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Experts Provide Insights into Causes And Complications of Pre-Term Births And Preemie Care in the NICU.



What are the most common causes and conditions that lead to preterm birth?

Labor that happens too soon, i.e. before 37 weeks of pregnancy is known as preterm labor. There is no specific cause of pre-term delivery, many factors may increase the risk of pre-term labor. A few of them being;

  • Smoking
  • Being very overweight or underweight before pregnancy
  • Not getting good prenatal care
  • Drinking alcohol or using street drugs during pregnancy
  • Health conditions, such as high blood pressure,  preeclampsia, diabetes, blood clotting disorders, or infections including bacterial vaginosis, Urinary tract infection or any systemic infection
  • Bleeding during current pregnancy for various reasons
  • Weak cervix  or cervical incompetence
  • Being pregnant with a baby that has certain birth defects
  • Being pregnant with a baby from in vitro fertilization
  • Being pregnant with twins or other multiples
  • Having a family or personal history of premature labor
  • Getting pregnant too soon after having a baby

Despite all the above factors, pre-mature birth can happen to anyone, there are also certain unknown factors that can induce pre-term labor.

What are the symptoms that a woman should look out for?

In order to be able to stop pre-term labor, one needs to know all the warning signs. Acting quickly upon the warning signs can make a big difference. You must consult a doctor immediately on experiencing any of the below symptoms;

  • Backache, usually in your lower back. This may be constant or come and go, but it won’t ease even if you change positions or do something else for comfort.
  • Contractions every 10 minutes or even more often.
  • Cramping in the lower abdomen or menstrual like cramps. This can also feel like gas pain that comes with diarrhea.
  • Fluid leakage from the vagina
  • Flu-like symptoms such as nausea, vomiting or diarrhea. On being unable to tolerate liquids for more than 8 hours, it is advisable to consult with a doctor. On noticing even any mild cases of nausea, flu etc. consult your doctor.
  • Increased pressure in the pelvis or vagina
  • Increased vaginal discharge, the color of which may be egg white, milky white, greenish, brownish or even blood stained discharge.
  • Vaginal bleeding even may be light bleeding.

A few of the symptoms may be difficult to differentiate from normal symptoms of being pregnant, for instance having backaches, However, you cannot be too cautious, so always get any warning sign checked by a specialist.

On what basis is a preterm birth determined?

Pre-term birth is also called preterm labor. It’s when your body starts getting ready for birth too early in your pregnancy. Labor is premature if it starts or is decided by the obstetrician to deliver the baby more than three weeks (37 weeks) before your due date. There are various factors that determine preterm birth. The one criteria are when there is a health compromise or danger to either the mother or the baby, in such a case delivery is planned.

Do preterm births always occur through C-section or can a preterm baby be delivered naturally?

Preterm babies can also be delivered vaginally. Again the mode of delivery whether vaginal or C- section depends on the gestational age of the fetus, health status of both mother and baby and how soon we need to deliver the baby depending on various health concerns.

Can preterm births be avoided?

Having known the causes for preterm births we should be able to avoid the same. This can be achieved through;

  • Pre-conception counselling to avoid the risk factors, to keep a good control of diabetes, hypertension etc.
  • Regular antenatal care and good compliance.
  • Knowing the warning symptoms and consulting a doctor on experiencing any visible warning signs.

What caused the pre term delivery? (With reference to Baby Sydelle)

The mother suffered from severe preeclampsia (Gestational Hypertension with Proteinuria) with abruption, i.e. separation of the placenta before the delivery of the baby.

Dr.Caroline Alphine Jenitha 

Specialist Obstetrician & Gynaecologist 

Aster Hospital Mankhool

Caroline_-_Gynecology 

What constitutes a NICU?

A neonatal intensive care unit is a specialised area within the hospital adjacent to the labor room and the obstetric operation theatre where babies with special requirements, either pre-mature, small for gestational age or unwell babies are treated.

What are the cases that call for a baby to be admitted to the NICU?

There is an admission criteria for babies to be admitted and treated in the neonatal intensive care unit. The types of babies admitted and treated in a NICU are;

  • Pre-term babies, any baby who is less than 35 weeks
  • Babies with low birth weight, below 2.2 kilograms
  • Babies with any suspected infection
  • Babies with respiratory problems
  • Babies who have vomiting and food intolerance
  • Babies unable to maintain glucose levels
  • Babies with any cardiac issues
  • Any sick babies

What are the various NICU Levels and how is the level of care determined?

 As per guidelines of the American Academy of Pediatrics, there are four levels of NICU, namely; Level I, Level II, Level III and Level IV. However, they are not all called NICU.

Level I is a Well New born nursery where stable babies between 35weeks -37 weeks are looked after.

Level II is called a Special Care Nursery where babies more than 32 weeks gestation and weighing more than 1500 grams are cared for. In this special care baby unit, short term ventilation for less than 24 hours is given to babies for stabilisation purposes before transferring them to a Level III unit. Babies below 32 weeks and less than 1500 grams are also temporarily admitted here for stabilization.

Level III intensive care unit is where sustained life support is provided. This unit is equipped to treat babies less than 32 weeks and weighing less than 1500 grams or any critically ill baby. A Level III NICU provides facilities such as full respiratory, cardiovascular and nutritional support for preterm babies of any gestational age and weight and for any critically ill baby.

Level IV is a regional unit consisting of sub-specialities like Paediatric cardiology, Pediatric gastroenterology, Paediatric surgery etc.

Generally, most hospitals have a Level III NICU. Aster Hospital, Mankhool is equipped with an 8 bedded Level III Neonatal Intensive Care Unit. The facilities at the NICU include conventional and high-frequency ventilators, CPAP machines, expertise to put in lines for long term care, total parental care for babies and provide comprehensive care for critically ill babies.

What type of care is provided at the NICU?

The major care provided in the neonatal intensive care unit is respiratory support, support for the cardiovascular system, nutritional support like parental nutrition and feeding. Apart from this support we also provide general care for extremely preterm babies.

How can parents contribute to the growth of their child while in the NICU?

We realise the importance of physical and emotional closeness of the parent and the preterm baby in the NICU. Hence we encourage parents to visit the NICU regularly. We contact the parents on a daily basis and update them about the progress of their babies. We discuss the present condition of the baby, in the case of any complications we explain to parents the possible management of the same and any change of medication. We encourage seamless contact with parents so that they clearly understand the functioning of the NICU and the care given to the baby. We also encourage physical contact and allow the parents to touch their baby because it aids in creating a bond between the parent and their baby.

Mothers of the babies also provide us with breast milk which we feed their baby. They are taught and encouraged to express breast milk.

Tell us more about Sydelle’s condition and the care she received that supported her growth over the 63 days?

Sydelle was born extremely premature at 27 weeks weighing 937 grams. She was admitted in the NICU for 63 days where she required ventilation and nutritional support for the first few days. Once her breathing was stabilised she was feeding and growing in Aster Hospital’s NICU for the next two months.

It is our policy to only discharge babies one they reach 35 weeks because it is when they can breathe properly on their own and they are able to suck milk from either a bottle or the breast and swallow.

Can the preterm delivery of a baby affect his/her health at a later stage in life?

Yes, preterm delivery can potentially affect the health of the baby. Extreme prematurity is associated with neuro-developmental disability. Some babies get chronic lung disease which may cause the baby to be oxygen dependent. To check for any disability in babies, we monitor their growth and development until they are 2 years of age.

 

Dr.Venkiteswaran Ramanathan 

Medical Director and Consultant in Pediatrics and Neonatology

Aster Hospital Mankhool 

Ramanathan_-_Pediatrician

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