Health, according to the World Health Organization, is “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”.[1] A variety of definitions have been used for different purposes over time. Health can be promoted by encouraging healthful activities, such as regular physical exercise and adequate sleep,[2] and by reducing or avoiding unhealthful activities or situations, such as smoking or excessive stress. Some factors affecting health are due to individual choices, such as whether to engage in a high-risk behavior, while others are due to structural causes, such as whether the society is arranged in a way that makes it easier or harder for people to get necessary healthcare services. Still other factors are beyond both individual and group choices, such as genetic disorders.
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Although premature babies have become far too common these days, their chances of survival can increase if the parents pay more attention to the baby’s care.
There has been an increase in the number of preterm or premature births over the years. According to the World Health Organisation (WHO), approximately 15 million preterm births occur globally each year, and around 1 million babies die with prematurity-related complications or due to insufficient treatment and care. Preterm birth and related complications impact families worldwide, making it imperative to develop an understanding of the condition, raise awareness and act according to what is needed.
Over the last couple of decades, India has also seen a significant number of premature deliveries and the associated problems these preterm babies go through. The various stakeholders involved in the management of multimodal ‘neonatal healthcare’ include paediatricians, obstetricians, nurses, and allied intensive care specialists. Such multi-modal teams that can execute specialised treatments work extensively towards ensuring the health and well-being of premature babies.
What must be kept in mind?
While premature babies are offered treatment and care at specialised units – NICUs, it remains equally important to monitor them once they are discharged and taken back home. Saving these babies is definitely the prime requirement for a neonatologist. However, it is also essential to sustain them into fully healthy and wholesome babies.
Awareness and timely intervention to therapy and care remain the key for minimising the health risks associated with premature births, reducing neonatal mortality rates and improving the overall expectancy of a preterm baby with a healthy life ahead.
Some important aspects of the care model are outlined below:
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Family planning and awareness:
Raising awareness about preterm births and prematurity in India remains a concern. The fact that prematurity cases require the availability of specialised healthcare needs today is still unknown to many. In today’s world of rapid urbanization, prematurity is one of the risks associated with postponed pregnancies in slightly older working women.
A child born before the completion of 37 weeks in pregnancy or three weeks before the due date is known to be a preterm or premature baby, who requires special care due to the organs being underdeveloped. Hence, it is critical to have regular antenatal check-ups by an obstetrician, follow their advice and have a parental guide for the journey of prematurity to plan your pregnancy along with the family.
Follow expert advice to take the best possible care. Image courtesy: Shutterstock -
Mitigating the possible risk factors:
Concerns about prematurity are not just about the short term as in some cases. They can be long term and could last up to 18 years of age. Multiple pregnancies, IVF, congenital anomalies, diabetes, intrauterine growth retardation, placental abnormalities and pregnancy-induced hypertension can lead to preterm births. Inadequate prenatal nutrition could also lead to abnormal neurodevelopment of these babies. Placental abnormalities result in growth failure, neuronal deficits and poor behavioural and cognitive outcomes in these vulnerable babies. The long term aim of care is to give a healthy life to the baby with minimal morbidities. Hence, it is important to monitor placental activity through regular check-ups, conduct ultrasound imaging for early detection and treatment of premature babies.
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Multimodal treatment approach:
To cater to high-risk pregnancies or premature babies, a healthcare facility requires a multidisciplinary team approach. An obstetrician is the first point of contact for pregnant women, followed by a sonologist and then a foetal medicine specialist. The foetal medicine experts specialise in looking at the pictures of the foetus in the uterus and deriving information from it. Paediatricians and neonatologists deal with aspects related to the baby. The team also comprises antenatal and genetic counsellors to ensure a complete system of care coverage. These units are there to address all the aspects for the complete well-being of the mother and the baby, which should be the central point of the care delivery model.
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Institutionalization and caution:
The preterm babies are taken care of in specialised units at hospitals, but they are not completely safe once they are discharged and taken home. Getting used to life at home is important for the baby since there is a considerable amount of change from the hospital environment. Usually, parents become anxious and puzzled during this phase due to the absence of doctors at home.
The most important advice here would be to follow the instructions in the discharge summary, which parents often miss out on. Spending time with the baby before discharge to understand the problems and share feedback with your doctors remains crucial. Premature babies are highly exposed to the risk of infections, dehydration and sepsis. The parents will have to regularly watch out for signs of lethargy or laxity in the baby as well as closely monitor the baby for temperature.
The last word
The bottom line remains that premature babies will need the special attention and care that they deserve so that they can survive and make their mark. This will be the joint responsibility of the doctor and facility that the parent selects!
Dr Shashidhar Vishwanath
Lead consultant Neonatologist and Paediatrician,
SPARSH Hospitals, Bangalore,
MBBS, MRCPCH, FRCPCH, DCH(Leeds, UK), CCT(UK), PGPN (Boston, USA)
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