk can be given. The amount of milk or formula is increased very slowly depending on the appetite especially for very premature babies. The practice minimizes the risk of an intestinal infection although it is not common in breast fed babies”.

Several studies seem to suggest that an estimated 15 million babies are born preterm. However, the survival gap between those born in high and low income countries is widening, with one million deaths a year due to direct complications of preterm birth, and around one million more where preterm birth is a risk factor.

Experts therefore advise that proper care should be provided and when in contact with preterm babies, a sterile environment should be maintained.