Caring for preterm newborns

New Delhi: Preterm babies are those born before 37 completed weeks. They could be classified as extremely premature (less than 28 weeks), early preterm (28 to 32 weeks), and late preterm (32 to 37 weeks). They need the most amount of attention and care.

Caring for a preterm newborn at the appropriate setting, with NICU facilities is very important to have the best outcome. If a mother has to deliver prematurely, it is better to transfer the mother with baby in-utero to a centre equipped with these facilities.

"The main concerns in caring for a preterm baby are feeding issues as the baby would not have developed good sucking as compared to a term baby. These babies often need paladay feeds or nasogastric feeds or, if very premature, may even require intravenous fluids," said Dr Usha BR, Consultant ObGyn & Laparoscopic Surgeon, BGS Gleneagles Global Hospitals.

Preterm babies are prone to hypothermia or low body temperature and hence, will require care in an incubator where temperature can be regulated. Kangaroo mother care is also very helpful in preventing hypothermia in babies. The main challenge in preterm care is to ascertain to what extent we can replace a physiological in-utero environment with an ex-utero NICU care.

Another important condition which accounts for most of the morbidity and mortality in preterm neonates is sepsis. This could be a result of infections developed just before delivery or during delivery, prolonged leaking followed by delivery or noso comial, if the NICU standards are not good.

Hand hygiene measures, good antibiotics, and efficient aseptic measures followed by monitoring and care from an obstetrician and neonatologists goes a long way in preventing these infections. Preterm babies may easily develop hypoglycaemia (low sugar levels) and jaundice which may require frequent monitoring.

Respiratory distress syndrome is known to occur in infants because of lung immaturity. This may require surfactant therapy or, if severe, may require ventilator care for the baby for a few days or weeks. Respiratory distress can be reduced by giving antenatal steroids, delivering the baby closer to 39 weeks, and by surfactant therapy after delivery.

"Preterm babies are also at a higher risk of developing neurological morbidity like intellectual disabilities, hearing and vision loss, cerebral palsy, and they require monitoring for the same in the infant life. Antenatal Magnesium sulphate given to mothers having preterm labour has shown to be neuro-protective to babies," added Dr Usha BR.

These precious little ones need utmost attention and care in the initial few days or weeks of life and need to be gradually stepped down from the NICU to the ward, followed by home care.