Premature miracles

There is nothing quite like welcoming a new life in your very own hands. Months of expectation culminate in this moment of joy. This miracle of life.

But what happens when the miracle comes too early?

Dr Steven Ng, paediatrician and neonatologist from Gleneagles Hospital shares his expertise in this delicate issue.

Why was the baby premature? Was it the parent’s fault?

Babies are born prematurely for a variety of reasons. Sometimes it is due to multiple births such as twins or triplets, and sometimes it is due to congenital abnormalities. Other times, it is due to maternal factors. Mothers may have something called ‘cervical incompetence’, where the cervix dilates before the baby is due, or infections which cause the womb to start contracting prematurely. Whatever the cause may be, it is not anyone’s “fault”, but a situation to be managed.

What are the chances that a second baby will be premature if the first birth was?

That depends on the factors leading to the first premature birth. Very often, there are no obvious reasons for the baby to be born prematurely.

Are there ways to prevent premature birth?

If the reason for it is cervical incompetence, then an obstetrician can put in a suture around the cervix to prevent it from dilating prematurely. Medication can be given to stop premature contractions, though this is not always successful. As a precaution, steroids are also routinely administered to moms at risk especially before 34 weeks of gestation. This is to ensure that the baby’s lungs are mature enough to function outside the womb in the event of a premature delivery.

What are the common health complications with premature babies?

Premature babies may encounter a multitude of health problems affecting the major organs of the body like the lungs, heart, gut, liver, brain, eyes, ears and nervous system. In general, the more premature the baby, the greater the likelihood and severity of health problems – some of which can be life threatening.

How early is too early for survival outside the womb, and what happens then?

In general, any baby more than 25 weeks of gestation would have a fairly good rate of survival with today’s advancements in neonatal medicine.  For cases less than 25 weeks, the neonatologist would normally discuss at length with the parents on potential complications and high mortality rate.

How long will a premature baby usually have to stay in the hospital?

Again, this is dependent on how premature the baby is. Typically, the baby can only be discharged if he is able to breathe on his own without support, bottle feed without the need for oxygen, attains at least the corrected age of 35 to 36 weeks of gestation, and a weight of at least 1.8 to 2kg.

Will the mother be able to hold and nurse a premature baby?

Once the baby’s condition is stable, most neonatal units strongly encourage "touch time" and baby massage by the mother. If feeding is possible, fortified expressed breast milk would be given. Once the baby is much older and able to co-ordinate the process of suck-swallow-breathe, then direct breastfeeding and skin-to-skin contact is ideal.

After baby is finally discharged from the hospital, are there any special follow up checks required?

Initially, there will be weekly medical check-ups and blood tests, which taper off to monthly visits until the baby is deemed to be thriving well. There will also be eye and hearing tests, as well as multivitamins and iron supplements for baby to take.

Publication of article by courtesy of Dr Steven Ng, a paediatrician and neonatologist from Gleneagles Hospital