Premature

by | July 30, 2020

In Sweden, about six percent of all children are born “prematurely”, which means before 37 weeks of completed pregnancy. In most cases, these premature babies are doing just fine.

Swedish neonatal care (newborn care) has developed a lot and is today among the most prominent in the world. This means that the vast majority of Swedish children born prematurely survive and become healthy, without disabilities.

Premature

Classification of premature babies

You usually divide the premature – premature children into groups according to maturity, that is, pregnancy duration. A normal pregnancy lasts for 40 weeks, calculated after the date of the first day of the woman’s last menstrual period.

By premature (premature) is meant children born before the 38th week of pregnancy. The newborn baby often weighs less than 2,500 grams.

However, some children born in the normal time have a weight below 2500 grams. These children are referred to as “light for time”. The cause may be a chromosome disorder, infection or failure of the placenta. Smoking is a contributing cause of low birth weight.

Most premature babies are born after the 32nd week of pregnancy and weigh over 1,500 grams. The group of very premature babies born between the weeks of pregnancy 29 and 32 constitutes 0.8 per cent.
Only 0.3 percent of the live-born children – about 300 children / year – are extremely premature, ie during pregnancy week 28.

Immediately after childbirth, the midwife makes an assessment of the child’s condition on the so-called Apgar scale, which gives so-called Apgar scores up to 10. It is a measure that indicates how the child is feeling right after the birth. The midwife assesses, among other things, the child’s breathing, heart rate, skin color and how much the child grimaces or screams. A high Apgar score shows that the child is doing well. The maximum score is 10.

The most common complications

Premature babies have not fully developed and therefore have not been able to prepare for the environment outside the womb. Children who are born prematurely but weigh over 1,500 grams usually do well and rarely get any complications.

It is above all the maturity of the lungs that sets the limit for the survival of the premature child. That limit lies in the transition between the 22nd and 23rd pregnancy weeks. About half of children born in week 23 survive, while eight out of ten children born in week 25 survive. In such a very premature baby, breathing and heart rate must be monitored. The child may need respiratory therapy or treated with mask with overpressure, so-called CPAP treatment, or only with extra oxygen in the incubator.

The immune system of the premature child is unprepared and the child is therefore extra susceptible to infection. Therefore, the child often has to receive antibiotic treatment in case of suspected bacterial infection.

The brain and nervous system are undergoing rapid development and sensitive to the effects of longer oxygen deficiency and bleeding. However, the brain of the premature child has an astonishing ability to self-heal.

Premature babies freeze easier

Because the premature children lack or have very little of the heat-insulating subcutaneous fat and the body’s “thermostat” is immature, they have difficulty keeping the body temperature. The body surface area is also relatively large in relation to the small body volume which increases the cooling. Cooling leads to increased metabolism with increased energy requirements and the child may therefore lie in an incubator or heating bed.

Only about the 34th week can the premature baby suck and swallow enough to fully breastfeed. Until then, the baby must be fed every two to three hours or to receive a drop of milk. Most children primarily get their own or another mother’s breast milk, possibly fortified with proteins, minerals and vitamins.

NIDCAP method

In many neonatal (newborn) wards, a nursing method is used for premature children that take into account each child’s maturity and individual needs. The child is observed before, during and after a care situation, for example during feeding, diaper changing or sampling to assess the child’s needs and adjust the care accordingly.

The child’s reactions are recorded as well as what is needed for it to come to rest again. The environment in the surveillance room should, as far as possible, be similar to the environment in the uterus, with muted lighting and low noise levels. Therefore, the incubator is covered to protect the child from unnecessary stimuli.

When the child’s condition is stabilized, parents can sit for long periods with the child against the chest, skin to skin according to the so-called “kangaroo method”, to get close body contact with the child.

Why are babies born prematurely?

The cause of preterm birth is often unclear. Causes may be factors in the woman, the fetus or the environment. If the mother suffers from so-called pregnancy poisoning (eclampsia) it may mean that the child must be delivered prematurely.

The woman may also have a weakness in the cervix or a malformation in the uterus leading to premature birth. Even diseases such as diabetes and infections can cause premature labor.

If there are causes in the fetus, it could be an infection, some other illness or chromosome disorder with malformation. Multiple births, ie twin or triplet pregnancies, increase the risk of premature birth.

Fertility problems and premature birth have a certain relationship. Women who have had difficulty getting pregnant often give birth prematurely than women without fertility problems.

Even children born after assisted conception are more often born prematurely than other children. To some extent, this is because twins, triplets, etc. With refined technology and improved methods, a maximum of two eggs are now implanted, which means that the multiple burdens are reduced.

A tough time – even for the parents

Parents of children born prematurely go through a tough time. Having children well before estimated descent means a great deal of stress, which means that you can end up in a crisis. Symptoms may include feelings of unreality, altered perception of time, anxiety attacks, sleep disorders and loss of appetite.

The short pregnancy means that the parents are neither practical nor psychologically prepared to receive the child. The woman encounters a child who is more unfamiliar to her than if she had passed the time and managed to create a clearer picture of the child. Instead of the full-fledged child, who usually has a few holes, the parents face a very small and lean child with almost translucent skin, and who need professional help from others to survive.

The outlook is good for premature children today

It works well for the vast majority of premature babies. The very premature babies, as well as the children who suffer from complications, are usually followed at a special reception. There you control the child’s growth, motor skills and other vaccinations.

Above all, it is the very premature babies who can exhibit some kind of disorder, such as delays in development or CP injury. In these children, concentration and learning difficulties are also somewhat more common than in adult children. The NIDCAP method can reduce, but not completely prevent, such complications.