Chennai: Prematurity is the leading cause of infant deaths in India, and India tops the world in premature deliveries. A survey by Indian Foundation of Premature Babies on 634 mothers who had delivered premature infant in Chennai showed very poor awareness of prematurity that relates in delayed treatment.Medicos say that intervention during the “golden hour” when brain-protective measures can help is often missed due to lack of awareness. On World Prematurity Day, doctors share insights on protecting premature babies brains.
The survey revealed that one in five Indian pregnancies can end in a premature delivery, but of the 634 mothers of premature babies interviewed 76 percent were not aware of pre-conceptional health check as a prerequisite to a healthy pregnancy.
The role of ideal pre-pregnancy body mass index, vaccines and genetic counselling before pregnancy were not addressed, as the first visit to the obstetrician was to confirm the pregnancy after 6 to 8 weeks.
The possibility of premature delivery was raised only 3 to 20 days before delivery in 72 percent of the women, even in high-risk pregnancies complicated by diabetes, poor placental function or multiple gestations.
Stressful events of a major nature (divorce, death of close relative etc) were reported as the sole risk factor in 19 percent of the women who delivered pre-term. Only 10% of pregnant women had some knowledge of pre-maturity at the time of delivery.
The reasons mentioned included parental unwillingness to know elaborately on this inauspicious complication earlier in pregnancy in 46 percent of the women interviewed.
At the time of premature delivery, 55 percent of the mothers needed 2 to 24 hours time to consent to immediate delivery and shifting of the baby to the NICU. This resulted in delayed transfer to the NICU or initiation of treatment after the “golden hour – first hour of life” during which therapy confers significant long-term protective effects to the pre-term brain.
In late pre-terms (34 to 37 weeks gestation) shifting to the NICU was significantly deferred, beyond 24 hours of age, in 38 percent of cases. These babies were shifted with serious complications such as severe jaundice, respiratory
failure etc, which could have been avoided by elective, earlier transfer to NICU. Lack of knowledge about physiologic immaturity in “apparently big babies” was expressed.
The survey stated that around 90 percent of mothers expressed difficulty in bonding with a tiny sick baby in the NICU. Similarly, practical difficulties and emotional barriers to expressing and feeding breast milk during a life-threatening phase were highlighted.
“Prematurity is considered inauspicious and more than 46 percent of them did not want to talk about it. However, a proper NICU set up after preparing the mother for the pre-term delivery can help to improve the outcomes. A significant amount of time is wasted because of lack of awareness among women and the golden hour to prevent the complications in the newborn,’ said senior neonatologist Dr Deepa Hariharan.
Researchers said that steps to protect neurological development steps with family participation, therapy beginning in the golden hour, early maternal bonding, use of colostrum within the 1st day could be implemented in less than 50 of the cases, due to the time taken in educating parents and offering psychological support around the time of delivery.
Dr Madhuri Prabhu, neonatologist at Motherhood Hospitals said that considering prematurity as a lifestyle disease with a check on preventable risk factors such as stress, diabetes, blood pressure, infections etc could reduce the pre-term complications.
“The physical, emotional and psychological preparation of the mother before a pre-term delivery after being given appropriate steroids can help to prevent the problems concerning neurological complications,” she added.
