In France, 60,000 births of premature babies are recorded each year, which represents 8% of births. What Defines a Premature Baby? How is it taken care of? Explanations.
A baby is born premature every 8 minutes in the country. We talk about premature birth when the child is born before 37 weeks of amenorrhea (WA) or 8 months of pregnancy. There are several types of prematurity depending on the stage of pregnancy. We speak of very great prematurity between 24 and 28 weeks, of great prematurity between 28 and 32 weeks, average prematurity between 32 and 37 weeks.
What can cause a premature birth?
There are several factors that can cause premature birth even though "in a number of cases, we do not find a cause", Reports the SOS Préma association.
In 50% of cases, premature births are spontaneous: early contractions appear without knowing why or the water sac ruptures before the normal term of pregnancy (37 weeks) and before labor begins. The premature rupture of membranes could be linked, in 30% of cases, to an intrauterine infection. Unfavorable socio-economic conditions and smoking are also implicated.
The remaining 50% of premature births are induced births by decision of doctors because the continuation of the pregnancy puts the mother and / or the fetus at risk of death. The birth is most often done by caesarean section because the mother has severe high blood pressure or a internal bleeding or because the fetus displays a severe growth retardation. At the origin of 20% of deliveries before 32 weeks of pregnancy, severe maternal hypertension increases the risk of serious complications such as pre-eclampsia or eclampsia (convulsions in the mother with cerebral damage), liver problems , destruction of red blood cells and blood platelets.
The premature birth of the baby can also be decided if igenitourinary or generalized infection, ofabnormalities of the uterus and placenta (placenta previa for example), maternal diabetes or a premature detachment of the placenta accompanied by a hematoma.
Finally, the multiple pregnancies are responsible for a third of infants born prematurely.
Premature babies, a fragile baby who must be watched closely
A baby born before term is by definition not fully developed in utero. All of its organs are present but they are immature. “This mainly concerns four organs: the brain, the lungs, the digestive tract and the arterial duct ”, says Inserm. For example, a premature newborn with “immature” lungs may have breathing difficulties that require ventilatory support for a few days. Also, before the 34-36 week term, the premature baby should be fed with a nasogastric tube because he is not yet able to coordinate sucking, swallowing and breathing. As their neuro-respiratory control is immature, premature infants under 34-36 weeks frequently take breathing pauses. These apneas can be associated with slowing of the heart rate (bradycardia). Premature babies with an immature liver are also more likely to develop jaundice (jaundice).
Finally, the immaturity of their immune system exposes them to potentially serious infections.
What is the management of the premature newborn?
The care process for a premature baby is done through hospitalization. It depends on his level of prematurity. The more premature he is, the more fragile his health.
Very very premature babies and very premature babies are placed in the neonatal intensive care unit which administers them the necessary care adapted to their risks and is closely monitored. Once their condition has stabilized, they are sent to intensive care and then to the neonatal unit. Premature babies are placed in an incubator to be kept at a temperature of 34/35 ° C (in utero temperature) with a humidity level of 80%. Babies can get out if their weight is at least 2 kg.
A baby born prematurely can be discharged from the hospital when he is respiratory and digestive independent. But before that, he can receive a number of treatments.
How to deal with pulmonary immaturity?
In addition to ventilatory assistance, the premature baby is administered a drug from the first hours of life, delivered directly into the lungs through an intubation tube. It is a medicinal surfactant, a substance that lines the airways of the lungs and helps them to function properly. Namely, in the event of a predictable premature birth, the expectant mother benefits from corticosteroids in the 10 days preceding the birth to accelerate the maturation of the fetal lungs.
How to deal with the immaturity of the central nervous system?
This mainly concerns premature infants under 32 weeks gestational age. In this case, the infant is monitored regularly during the first month of life using electroencephalograms and brain ultrasounds. A hearing check is also carried out before returning home.
How to deal with digestive immaturity?
The child is fed with a catheter attached to his stomach, and later with a spoon, cup or syringe. Its nutritional needs are special. The milk with which he is fed depends on his gestational age, his postnatal age, the mother's desire to breastfeed … It can be breast milk, lactarium milk or specific milk for premature babies. Breast milk or milk milk can sometimes be fortified.
If the premature baby can latch on to its mother effectively, breastfeeding can be considered, even if sucking is weak (its weight is regularly monitored to adjust food intake).
How to deal with the immaturity of the cardio-respiratory rhythm?
To compensate for the decrease in the amount of oxygen in the blood (due to apnea), a derivative of caffeine is given to the baby to stimulate the neuro-respiratory centers. Assisted nasal ventilation can also be used.
How to manage hepatic immaturity?
Blue light phototherapy is the treatment indicated to remove excess bilirubin in the blood (responsible for yellow complexion).
How to deal with kidney immaturity?
The volume and content of the urine of the premature infant are checked regularly to check the intake of mineral salts and adapt the infusion and feeding volumes accordingly. Very premature babies are given erythropoietin, a hormone normally made by the kidney and needed to make red blood cells.
Many advances in the care of premature babies
The treatments mentioned above are integrated with the greatest respect for the child's sleep / wake rhythm to stress him as little as possible. In addition to medical care, there is developmental care which includes "all the environmental and behavioral techniques aimed at helping the harmonious development of the child born before term", Explains the SOS Préma association. NIDCAP is the most successful form today and the one that has shown significant effectiveness (reduction in the length of hospital stay and improvement in child development at 9-12 months). This method notably integrates skin to skin, parental participation in care, non-nutritive suction, reduction and adaptation of the sound level and the light level, etc.
Despite complete and personalized care, neurological sequelae are frequent, especially in very premature babies. This can be motor disturbances with delayed or difficulty walking, cognitive impairment with oral or written language difficulties, or attention disturbances and sensory, visual or hearing disturbances.
While the number of premature births has increased by 20% since 1995, it is important to note that their care has improved considerably over the years. We observe "a significant improvement in survival and survival without severe neonatal morbidity in children born between 25 and 31 weeks since 1997 ”, notes Inserm.
So fragile at birth, premature babies are stronger than you think!
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