Preterm birth is one of the major issues facing modern healthcare science. It is estimated that premature births account for more than 10% of live births and more than 40% of all new-born deaths globally. Preterm babies possess immature immune systems with reduced innate and adaptive immunity, resulting in weak defense against disease-causing pathogens. Also, intrauterine inflammation, which is a major contributor to preterm birth, leads to reduced immune function in new-borns. The development and functioning of immune systems are further impacted by necessary medical interventions. All these factors cumulatively add to the lower defending power of the infant against invasive and harmful pathogens.
There is a huge gap prevailing between mortality rates of preterm babies in high income developed countries and those born in low-income developing countries. Over the last four decades with increasing evidence-based care for premature babies in high-income countries, the risk of long-term impairments is mitigating gradually. With Neonatal Intensive Care moulding into a more non-interventionist form, some aspects are also becoming potentially feasible for adaptation in low-middle income nations. Some notable advancements in this aspect include widespread use of antenatal corticosteroids in high and some middle-income countries, incubation of highly skilled trained nurses and frontline workers in the child healthcare domain, and deliberate attention to baby and family-friendly care services.
Precautionary measures to reduce long-term impairment in preterm babies
Despite all the advancements, the risks faced by preterm babies are quite high and suitable precautionary measures ought to be taken to alleviate the long-term and short-term impact. Some of the preventive measures are outlined below: -
In the case of hypothermia (low body temperature) which causes increased risk of infections, mortality, and RDS, simple thermal care (Drying, warming, skin-to-skin, and delayed bathing) won't suffice. Extra thermal care support systems should be initiated including new, novel techniques like the use of Kangaroo Mother Care, baby hats, blankets, overhead heaters, incubators.
In cases of cord and skin infections or neonatal sepsis, hygienic practices like regular hand-cleaning should be maintained. The other alternatives are delayed cord clamping and the use of chlorhexidine and emollients.
Preterm babies are also in danger of being victims of hypoglycaemia (Low blood sugar). This causes increased risks of impairment or death or both. The only cure for this is increased blood sugar levels through early and exclusive breastfeeding. Also, in case of serious situations, advanced breastfeeding techniques can be used like a cup or tube feeding. Lack of breast milk is a risk factor for necrotizing enterocolitis in preterm babies.
Things parents of preterm babies can do at home
These old, true, and tested natural practices should be used as precautionary measures, by parents at home.
Breast Feeding: Breast milk contains loads of molecules that boost the immunity of baby and help them fight against a wide variety of common infections. Breast milk also acts as continuous source of antibodies from mother to baby. Breast milk is known to reduce gut infections significantly. In circumstances where mother milk is not sufficient, consider availing donor breast milk.
Clean Care: The clean and hygienic practices employed in NICU should be continued at home. Keep babies' clothes separately and also wash them individually with hot water. Wash your hand after using toilets, after nappy change, before preparing milk/ feeding the baby etc.
Avoid environmental exposure: Although preterm babies can't live in a bubble, limit the exposure to visitors and outside travel. Limit the visitors and completely avoid them if they have cold cough or stomach bug.
Provide warmth: Kangaroo mother care is an excellent way to boost bonding, immunity, and warmth. Use room heaters, extra clothing (mittens, socks, caps etc) wherever necessary.
Vaccination: Vaccine are very important to protect against serious infection. Regularly follow up with your paediatrician and take vaccinations on time.
Probiotics: Though it sounds a bit strange, recent studies indicate that more than 80% of the child's immunity came from the gut. So, investing in probiotics is both a cost-effective and risk-mitigating option for taking care of the baby at home.
Daily Massage: Recent studies reveal that daily, frequent massages can not only help build immunity but also leads to reduced stress and faster weight gain for premature babies.
The article is contributed by Dr Sameer S Rao, Consultant Neonatologist & Paediatrician, Motherhood Hospitals, Banashankari, Bangalore.
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