Born too soon

CHENNAI: Becoming a mother is joyful indeed, but when a woman delivers a pre-term baby, that blessed experience quickly turns into a nightmare. And what’s shocking is that one in five children is born pre-mature in Tamil Nadu which is similar to the number of cases across India too.

Since Tamil Nadu has far better infrastructure facilities in its government hospitals, especially the Neonatal Intensive Care Unit (NICU), ‘1 in 5’ is an alarming statistic.

Dr Deepa Hariharan, senior consultant neonatologist, Sooriya Hospitals, author of the study titled, ‘Oral Motor Intervention in NICU’, also highlighted neonatal care practices and concerns about pre-term babies (also known as preemies).

“The number of prematurity has also increased over the years and it would only go upwards in the future,” said Dr Deepa.

A pre-term delivery is a baby born in less than 37 weeks of gestation. Treating a preemie is expensive, and costs more than even treatments for heart-related issues and cancer. In most cases, parents and their families are unaware of this.

“The cost of admission for a preemie admitted in a NICU at a private hospital with ventilator support varies from Rs 10,000 to Rs 40,000 per day, with an average of Rs 15,000 to Rs 20,000,” said a doctor from a city-based private hospital.

Reasons for pre-term delivery

A baby born after the gestation period of more than 34 weeks can be saved, most of the time, even in a small hospital as the baby could be fed directly from the mother.

“However, it’s absolutely necessary for babies born before 37 weeks to be admitted in the hospital, as they require maximum medical attention and round-the-clock nursing care,” opined Dr Rema Chandramohan, director, Institute of Child Health, Egmore.

Preemies are a huge risk in teenage pregnancies. If the mother has anaemia, diabetics, hypertension, etc., and whether she gained adequate weight during pregnancy, are all factors to determine whether the baby would be a preemie.

“Due to the late marriages and infertility treatments, doctors and parents want to spend money to treat preemies, as the chances of getting pregnant again could be risky for both the mother and baby,” pointed out Dr Deepa.

Some pre-term deliveries may not be preventable, and are genetic, like pre-eclampsia (high BP-related disorder during pregnancy). She recalled a case in which a patient had to undergo a C-section in the 28th week of pregnancy due to pre-eclampsia. A baby boy was born, and he weighed just 1.1 kg. He was in the NICU for 71 days, gained weight and was discharged. He’s now a healthy baby.

“Expecting mothers have to maintain optimal weight before pregnancy, follow moderation in diet and also exercise regularly to reduce the risk of gestational diabetes, which can lead to pre-term labour,” she explained. “Pregnancy-induced hypertension, up to a certain extent, is genetic but it’s also due to lifestyle. There are surveys that reveal stress, excess travel and certain infections as reasons for pre-term delivery.”

Health concerns

“For a preemie, major health concerns will be getting enough nutrition, maintaining sugar and calcium level, hydration, temperature and sepsis, among other challenges,” added Dr Rema.

Retinopathy is a common issue that preemies face when they grow older, though the number of children affected by this condition has reduced remarkably over the years.

“A preemie child can have issues with hearing and abnormal neurologic development,” opined Dr Deepa. “Keep the surroundings clean. Wash your hands and maintain very high hygiene standards before you touch the baby. In some cases, a preemie’s lungs are not well-developed as it’s the last organ to develop. So surfactants, which expand the lungs, are given to them.”

Most preemies face difficulty in feeding and breathing. “In some cases, the baby and mother are separated, and preemie is supported using the milk bank,” said G Shanti, nurse in-charge, department of neonatology, ICH. “The kangaroo model is another important form of care given to preemies where they’re carried by their mothers offering skin-to-skin contact. Health complications and the care given varies with every baby.”

GHs fully equipped

Many hospitals, both in private and government hospitals, have set up NICUs so that the mother and the baby are not separated. “Compared to 20 years ago, there has been a huge increase in the number of pre-term deliveries, stated Dr Deepa.

“If a preemie weighs less than 1,000 grams, survival is difficult. Only 30% of such babies make it,” said Dr CN Kamalarathnam, HoD, neonatology, ICH.

The government hospitals in TN have all the facilities on par with those in the private sector. “Non-invasive ventilation, human milk bank, kangaroo mother care, robust neonatal transport system which carries babies from delivery point to NICU, bedside x-ray facilities, surfactants, etc., are all available at GHs,” he added.

Support for mothers

Mothers of preemies also need support from other mothers who have undergone similar situations. So, relying on support groups helps them manage any challenges.

Educating mothers about pre-term pregnancy and delivery is also very important. By mid-trimester, women with a history of pre-term delivery must take bed rest to prevent it from happening again.

“It’s always advisable for a woman to get pregnant after she is 21 years of age. That’s when her uterus is fully developed to carry the baby,” pointed out Dr Rema.

When the cervical lens is small or decreasing in the 22nd week of pregnancy, it’s most likely the patient would have a pre-term delivery. “Also, more often than not, if the woman has had a history of pre-term delivery, there is a high chance her next baby be born pre-mature,” said Dr K Kalaivani, Director of Institute of Obstetrics and Gynaecology, Egmore. “During the COVID period, the number of pre-term deliveries was higher as several expectant mothers were infected with the coronavirus and some babies had to be delivered early.”