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Sunday, October 18, 2020

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The premature baby

 A baby is considered premature when it is born before the 37th week of pregnancy. Premature births represent 7.7% of births in Quebec, or more than 6,000 children each year. Approximately 1,000 of these babies will be born before 32 weeks.

What causes premature delivery?

There are two kinds of preterm births: those that are spontaneous and those that are medically induced due to the health of the mother or the unborn child.

Several factors can contribute to preterm delivery:
  • the age of the mother;
  • having already given birth prematurely;
  • maternal infections;
  • blood pressure and diabetes problems related to pregnancy;
  • certain problems related to the baby (growth retardation, malformation);
  • the number of babies expected;
  • Premature dilation of the cervix;
  • certain lifestyle habits of the pregnant woman (smoking, alcohol, drugs).

The different types of premature babies

The duration of a normal pregnancy is 40 weeks. The majority of premature babies are born between the 32nd and 37th week of pregnancy, but some may be born between the 22nd and 25th week.

The presence and severity of sequels will depend on the number of weeks of pregnancy completed at the time of delivery, the presence of certain complications, steroid use and birth weight.

Premature babies (born between 33 and 36 weeks)

The premature baby has some respiratory immaturity and has difficulty keeping warm.
They are able to feed themselves on their own or almost on their own. However, they have difficulty swallowing, breathing and suckling in a coordinated manner and tire quickly.
He is 2 to 5 times more likely to have developmental problems than a full-term baby.

The very premature baby (born between 29 and 32 weeks)

The very premature baby does not have good control of his breathing, which can be interrupted. It often needs oxygen and must be in an incubator because it has less control over its temperature.
They are first fed with a small tube (gavage) that goes through their nostrils or mouth to their stomach. This minimizes the effort required to suck and swallow. A solution can also be administered to ensure that he receives the calories and elements essential to his growth.
The risk of sequel in the very premature baby is 50 to 80 times higher than in a full-term baby.

The very premature baby (born before 28 weeks)

The very large premature baby cannot breathe on its own or feed itself. It is therefore placed on a ventilator and intravenous. He also receives several medications.
He has many health problems and is more likely to experience complications in the hospital.
If he was born between 22 and 25 weeks of age, he is at the limit of viability and may suffer severe after-effects.

The shock of premature delivery

For some parents, a premature delivery is a painful memory. Several emotions can be felt. For example, stress occurs when parents realize that nothing is going the way they planned. This feeling is amplified by the fear that something will happen to the baby or by the feeling of being completely disorganized. 

Some mothers also feel guilty. They believe they are responsible for what happens. Other parents feel bad that they don't instantly love a baby so different from the one they imagined. So there is grief to be mourned for the perfect pregnancy, the desired delivery and the healthy baby. All of these feelings are normal. You have to accept them and try to express them. 

If necessary, parents should not hesitate to talk about their feelings to the doctor, nurses or a psychologist. Parent associations for premature babies also offer support groups.

What are the possible complications for a premature baby?

A premature baby is at risk for several problems because he or she still lacks reserves and many of his or her functions are immature.

  • Respiratory Distress Syndrome: This is the most common problem in premature babies because of the immaturity of their lungs. This is why some premature babies will need to be put on a ventilator.
  • Abnormality in lung development: This complication occurs in newborns born before 32 weeks of pregnancy who have received oxygen on a ventilator over a long period of time.
  • Temporary cessation of breathing and irregular heartbeat: Because the brain is not yet mature, control of breathing and heartbeat is more difficult. Premature babies therefore have breathing and heart irregularities. They will often be connected to a cardio-respiratory monitor to monitor their vital signs.
  • Gastroesophageal reflux: The muscle controlling the opening of the stomach of premature infants is still immature, allowing the contents of the stomach to flow back up into the esophagus. Approximately 3-10% of very premature babies will suffer from gastroesophageal reflux.
  • Jaundice: This condition is more common in premature babies because their liver is immature and feeding is often delayed. Premature babies need photo therapy to treat this condition.
  • Anemia: Premature babies are at higher risk of anemia because about 80% of iron stores are accumulated during the last trimester of pregnancy. Their rapid growth after birth also increases this risk.
  • Infections : Premature babies are at greater risk of infections because of their fragile, permeable skin, not fully developed immune system, low body weight and the many medical procedures they are exposed to. Infections can develop during pregnancy, childbirth or childbirth.
  • Damage to the brain: Brain hemorrhage affects 30% of babies born before 30 weeks or weighing less than 1,500 grams. It is due to the fragility of certain areas of the brain in premature babies. Blood vessels can bleed if the pressure increases. The after-effects vary according to the severity of the bleeding. However, simple interventions can be put in place to prevent these hemorrhages.
  • Necrotizing enterocolitis : This complication is an inflammation of the intestine that can be fatal. It occurs mainly in the first 2 weeks after birth and affects 5 to 10% of babies who weigh less than 1,500 g.
  • Cardiac malformation: Some premature babies can suffer from a heart murmur, because their arterial canal did not have time to close.
  • Deafness: Hearing function is often immature in premature babies. It is estimated that 2-10% of babies born at or before 32 weeks of pregnancy will have hearing problems.
  • Retinopathy: This abnormality affects the eyes of premature babies and consists of an abnormal growth of blood vessels in the eye, which causes the retina, the membrane covering the back of the eye, to detach. The main cause is the administration of oxygen. It mostly affects babies born before 28 weeks of age and can sometimes cause vision loss.
Because of these many possible complications, a premature baby may be hospitalized for several weeks, and sometimes months, in the hospital's neonatal unit after birth. For example, a baby born before 28 weeks of pregnancy will stay in the hospital until he or she is born. If he or she is born between 35 and 36 weeks, he or she will leave the hospital within the normal time frame.

Caring for a premature baby

At the hospital, once your child's condition is stabilized, there are several ways you can get involved in your child's care. Here are some examples of what you can do.

Comfort him or her

A premature baby is very sensitive to pain. Because he is exposed to many medical procedures, your support can bring him comfort. If his condition allows, you can, for example, carry him skin-to-skin (kangaroo method) and talk softly to him. Some babies also like to be swaddled or have a lullaby sing to them.

When a medical procedure is necessary, make sure your baby is gently woken up. You can also offer breast milk or sugar water to help reduce pain. If your baby is able to feed, you can offer the breast. A pacifier can also provide comfort.

Stimulate him by following his rhythm

A premature baby can quickly become over-stimulated. Watching his parents, listening to them sing and feeling their caresses may be too much for him to handle at once, because his nervous system is immature.

In addition, the hospital is a major source of unpleasant stimuli: stings, handling by medical staff, the smell of disinfectants, the noise of medical devices, etc. It is therefore important to also provide pleasant sensations, but it is preferable to do so gradually.

For example, you can do skin-to-skin with your baby first. When he's comfortable, sing him a lullaby. Then you can gently massage her back. Finally, you can rock him/her when he/she can handle the extra stimulation.

Feeding him

When a baby is born before 34 weeks of pregnancy, he or she will probably need to receive some of the food intravenously. As the baby matures, he or she may receive small amounts of milk through a tube that goes through the nostril or mouth to the stomach.

It is then possible for mothers who wish to express their milk to give it to their baby. Breast milk is a great help for a premature baby. However, breastfeeding can be a challenge in the case of a premature delivery. It is therefore important for the mother to be well surrounded.

When the baby reaches the equivalent of 30 to 34 weeks of pregnancy, he or she can successfully breastfeed. This ability develops before the baby can bottle-feed.

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