A preterm baby is born before the pregnancy is at term. The prematurity threshold is defined at 37 weeks of gestation, equivalent to 35 weeks since fertilization. Several sub-categories of preterm birth exist:
Moderate to late preterm: between 32 and 37 weeks of gestation,
Very preterm: between 28 and 32 weeks of gestation,
Extremely preterm: less than 28 weeks of gestation.
What is preterm birth?
Babies born at less than 22 weeks of gestation or with a birth weight of less than 500 grams are not considered viable. Around 7% of pregnancies result in preterm births and in 0.5% of pregnancies, babies are extremely preterm, born between 24 and 28 weeks of gestation. The earlier the baby is born, the greater the risk of consequences: the rate of complications is estimated at 50%.
There are several causes for preterm birth. The term induced preterm birth is used when the birth is induced upon medical decision while the term spontaneous preterm birth is used when labor begins naturally. The causes of preterm birth may be related to the mother, such as preeclampsia (gestational hypertension which develops in the second half of the pregnancy (after 20 weeks of gestation) and proteinuria, i.e. the presence of excess proteins in the urine - whether physiological or pathological) or related to the fetus itself, such as chromosomal anomalies or delayed development. Other causes may be loco-regional (concerning a specific part of the body) such as a malformed uterus or an excessively large cervix.
Other risks may give rise to spontaneous labor:
If the mother is aged under 18 or over 35,
If she does heavy work,
If she consumes toxins, particularly tobacco.
What care or treatment is delivered to newborns?
Babies are looked after in a maternity hospital that can meet their needs. An extremely preterm baby must be looked after in a Level III maternity unit, which is generally a university hospital. Organs are formed and finished during the pregnancy. When the baby is born preterm, the organs are not yet mature and each one requires specific care.
The ductus arteriosus closes at birth when babies are born at term. Preterm babies must be monitored regularly with echocardiography. If the ductus arteriosus does not close, medical treatment may be proposed. In rare cases, surgery may be necessary.
To breathe at birth, the baby may be assisted by machines, invasively or non-invasively. The duration of such treatment varies greatly from baby to baby.
A preterm baby is not able to regulate its temperature itself, and therefore requires a heated incubator.
The ability to suck is developed from 32 weeks of gestation. To feed a preterm baby, two systems are available: feeding through an intravenous line or by nasogastric tube, through which it is possible to deliver the mother’s breastmilk.
Milk intake is initially exclusively breastmilk from the mother or another woman through a donation to the milk bank.
Extremely preterm babies’ vision must be monitored by an ophthalmologist by means of regular fundus examinations.
Highly fragile in the first days after the birth, great care must be taken by using mild products, particularly during perfusions.
A preterm baby sleeps a lot during the day and interacts less than a baby born at term. It can, however, recognize its mother’s smell and is sensitive to touch. This is why types of nursing care such as skin contact, cocooning and placing clothing with a familiar smell in the incubator have been developing in recent years. This allows the baby to create an interaction with its parents and to get to know them.
Preterm babies are monitored over the long term. Some preterm babies may have more fragile lungs. They are at greater risk of developing childhood asthma. In terms of psychomotor development, the fact that the child was born preterm is considered until the age of 7. A preterm baby spends the first months of life catching up on the lacking time in the womb and there is a difference with a full-term baby. It is for this reason that the notion of “corrected age” is used. Motor development, speaking, gripping and understanding are monitored closely by a specialist doctor.
There may be consequences such as impaired coordination, learning difficulties or behavioral disorders. These must be detected as early as possible so that assistance may be provided to contribute to an optimal psychomotor development.
- In the event of a high-risk pregnancy, you should be monitored regularly in a specialist center able to treat a preterm baby. - If there is a real risk of preterm birth, it is possible – in some teams – to meet the pediatricians who will look after your child after birth.
MSH International is there to support you
Declare your pregnancy before the end of the third month, stating the expected term date. You will then be contacted by our medical team who will help you to find the best healthcare facilities and will support you throughout this important time. You will also receive a maternity guide which includes a range of practical advice to help you to understand more fully your pregnancy, the birth and the first weeks with your child and a “Baby Welcome Pack”.
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