Tiny Fighters: Understanding Premature Births in Malaysi

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World Prematurity Day is observed on 17 November each year to raise awareness of preterm birth and the concerns of preterm babies and their families worldwide. Purple is the official colour for World Prematurity Day. In this article, Dr Cheong Shu Meng, Neonatologist and Paediatrician at Sunway Medical Centre, Sunway City (SMC), discusses the prevalence, causes, and complications of premature birth and what mothers should know.

Prematurity, also called preterm, is defined as a birth that occurs before 37 completed weeks of gestation. There are sub-categories of preterm birth based on gestational age:

• Extremely preterm (less than 28 weeks)
• Very preterm (28 to less than 32 weeks)
• Moderate preterm (32 to less than 34 weeks)
• Late preterm (34 to less than 37 weeks)

An estimated 13.4 million babies were born too early in 2020. That is more than 1 in 10 babies. Globally, prematurity is the leading cause of death in children under the age of 5 years. Many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems.

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The Causes of Preterm Birth
Malaysian National Neonatal Registry (MNNR) reported 319,867 total live births in the participating hospitals in 2020, in which 10.7% of livebirths were delivered preterm at less than 37 completed weeks with 77.6% delivered at late preterm gestation between 34 to 36 completed weeks.

Preterm birth can be caused by:

• Chronic health conditions, such as diabetes or infections.
• Drug or alcohol abuse.
• Multiple pregnancies, such as twins or triplets.
• Preeclampsia (high blood pressure during pregnancy).
• Problems with their uterus or cervix.
• Short interpregnancy interval.
• Vaginal bleeding or infections during pregnancy.

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Complications in Preterm Babies
Preterm babies often have complications due to prematurity, and the severity of the complications is inversely proportional to the gestational age of the baby.

Complications of preterm babies include:

• Breathing problems such as respiratory distress syndrome (RDS) due to lack of surfactant, apnoea of prematurity in which they have temporary cessation of breathing and bronchopulmonary dysplasia (BPD) in which some preterm babies with severe BPD will require home oxygen therapy.
• Heart problems, in which the most common heart problems are patent ductus arteriosus (PDA) and low blood pressure.
• Intraventricular haemorrhage (IVH) or bleeding in the brain.
• Temperature instability, especially hypothermia.
• Feeding problems due to the immature digestive systems, which can lead to issues such as necrotising enterocolitis (NEC) or inflammation of the intestines.
• Higher risk of getting infections due to an immature immune system. Sepsis occurs easily in preterm babies as the infection can quickly spread to the bloodstream.
• Retinopathy of prematurity, or underdeveloped blood vessels in the eye.
• Blood problems such as anaemia and jaundice.

Preterm babies are also at a higher risk of neurodevelopmental delay. Complications during the neonatal period can contribute to the severity of the neurodevelopmental delay. These include:

• Cerebral palsy. This group of disorders can cause problems with movement, muscle tone or posture.
• Learning disabilities.
• Behavioural problems.
• Vision and hearing problems.
• Poor growth.

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Treatment Management for Preterm Birth
As preterm babies require intensive care upon birth, it is best to go to a hospital that has a neonatal intensive care unit (NICU) when having preterm labour, in which these preterm babies are under the care of the neonatologist. A neonatologist is a paediatrician who subspecialises in caring for newborn babies, particularly those who are ill or born prematurely.

To have a good outcome for preterm babies, the management includes:

• Antenatal corticosteroids help to speed up the baby’s lung growth and decrease the chances of breathing problems if the baby is born preterm.
• Stabilisation of preterm babies during golden hour. The golden hour in neonatal life is the first hour of post-natal life in both term and preterm babies.
• Support breathing – early continuous positive airway pressure (CPAP), ventilatory support, surfactant, caffeine and judicious use of oxygen.
• Nutrition – address feeding issues, total parenteral nutrition (TPN), breast milk, etc.
• Prevent hypothermia – incubator nursing
• Treat infection, PDA, anaemia, etc
• Kangaroo mother care (KMC).

Unfortunately, preterm birth cannot always be prevented. However, there are steps to reduce the risk of having preterm labour.

• To have an early booking with an obstetrician and have regular antenatal follow-up.
• Good control of medical illnesses such as diabetes, high blood pressure, or depression.
• Do not smoke, consume alcohol or use illegal drugs.
• Healthy diet.
• Gain a healthy weight (not too much or too little).
• Reduce infection risks – good hand hygiene, avoiding raw meat/fish or unpasteurised cheese, not handling cat litter, etc.
• Reduce stress levels.
• Wait at least 18 months between pregnancies.

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Impact on Family Members
When a baby is born prematurely, it can have a substantial emotional impact on the entire family. Preterm labour can cause anxiety, post-partum depression, post-traumatic stress disorder (PTSD) and mother-baby bonding difficulty. Empathy from healthcare providers who are looking after preterm babies is essential, and directing them to registered preterm support groups or counsellors can be beneficial to them, too.

When a preterm baby is fit for discharge, preterm baby care counselling is important to ensure that parents are confident to take care of the baby at home. Follow-up appointment is given to monitor their growth and neurodevelopment.

In summary, it is important to have good antenatal care and, if possible, to avoid preterm labour, which can lead to preterm babies being born too early. However, preterm birth is not always preventable. Hence, delivery of preterm babies is best to be done in a hospital with NICU beds to ensure optimal care is provided to these preterm babies for a good outcome.

This article is contributed by Dr Cheong Shu Meng, Neonatologist & Paediatrician at Sunway Medical Centre, Sunway City, and does not represent the views or opinions of Health Matters Malaysia.

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