Premature Baby: Complications and Postmature Situations
A premature baby who has low body weight and postmature needs special care and management. As the newborn is different from normal babies, it's easy for them to develop abnormalities and complications. In order to properly care for a premature baby, it's essential to have an understanding of minor and common diseases which it’s susceptible to.
What is a Premature Baby?
A premature baby refers to a baby born before the 36th week of pregnancy. If its weight is below 1.5 kilograms, it's known as an ultra premature baby (a newborn with extremely low body weight).
Babies born before the 28th week, the longer it's in the womb, the heavier it'll be upon delivery, and its survival rate will be higher. Babies born between the 28th and 33rd week of pregnancy don't need any special care or management.
As a premature baby misses out on the growing of subcutaneous fat towards the end of pregnancy and its layer of body temperature regulating subcutaneous fat is still very thin, the newborn will be more sensitive to temperatures. If the surrounding temperature falls, it's body temperature will also fall and lead to physiological changes which can be fatal to the premature newborn.
So premature newborns must be sent to hospitals equipped with central treatment facilities for premature babies. That's because those hospitals will have skilled specialists and nursing personnel, as well as incubators and special surveillance equipment to properly care for them.
Completely unable to grow
As subcutaneous fat isn't completely formed, thin, red blood vessels can be seen when light is shined on the premature baby. As its blood vessels are very weak, it gets bruised quite easily during birth, but the bruises will disappear immediately after birth. Its muscles are still underdeveloped so the premature baby's limbs are not bent or clawing like those of a normal baby. Its limbs will be straight and will display a little of that 'clawing' action. If the pregnancy is short and the baby's lungs are not yet fully developed, it'll experience breathing difficulty.
There aren't a lot of creases on the premature baby's palms and soles – they're very smooth and there's a lot of fine hair. This is because the fine hair which would have disappeared towards the end of pregnancy if the baby is born full-term. The premature baby's ears also don't have complex undulations like that of a normal baby. Its ears are very soft and easily foldable, and will not bounce back into its original shape if folded.
Babies born before the 34th week doesn't know how to suckle or suck milk from a bottle. A stomach tube must be inserted into its nose or mouth to feed it. As the premature baby grows, it'll acquire sucking strength and can start sucking its own milk. So there's nothing to worry about.
Sequelae will happen if a premature baby doesn't receive undivided care
Within a year of birth, the premature baby's resistance is still very weak so it'll frequently catch a cold or be infected by diseases. However, more than 90% of premature babies will be back to normal after that. A few months after birth when it gets its body and intellectual development checkups, the premature baby must be compared with a full-term baby. By the time it's two or two-and-half years old, the premature baby and normal baby will no longer have any developmental differences. However, if the premature baby has chronic diseases, malnutrition or hasn't been properly taken care of, its growth will lag behind that of a normal baby. There will also be sever neurological sequelae (a condition resulting from a prior disease, injury, or attack) and learning disabilities.
Ultra premature babies whose lungs are not completely developed
An ultra premature baby is born before all its organs are fully developed. There are many cases of lungs underdevelopment leading to breathing difficulty. Blood vessels in the brain can also easily rupture, causing cerebral hemorrhage (uncontrolled bleeding in the brain). As its retina isn't fully developed, the ultra premature baby has very poor vision. A fetus will receive antibodies from its mother's body and develop immunity after the 28th week. If the baby is born before that, it'll be susceptible to infections as it didn't receive antibodies from its mother.
Before an ultra premature baby can get used to the outside world, it must be put in a special incubator to help it breathe. It must be under various types of surveillance for its health condition to be very closely monitored. The ultra premature baby will also have to receive special nutrition treatment directed from blood vessels. If a baby weighing above one kilogram receives treatment, it can live like a normal baby. There are many reasons causing ultra premature delivery which are still unknown today. For pregnant mothers with urinary tract infection during pregnancy, viral infections or toxemia (blood poisoning during pregnancy characterized by high blood pressure, presence of excess protein in the urine and swelling of limbs and face), the possibility of giving birth prematurely is very high. An expectant mother who smoke or has drug poisoning may also deliver prematurely. There isn't any other solution besides taking extra care during pregnancy to prevent premature childbirth.
Proper care of ultra premature baby can let them grow normally
Due to medical advancements, the survival rate among premature babies below 1.5 kilogram in Taiwan has increased from 20-30% since 20 years ago and has further risen to 75% in recent years. Though 15% among babies who survived have neurological sequelae, early treatment shouldn't be given up in the first place. Though being in the high-risk group of having neurological sequelae, if ultra premature babies are properly cared for, treated and managed carefully, they still have a chance of growing up like normal babies.
Complications that arose easily
Intracranial hemorrhage in premature babies is the most severe sequela among all complications. The lighter the body weight, the lesser the number of weeks, the more likely intracranial hemorrhage will happen. The cause of intracranial hemorrhage is due to weak supportive tissues of the blood vessels around the brain ventricles (a small cavity or chamber, as in the brain). Due to lack of support from surrounding muscles, these blood vessels rupture causing intracranial hemorrhage. The brain ventricles are in a central position in the brain and are filled with cerebrospinal fluid (a clear, colorless body fluid found in the brain and spine). Most minor hemorrhage is absorbed and the newborn can recover completely. Some premature babies may also have complications such as microcephaly, convulsions and cerebral palsy.
To check for intracranial hemorrhage, an ultrasound scan is the best way. Treatments are administered in four stages according to the position and extent of the hemorrhage.
Infantile temporary shortness of breath
Shortness of breath is caused by the delayed absorption of fluid in the pulmonary alveoli (any of the small air spaces in the lungs where carbon dioxide leaves the blood and oxygen enters it). If the premature newborn experiences breathing difficulty upon two to three days after birth and there are 60 to 100 breaths which are abnormally fast within a minute, this condition is infantile temporary shortness of breath. Breathing will naturally return to normal after two or three days. If the condition becomes increasingly serious as time goes by, seek treatment in the hospital immediately.
Supply oxygen via supporting means and the baby will be all right within two or three days.
Retinopathy of prematurity
Retinopathy of prematurity refers to abnormal blood vessels development behind the baby's eyes which causes wounds concurrently. If this happens to babies with a very light body weight, its retinas cannot be used anymore. Blood vessels growth behind the eyes of normal babies is already completed in the mother's womb. However, for premature babies, blood vessels continue to grow after birth until they become normal.
It's very dangerous if the baby suffers from this condition. Treatment from an eye specialist is a must. If the condition is still in its first or second stage, no treatment is necessary as it'll improve with time and will not worsen. However, if it's at the third stage, seek treatment at once. Cryotherapy (freezing) or laser therapy may be administered to stop the development of blood vessels behind retinas.
Hematosepsis (blood poisoning)
When bacteria gets into the blood stream and causes conditions such ashypotensive shock (life-threatening condition caused by low blood pressure) or failure of major organs, this is known as hematosepsis. There is a three to four times probability of this happening to a premature baby whose immune system is weak. Antibiotics must be administered. If full-body symptoms such as weakness, lethargy, vomiting, loss of appetite, diarrhea, bloated stomach, breathing difficulty and fever appear, send the baby for a blood culture test. If bacteria are discovered in the blood, then it can be diagnosed as hematosepsis.
Generally, babies are easily infected if their immune systems are weak. For a premature newborn, its immune system is even weaker so the possibility of having hematosepsis is very high. Especially for babies born before the 28th week, it hasn't received any antibodies from its mother, so it's totally not resistant to bacteria. Moreover, the premature baby has stayed in the hospital for a longer period of time, so the chances of getting infected by bacteria are also very high. So the possibility of premature babies having hematosepsis is very high.
In the early stage of the disease, antibiotics can be directly injected into the baby. With this, the baby will have no problem recovering. However, if the bacteria is more malignant or is endogenous (growing from the inside) in nature, even antibiotics will not be able to treat this dangerous condition. That's because infantile hematosepsis will infect the whole body. Other than the blood culture test, a urine culture test and cerebrospinal fluid test must be done. Antibiotics or anti-fungal agents will be administered to kill the bacteria or fungus.
If the baby lacks iron before birth, that deficiency can easily become anemia. A premature baby born before the 37th week of pregnancy hasn't stored enough iron in its body before birth, so they must be given iron supplements. Otherwise, the baby will develop anemia six months before birth. Anemia can be detected with a simple blood test. The life spans of red blood cells in premature babies are short so it's easily susceptible to anemia. Anemia will be worse in situations where the baby and mother have different blood types. During the first week after birth, the baby's red blood cells are not yet made. In order to have a blood test, it's very common for the baby to have a blood transfusion.
For premature babies, transfusion therapy will usually be administered. Substances such as erythropoietin (an essential hormone for red blood cell production) will also be used to promote the creation of red blood cells. From the eighth week onwards post-birth, premature babies weighing less than 2.5 kilograms are supplemented by one to three milligrams of iron for every kilogram of its weight.
Meningitis (an infection of the membranes covering the brain and spine)
The immune system of a premature baby is not yet developed, especially if it's born before the 28th week, since it hasn't received antibodies from its mother. Hence, it runs the risks of being infected by bacteria and viruses before and after birth. The premature baby is especially susceptible to pneumonia, meningitis and urinary tract infections. Bacteria, viruses or microbes may be the causes of infections. Inflammation can happen while it's still in its mother's stomach, during birth or after birth in the neonatal room. Meningitis refers to the inflammation of the membranes covering the brain and spine. The newborn will have symptoms such as weakness, breathing difficulty and fever.
In the hospital, meningitis is detected via the baby's blood or urine test. Different antibiotics will be administered according to the bacterial infections and pathogenic bacteria. If meningitis is severe, there will be several complications.
What is a Low Birth Weight Infant?
Though the infant is carried for more than 37 weeks, if its development inside the womb is slow and its weight is below 2.5 kilograms, it's a low birth weight infant. Reasons could be congenital or it could be that the fetus couldn't get enough nutrition from its placenta.
If the problem lies with the mother, reasons could be chronic illnesses such as endocrine disorders, heart diseases, toxemia or pyelonephritis (a sudden and severe kidney infection). Causes could also include viral or bacterial diseases, drug poisoning, nutritional imbalance, smoking, drinking, carrying twins or frequently overworking. Problems which lie with the fetus include intrauterine infections (infections within the womb) such as congenital abnormalities, German measles and syphilis as well as incomplete placental function or blood circulation disorders.
Low birth weight can be detected in babies with a shorter gestational age via prenatal checkups – the earlier it's detected, the earlier treatment can be administered. If the pregnancy continues but the fetus' weight doesn't increase or due to illnesses which cannot be treated as the mother is pregnant, induced birth must be undertaken. Though a low birth weight infant is small in size, lighter and has less flesh, it looks exactly like a normal baby.
No experience in raising a kid and major complications
Premature newborns are seldom afflicted with breathing disorders. However, the possibility of congenital abnormalities is very high. Having low blood sugar and calcium levels are also very common. Depending on its condition, glucose will be administered intravenously and the stability of glucose level must be consistently observed. A low birth weight baby can adapt to the outside world much better than a premature baby. It's not difficult to raise a low birth weight baby as it doesn't bring raising and caring difficulties which a premature baby may bring. It also grows faster than a premature newborn. Its development will take maximum one year to be on par with that of a normal baby.
What is a Postmature Baby?
A baby who is born only after 42 weeks of pregnancy is known as a postmature baby. Conditions such as fetal oxygen deficiency or complications such as ingestion of meconium (the newborn’s earliest stools) are also under this situation. Therefore, along comes the danger of a natural birth. There are also instances in which the baby is suffocated to death in the womb. So it's better to have an induced birth or cesarean section.
A mature placenta will have decreased blood flow, impeding or reducing the growth of the fetus. Therefore, a postmature baby is only slightly heavier or can even be lighter than a normal infant.
It doesn't look like a newborn
The creases on a postmature baby are more defined than those of a normal baby. Its skin is white and the vernix will dry after two or three days and flake off before the new skin grows. Its head circumference and height are slightly bigger and its body is a little thin. A postmature baby looks mature and will observe its surroundings with wide-open eyes – this is different from a normal newborn. As fetal oxygen deficiency caused the fetus to pass its meconium into its amniotic fluid, the amniotic fluid becomes a brownish tea color. Thus, it's very common for the skin, fingers and umbilical cord of a postmature baby to be all stained yellowish. They'll return to a normal color 56 days after birth.
General Knowledge in a Box: Categorization of Newborns
Health conditions of normal weight and full-term babies are the best. They're known as normal babies or newborns if defined in a narrow sense. Generally, its birth weight and gestation period are proportionate to each other – the longer the gestation period, the heavier its weight will be. If categorization is done strictly, the definitions of a full-term baby, normal-weight baby, postmature baby and a baby with excessive birth weight are all different.
1. Birth weight benchmark
Its birth weight is between 2.5 and 4 kilograms. This type of baby forms the majority of newborns.
Low birth weight baby
Its birth weight is 2.5 kilograms and below. This type of baby makes up 7-8% of all newborns. When newborns who don't even weigh one kilogram are given focused attention and care, its survival rate will increase by the day. Two-thirds of low birth weight babies are prematurely born. The remaining one-third are full-term or postmature babies.
Babies with excessive birth weight
When a newborn weighs four kilograms and above, it's known as a newborn with excessive birth weight. Normal pregnancy could also give rise to such a newborn. If the expectant mother is diabetic, the possibility of giving birth to such a newborn is higher. Diabetic mothers giving birth to babies with congenital cardiac system disorders are also very common.
2. Gestation period benchmark
This isn't related to the newborn's birth weight. A fetus born after being carried for between 37 and 42 weeks is a full-term baby. This type of baby forms the majority of all newborns.
This refers to a baby born before the 37th week of pregnancy.
This refers to a baby born after the 42nd week of pregnancy. There are postmature babies whose development is poor due to the long period of pregnancy. Compared to its gestational age, if the baby is underweight, there could be congenital abnormalities and metabolic disorders.
Quite much information about a premature baby but will definitely help new mothers.