What is premature birth?
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What is premature birth?

Post by Dr Khalid Ur Rehman on Sunday, November 20, 2022

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A Premature Birth is a birth that takes place more than three weeks before the baby's estimated due date. In other words, a premature birth is one that occurs before the start of the 37th week of pregnancy. Premature babies, especially those born very early, often have complicated medical problems. Typically, complications of prematurity vary. But the earlier your baby is born, the higher the risk of complications.
Depending on how early a baby is born, he or she may be:
a. Late Preterm, born between 34 and 36 completed weeks of pregnancy
b. Moderately Preterm, born between 32 and 34 weeks of pregnancy
c. Very Preterm, born at less than 32 weeks of pregnancy
d. Extremely Preterm, born at or before 25 weeks of pregnancy
Most premature births occur in the Late Preterm stage.
1.     Symptoms 
Your baby may have very mild symptoms of premature birth, or may have more-obvious complications.Some Signs of prematurity include the following:
a. Small size, with a disproportionately large head.
b. Sharper looking, less rounded features than a full-term baby's features, due to a lack of fat stores
c. Fine hair (lanugo) covering much of the body.
d. Low body temperature, especially immediately after birth in the delivery room, due to a lack of stored body fat.
e. Labored breathing or respiratory distress.
f. Lack of reflexes for sucking and swallowing, leading to feeding difficulties.
Special Care: If you deliver a Preterm baby, your baby will likely need a longer hospital stay in a special nursery unit at the hospital. Depending on how much care your baby requires, he or she may be admitted to an intermediate care nursery or the neonatal intensive care unit (NICU). Doctors and a specialized team with training in taking care of preterm babies will be available to help care for your baby. 
Don't hesitate to ask questions. Your baby may need extra help feeding, and adapting immediately after delivery. Your health care team can help you understand what is needed and what your baby's care plan will be.
2.     Risk Factors 
Often, the specific cause of premature birth isn't clear. However, there are known risk factors of premature delivery, including:
a. Having a previous premature birth
b. Pregnancy with Twins, Triplets or other multiples
c. An interval of less than Six months between pregnancies
d. Conceiving through in vitro fertilization
e. Problems with the Uterus, Cervix or Placenta
f. Smoking cigarettes or using illicit drugs
g. Some Infections, particularly of the amniotic fluid and lower genital tract
h. Being Underweight or Overweight before pregnancy
i. Stressful life events, such as the death of a loved one or domestic violence
j. Multiple miscarriages or abortions
k. Physical injury or trauma
For unknown reasons, Black Women are more likely to experience premature Birth than are women of other races. But Premature Birth can happen to anyone. In fact, many women who have a premature birth have no known risk factors.
3.     Complications
While not all premature babies experience complications, being born too early can cause short-term and long-term health problems. Generally, the earlier a baby is born, the higher the risk of complications. Birth weight plays an important role, too.
Some problems may be apparent at birth, while others may not develop until later.
4. Prevention 
Although the exact cause of Preterm Birth is often unknown, there are some things that can be done to help women — especially those who have an Increased Risk — to reduce their risk of Preterm Birth. These includes: 
a. Progesterone Supplements: Women who have a history of Preterm Birth, a Short Cervix or both factors may be able to reduce the risk of Preterm birth with progesterone supplementation.
b. Cervical Cerclage: This is a Surgical procedure performed during Pregnancy in women with a Short Cervix, or a history of Cervical Shortening that resulted in a Preterm birth. During this procedure, the cervix is stitched closed with strong sutures that may provide extra support to the uterus. The sutures are removed when it's time to deliver the baby. Ask your Physician if you need to avoid vigorous activity during the remainder of your Pregnancy.
5. Diagnosis
After your premature baby is moved to the NICU, he or she may undergo a number of tests. Some are ongoing, while others may be performed only if the NICU staff suspects a particular complication.Possible tests for your premature baby may include:
a. Breathing and heart rate monitor.
b. Fluid Input and Output.
c. Blood tests.
d. Echocardiogram.
f Eye exam
6. Treatment
Intensive care for your premature baby:The neonatal intensive care unit(NICU)or special care nursery provides round-the-clock care for your premature baby.
7. Supportive Care
Specialized supportive care for your baby may include:
a. Being placed in an incubator
b. Monitoring of your baby's vital signs
c. Having a feeding tube
d. Replenishing fluids
e. Spending time under bilirubin lights
f. Receiving a blood transfusion
8. Medications 
Medications may be given to your baby to promote maturing and to stimulate normal functioning of the Lungs, Heart and Circulation. Depending on your baby's condition, medication may include:
a. Surfactant: a medication used to treat Respiratory Distress Syndrome
b. Fine-Mist(Aerosolized)or IV medication to strengthen breathing and heart rate
c. Antibiotics if infection is present or if there's a risk of possible infection
d. Medicines that increase Urine Output (Diuretics)to manage Excess Fluid
e. An injection of Medication into the Eye to stop the growth of New Blood Vessels that could cause Retinopathy of Prematurity
f. Medicine that helps close the heart defect known as Patent Ductus Arteriosus
9. Surgery: 
Sometimes surgery is necessary to treat a number of conditions associated with Prematurity. Talk with your baby's health care Physician to understand which complications may require Surgery, and learn about the type of surgery that might be necessary to treat them.
10. Taking Your Baby Home:
 Your baby is ready to go home when he or she:
a. Can breathe without support
b. Can maintain a stable body temperature
c. Can breast- or bottle-feed
d. Is gaining weight steadily
e. Is free of infection
In some cases, child may be allowed to go home before meeting one of these requirements — as long as the baby's medical team and family create and agree on a plan for Home care and Monitoring.
Your baby's health care team will help you learn how to care for your baby at home. Before dismissal from the hospital, your baby's nurse or a hospital discharge planner may ask you about:
a. Living arrangements
b. Other children in the household
c. Adult relatives and friends who may assist you in caring for your baby
d Primary pediatric care
11. Lifestyle and Home Remedies
 When it's time to bring your baby home, you might feel relieved, excited — and anxious. Take time to consider ways to prepare for life at home with your baby after you've left the hospital:
a. Understand how to care for your baby.
b. Before you leave the hospital, take a course in infant CPR.
c. Ask your baby's medical team any questions you might have and take notes.
d. Make sure you're comfortable caring for your baby, especially if you'll need to administer medications, use special monitors or give your baby supplemental oxygen or other treatments.
e. Discuss symptoms
f. Discuss feedings
g. Keep in mind that premature babies usually eat less and may need to be fed more often than full-term babies. 
h. Find out how much and how often your baby should be eating.
i. Protect your baby's health. 
j. Ask people who are ill to postpone their visit until they are well.
k. Follow a recommended schedule for check-ups. 
l. Discuss your baby's need for future appointments with your baby's care Physician 
m. Your preterm baby may initially need to see his or her care provider every week or two to have his or her growth, medical needs and care monitored.
n. Stay on top of Vaccinations: While it's recommended that Immunizations be given to medically stable Premature babies according to their chronological age, delays in the Immunization schedule are common. Work with your baby's care provider to stay on top of your baby's vaccinations.
o. You may also protect your Preterm Infant by ensuring that others in the home are up to date on their Immunizations, including Influenza. 
p. Pregnant women, family members and adult caregivers should also check with their doctors to be sure they're up to date on their whooping cough vaccine.
q. Monitor for Developmental delays 
r. Babies who are identified as at risk may receive further evaluation and be referred to early intervention services.
12. Coping and Support for your baby: 
Caring for a Premature Baby can be Physically and Emotionally Exhausting.You may be Anxious about your baby's health and the long-term effects of Premature Birth.You may feel Angry, Guilty or overwhelmed.
Some of these suggestions may help during this difficult time:
a. Learn everything you can about your baby's condition.
b. In addition to talking to your baby's doctor and other care providers, ask for informational pamphlets and recommendations for good books and reliable websites for more information about taking care of your preterm baby.
c. Take care of yourself.Get as much rest as you can and eat healthy foods.You'll feel stronger and better able to care for your baby.
d. Establish your milk supply:Use a breast pump until your baby is able to breast-feed. Ask the hospital staff for help — they can show you how to use a breast pump and find the supplies you'll need to store milk.
e. Accept help from others. Allow friends and family to help you. They can care for your other children, prepare food, clean the house or run errands. This helps you save your energy for your baby.
f. You may want to include pictures of your baby so that you can see how much he or she changes from week to week.
g. Seek good listeners for support
h. Caring for a baby is a great challenge
i. Keep a journal: Record the details of your baby's progress as well as your own thoughts and feelings.

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