Premature babies are babies born alive before 37 weeks of pregnancy are completed. Every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising, according to the World Health Organisation.
The world health agency noted that in lower-income countries, on average, 12 percent of babies are born too early compared with 9 percent in higher-income countries.
Statistics by WHO places Nigeria third among top 10 countries with the highest number of preterm births, with 773,600 preterm births per annum.
Speaking in an interview with PUNCH HealthWise, a paediatrician at the Barau Dikko Teaching Hospital, Kaduna, Dr. Anisa Yahaya Lawal, says the gestational age, birth weight, the availability of the right facilities, well-trained personnel and equipped health centres are the determinants of the survival of premature babies.
In addition, the expert said those born below 28 weeks have fewer chances of survival in low-income countries like Nigeria, because the official age of viability is 28 weeks in the country.
“Those that are delivered close to term like 36 weeks do better. Those that weigh less than 1,000g survive less than those with higher birth weight.
“The time of referral also matters. It is advised that babies born where there are no facilities to care for them are referred to a good health centre as soon as possible or transfer the mother to a better centre while the baby is still in her womb.
“The availability of the right facility makes babies born prematurely survive better; like the presence of a neonatal intensive care unit in a hospital, presence of the machines like the incubator and the ventilators or the Continuous Positive Airway Pressure machine.
“The presence of well-trained personnel like doctors and nurses. All of these are factors that help premature babies to survive,”
She said the causes of preterm birth vary and it include infections, chronic conditions such as diabetes, sickle cell anaemia, heart disease, thyroid disease, hypertension, multiple pregnancies, fetal distress, erythroblastosis fetalis.
She added that other causes are placental insufficiency, abruption placenta, placenta previa, abnormal uterine shape like bicornuate uterus, cervical incompetence.
“Other causes are young maternal age like mothers that are less than 17 years and mothers that are above 35 years, substance abuse, cigarette smoking and a woman who have had a previous preterm birth is at higher risk of another preterm birth,”
She, however, said sometimes there is no identified cause of having preterm births. The expert noted that babies born prematurely develop complications like respiratory distress syndrome, chronic lung disease, pneumonia, congenital heart diseases (patent ductus arteriosus), intraventricular hemorrhages in the brain, infections, aneamia, jaundice, retinopathy of prematurity.
Dr. Lawal said prematurity in babies can be prevented with good nutrition, regular ante-natal care, prompt diagnosis of symptoms of preterm birth.
“It is also important to refer mothers to well-equipped health centers that will be able to cater for the baby in case it is delivered.
“Then, pregnant women need to be educated on the signs of imminent delivery and labour and in case of inevitable deliveries, mothers can be given corticosteroids to aid in the lung maturation of the babies to prevent respiratory distress syndrome when the baby is delivered,”
The paediatrician noted that a preterm baby can be well-managed if the baby is in a facility that can cater for it when it is delivered.
“The baby has to be kept warm immediately, ensure that the child is breathing and also there may be a need to assist the preterm baby to breath using oxygen, CPAP or even ventilators, caring for the baby in an incubator where it will be kept warm with the right amount of temperature and humidity,”
According to her, Nigeria still has a long way to go in terms of the right facilities and equipment to cater for preterm babies.
“In my centre, we still lack a lot of the needed equipment, and the ones we have are grossly inadequate in terms of number,”
the expert said.
She advised pregnant women to eat healthy, avoid cigarettes, substance abuse as healthy mothers have healthy babies.
Top on the list of countries with the highest preterm births according to WHO are India with 3,519,100; and China 1,172,300. Pakistan is fourth with 748,100; followed by Indonesia 675,700; United States of America 517,400; Bangladesh 424,100; Philippines 348,900; Democratic Republic of the Congo 341,400; and Brazil 279,300.
“Every year, an estimated 15 million babies are born too early. That is more than one in 10 babies. Approximately one million children die each year due to complications of preterm birth,”
It adds that many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems.
Globally, prematurity is the leading cause of death in children under the age of five years; and in almost all countries with reliable data, preterm birth rates are increasing, WHO said.
WHO said inequalities in survival rates around the world are stark.
“In low-income settings, half of the babies born at or below 32 weeks (two months early) die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties.
“In high-income countries, almost all of these babies survive.
“Suboptimal use of technology in middle-income settings is causing an increased burden of disability among preterm babies who survive the neonatal period,”