Caring for a premature baby

In addition, an estimated 10.9 per cent of babies are born with a birth weight of less than 2.5 kg, which is still considerably above the percentage targeted by the Ministry of Public Health.

Figures released by Unicef in 2011 showed that the number of neonates in Thailand dying before reaching 28 days of age, or the neonatal mortality rate (NMR), was 8 in 1,000 live births. This figure was twice the rate found in developed countries, and resulted in an increase in the infant mortality rate (IMR) in Thailand, as NMR accounted for 60 per cent of the total IMR in Thailand. Together accounting for a total of 80 per cent of these deaths, the 3 major factors were prematurity and low-birth-weight (LBW), infection (sepsis), and lack of oxygen (asphyxia). 

When adults are in a critical condition, they are admitted to an ICU (Intensive Care Unit) for close observation and treatment. Newborns, on the other hand, go straight to the NICU (Neonatal Intensive Care Unit) as they require special equipment, neonatologists and neonatal nurses.

In a normal scenario, foetuses have developed in the womb for at least 37 weeks before they are born and the normal birth weight is at least 2.5 kg. Operating on babies born with a low birth weight is no simple matter because most of the organs are very small and not fully developed. For example, generally, at 23 weeks old, foetuses are quite active and enjoy experimenting with their body movements. The blood system and the veins have started to develop and the lungs are also developing as they prepare for breathing air. At the same time, the foetuses’ hearing is becoming well established and they start to hear loud noises. However, if they are born at this stage, their blood circulation is not fully functional, resulting in heart and lung problems that will require surgical intervention.

Each foetus in the uterus has a major blood vessel, the ductusarteriosus. This blood vessel is an important part of foetal blood circulation and feeds its heart. This vessel closes at the completion of the full term of the pregnancy. However, in the case of a premature birth, the vessel remains open and surgery will be required to close it; otherwise it can put extra strain on the heart and increase the blood pressure in the lung arteries, which can be fatal. After the surgery, the baby will stay in an incubator in the NICU. A ventilator will be used to help the baby breathe as well as a nasogastric tube for milk feeding and all necessary medications.

In addition to premature births, another common case of fatalities among newborns is meconium aspiration syndrome. Meconium is a newborn’s first intestinal discharge. It is a viscous, dark-green substance composed of materials ingested during the time the infant spent in the uterus such as intestinal epithelial cells, mucus, lanugo, and intestinal secretions. Meconium is normally stored in the infant’s intestines until after birth, but sometimes if there is a foetal distress, meconium is expelled into the amniotic fluid prior to birth or during birth. If the baby inhales the contaminated fluid, the pressure within their pulmonary space will be high because the air is allowed to accumulate inside, but prevented from being fully exhaled. Thus, the lung may become over-expanded and infected, resulting in rapid breathing after delivery. In a severe case, the lack of oxygen may be fatal. 

When the baby suffers from meconium aspiration syndrome, medication and a ventilator may not be enough and if severe lung infection is present anextracorporeal membrane oxygenation (ECMO) will be required to save the baby.

 

*Source: Bureau of Policy and Strategy, Ministry of Public Health (Statistics from 2007 to 2011)

 

 

Dr Raungpung Tangpolkaiwalsak is a Neonatal-Perinatal Specialist at Samitivej International Children’s Hospital, Sukhumvit Campus. Call (02) 711 8236-7.