Hello everybody, I am Praveen, neonatologist at NCRI neonatal network. Today, I’m talking about a very common condition called prematurity. Normally, the new-borns are born after the completion of 40 weeks inside the womb. Any infant who is born before 37 weeks that is 3 weeks prior to the due date are called premature infant. Now, prematurity can range between 24 weeks till 36 (weeks) plus 6 days of age. The problems related to prematurity also depends on when these infants are born. Generally, the infants who are born from 34 to 36 plus 6 days are called late prematurity. These infants have more problems compared to a baby who’s born in 40 weeks. However, they have much less problems compared to somebody who’s born at less than 32 weeks of gestation age. The prematurity incidents is roughly around 10 to 12 percent throughout the world.
Not all the reasons why premature infants are known, however, infections in the mother, high blood pressure in the mother or multiple pregnancies that means, where the twins or triplets are there, prematurity can happen. If the spacing between the pregnancies are very less or mother’s nutrition status is poor or in any conditions where mother’s life is threatened due to the pregnancy, the premature deliveries take place.
The problems that the premature infants face once they are outside the womb is because of lack of opportunity for the organs to grow. However, as the time progresses, if they do not face any major problems, they do attain many of those functions. Once they are out of the womb, they are exposed to cold environment. Hence, they can become very cold, a condition called hyperthermia. This can have immediate as well as long term consequences. Hence, very small babies are immediately put into a plastic bag so that the evaporation of the water doesn’t cause low temperature in the infant. And every measure is taken to ensure that the baby doesn’t become cold throughout their stay in the neonatal intensive care unit. This might be helped by use of warmers, covering with the sheets and not exposing the infant and use of incubators.
The second problem that occurs in premature infants as soon as they are born is difficulty in breathing. This again depends on how premature the infant is, with extreme prematurity, the lungs are not matured enough and they lack a substance called surfactant which keeps the lungs open. If the lungs are unable to expand, then the oxygen will not enter the lungs and hence, the new-borns can be at a risk of hypoxia that is, low level of oxygen in the body. Hence, trained team of neonatologists, nurses are essential at the time of birth of premature infant. They would ensure that the baby gets oxygen by placing a tube inside the throat which gives oxygen directly to the lungs. And once the baby is in the neonatal intensive care unit, they might require the artificially prepared surfactant given through this tube which is called endotracheal tube. And also, these new-borns may not have adequate respiratory efforts. Hence, they might be placed on a machine called ventilator. The ventilator takes care of the breathing for the infant. The extent to which the problem in the lung is there will be determined by the X-rays as well as by a blood test called blood gas analysis. Depending on the severity the support from the ventilator is varied. Some infants need only for 2 days ventilation to some infants who need for even up to 3 weeks of ventilation as well.

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