4.1 The premature childbirth 4.2 Possible causes of the premature childbirth 4.3 Characteristics of the premature baby 4.4 Special cares 4.5 What parents can do for their premature baby 4.6 The release from the hospital

 

 

A baby is considered premature baby if he is born before the pregnancy arrives to term, although a baby is usually considered premature when the childbirth takes place before the 36ª week of the pregnancy.

The more premature the baby, the fewer the possibilities that the vital functions of the breathing, digestive and cardiovascular systems are sufficiently developed so that he is able to live outside of the uterus.

For example, if the childbirth happens in the 2nd week of the pregnancy, the baby would measure about 37 centimeters and he would weigh about 1 kilo. His lungs would have reached a certain level of development, but they would not be prepared to work correctly. He could survive, but with specialized hospital care and attentions.

Premature childbirths happen unexpectedly. Although the mother may be following a rigorous medical control, in many occasions it cannot be foreseen. In other cases it happens after trying to avoid an early childbirth.

The approximate percentage of premature childbirths is of 6% or 8% of the newborns.

A healthy woman can give birth, prematurely, to a completely normal baby.

If the baby is born after the 34th week he usually weighs more than two kilos and, with the exception of maintaining a strict surveillance, he doesn't require special cares.

When the baby is born before the 34th week, he weighs less than two kilos and he has had difficult conditions during the birth, it is very possible that he breathes with difficulty and he cannot eat well, besides running the risk of catching infections.

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SECTION 2 - BLOCK 4	CHAPTER 1	Date:
1. A baby is considered premature if he is born before the 36th week of the pregnancy. T r F r
2. The doctor can always detect when there is going to be a premature childbirth through the ecographies. T r F r
3. The premature baby must always remain in the incubator until he reaches nine months. T r F r
4. If the baby is born before the 40 weeks of pregnancy, his vital functions will not have developed fully. T r F r

The causes that induce the premature childbirth are very diverse, among those detected, the following ones are the most frequent:

Malformation of the uterus, problems of the opening of the neck of the uterus. During the first eight months of pregnancy the neck of the uterus is closed and it has a lengthened form. Around the beginning of the ninth month, the neck of the uterus shortens and it begins to open up. But it can happen that this process begins ahead of time and may start from the 6º month, thus inducing a premature childbirth due to the contractions that it produces.

Many malformations of the uterus or of the neck of the uterus can be due to the use of dietilestilbestrol, this is a substance that was withdrawn from the market in 1975 and that in the previous decade was frequently prescribed to prevent abortions in the first three months of pregnancy. The reason of its withdrawal from the market was motivated by the confirmation that the girls whose mothers had taken the drug during their gestation, presented some anomalies in their genital system that could provoke spontaneous abortions and sterility, besides having more risks of suffering extra uterine pregnancies, premature childbirths and cancer of the uterus.

•  Alterations of the placenta: previous placenta or precocious detachment of the placenta.

•  Ailments of the mother: anemia, thyroid problems, coronary or renal illnesses, etc.

•  Mothers with addictions to some kind of drug. Gravidic toxemia.

•  Traumatisms during the pregnancy that provoke uterine contractions.

•  Infections acquired by the mother: histeriosis, streptococci B, etc.

•  Twin pregnancies that provoke an abnormal distension of the uterus.

•  Excess of physical exercise, exhausting work or work carried out under bad conditions, daily long travels, etc.

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SECTION 2 - BLOCK 4	CHAPTER 2	Date:
1. When there is a premature childbirth, the causes are due to the body of the mother, her habits or customs (smoking, working excessively, etc.). V r F r
2. If the pregnant woman receives a strong blow on the abdomen, she could have a traumatism that unchains a premature childbirth. V r F r
3. Some pregnant women have uterine malformations that could be the use of dietilestilbestrol by their mothers when they were expecting them. V r F r
4. When a pregnant woman does excessive work and in poor conditions and with long daily travel, she has more chances of having a premature childbirth. V r F r

The premature state of the newborn will depend on his stage of development, presenting specific particularities that are due to the grade of immaturity of his vital organs. The more premature the birth, the smaller his size and weight.

In general, the head is big considering the rest of the body and the extremities are less developed, the arms and the legs are very thin, with fine, wrinkled and rosy skin. The fingernails are extremely soft and habitually they don't reach the end of the fingers.

The bones of the skull are still not ossified, mainly the occipital and parietal bones that are very soft. The face is small and in many cases it seems wrinkled, the hair is very scarce and he will possibly lack eyebrows. We can see the blood veins through the skin because there is little subcutaneous fat. The palms of the hands, the heels and the feet can be red or blue. The whole skin is covered by a great amount of lanugos hair.

Jaundice is more frequent among premature babies than in those born to term. Since it is more intense and durable, it is usually necessary to apply phototherapy by placing the baby under the blue light of ultraviolet lamps.

His vital functions

The premature baby's vital organs have not had enough time to complete their development inside the uterus, for that reason they usually present difficulties to carry out the indispensable functions for survival in the new environment. 

The breathing system

The muscles that intervene in breathing are weak, the center of the brain that governs breathing is immature and the lung alveoli have not completed their development. All these factors provoke breathing to be quick, superficial and irregular, with apneas (pauses in breathing) that can provoke incorrect cerebral oxygenation (hypoxemia). Due to the immaturity of his immunologic system, these breathing problems can be increased if the baby suffers pneumonia, an affection in the hyaline membrane or other complications.

The digestive system

The digestive system of the premature baby is not completely prepared to assume its functions. The suction and deglution reflexes are either weak or they have not yet appeared, the stomach has a very reduced size and the secretions that facilitate digestion are very scarce. However, the need to feed the baby is very big so that he has the indispensable nourishing substances to complete, in the shortest possible time, his process of growth and maturation until he reaches a similar level to that of babies born to term.

The nervous system

It also has not reached the indispensable maturity. He gesticulates very little, his movements are slow, the archaic reflections don't exist or are very weak, the same as the muscular tone. The premature babies usually have long periods of drowsiness and they don't go through the same phases of sleep and vigil as the babies born to term due to the lack of maturity of the center that regulates these processes.

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SECTION 2 - BLOCK 4	CHAPTER 3	Date:
1. The condition of the premature baby depends on the degree of immaturity of his vital organs. T r F r
2. A common characteristic of all premature babies is the excessive length of their fingernails. T r F r
3. When the breathing system of the premature baby is immature, his breathing is irregular, quick and superficial. T r F r
4. The premature baby evolves favorably thanks to the reflexes of suction and deglution. T r F r
5. Premature babies have lengthy periods of drowsiness. T r F r

The babies born before week 34 of pregnancy, or those that are under weight or whose vital organs are immature, require specialized care in the neonatology service of a hospital. This attention begins in the same moment of the childbirth when the neonatologist carries out the reanimation, installs the baby in the portable incubator and decides if he should remain several hours in the incubator of the hospital where he has been born or if it is necessary to transfer him to another hospital specialized in the care of premature babies.

The incubator is a glass case that has the means to create conditions similar to those that the baby had in the maternal uterus. It is used for the care of premature newborns that are under weight or have health problems.

All the incubators work in a similar way and they offer the same cares to the baby. To compensate the deficiencies of the breathing system, they regulate the humidity and the oxygen concentration, guaranteeing the oxygenation of the tissues and of the brain.

The incubator also regulates the temperature because the organism of the premature baby doesn't have the capacity of adaptation to the changes of temperature and he cools down easily.

The incubator has some protected openings to manipulate the baby and to offer him the cares that he needs without opening the case, this way the best hygienic conditions are guaranteed and the newborn is well protected because he has very few defenses and is susceptible to infections.

If the baby doesn't tolerate the feeding, the personnel of the hospital feeds him/her through a probe or perfusion.

The length of stay in the hospital varies between some days and several weeks, depending on the complications that come up and what takes to overcome them. When the quality of the breathing is satisfactory, the evolution of the weight reaches an acceptable level, the tolerance to feeding is adapted, there are no infectious episodes and the level of development of his vital organs is favorable, the baby will leave the incubator and spend some time in the cradle of the hospital until he reaches functional autonomy and enough weight to allow his transfer to his house.

SELF CHECK QUIZ
SECTION 2 - BLOCK 4	CHAPTER 4	Date:
1. If the neonatologist or pediatrician who assist the premature baby at the delivery room consider it necessary, the baby will be taken to a hospital specialized in the treatment of premature babies. T r F r
2. The incubator has the means necessary to create conditions similar to those the baby had in the maternal uterus. T r F r
3. The baby can be handled from the outside of the incubator but there is the risk that the germs from the outside may affect him. T r F r
4. The baby is released when he weighs two kilos. T r F r

 

When the parents are faced with a premature childbirth and a baby that is very different to the one they had imagined, they have feelings of concern, frustration and guilt.

In those moments the parents need emotional support and very precise information so that they overcome their initial feelings and collaborate with the hospital team in the baby's physical and neurological recovery. Their affective stimulation is decisive for the small one to achieve the development that he needs.

The voice of the father and of the mother and the sounds that he has listened to while he was in the maternal uterus have an incomparable therapeutic value in those moments.

They are many hospitals that allow parents an unrestricted access free to intensive care unit to foster the bond between the family and the premature baby.

It is fully demonstrated that the intimate contact with the mother, breastfeeding and the parents' words and loving songs favor the evolution of the newly born .

The baby needs the maternal milk (even more than those born to term)and the contact with his mother's skin to satisfy his psycho affective, immunologic and the nutrition needs. If his level of maturity doesn't allow him to suction, the hospital staff can use a probe or another method to give the baby the milk that the mother has provided.

When the baby is in the incubator, the parents can be located within his visual field, to speak to him, to sing to him and even to play with him through the openings of the incubator. It doesn't matter if he is connected to machinery, it is necessary for the parents and the baby to establish the affective bonds needed by all of them.

The "kangaroo method"

In many maternity wards of different countries from all over the world they use the "kangaroo method" whose results are, in general, very positive and, in many cases, spectacular.

This method consists on substituting the incubator for the mother's body that offers the baby the necessary heat. The contact with the skin and the maternal chest stabilizes the baby's heart frequency and improves his breathing rhythm. Without a doubt this contact guarantees the best physical and affective stimulation so that he evolves correctly.

When the time finally comes of releasing the baby so he can be taken home, the parents usually feel some kind of uncertainty because they see their baby as very small and weak.

To acquire the trust and necessary tranquility, they should request the personnel of the hospital to explain to them all the details of the cares that the baby requires.

It is convenient to observe how the nurses take care of the baby during the time that is in the hospital and to request for advice in the topics that they may have doubts.

•  The intervals of time between takings.

•  How to bathe and change him.

•  How much water to offer.

•  How and when to put to him to bed him.

•  Orientations on the temperature and humidity of his room.

•  Any other question that they may have.

In the following visits, the pediatrician will follow up on the baby's evolution and he will tranquilize the parents responding to the questions that they may ask.

SELF CHECK QUIZ
SECTION 2 - BLOCK 4	CHAPTER 6	Date:
1. Parents should ask all the questions they may have before taken their premature baby home. T r F r
2. When the baby's weight has reached normal levels, his vital organs function correctly and he feeds without problems, even if born prematurely, the baby no longer needs special care. T r F r
3. Parents should protect in special ways the premature baby during all his childhood. T r F r
4. For the baby to evolve properly, parents should follow strict sleep and feeding timetables. T r F r