Preemies: the tiny treasures
Shravya Misra is smart, energetic, lovely, bubbly, and brilliant. Her parents are extremely happy with the growth of the kid and they still remember the day when Shraavya was born as a premature baby after 26th week of pregnancy due to preeclampsia, with a birth weight of 960gms, with under-developed organs. No one could imagine seeing Shraavya that she is a Preemie. But timely administration of the three low-cost interventions: steroid injection, Kangaroo mother care, and basic antibiotics saved her life. Now she is a 5-year-old healthy intelligent girl.
Shraavya’s parents celebrate November as Preemies’ month every year since her first birthday. The world celebrates November 17 as “International Prematurity Day”.
The premature babies born before 37 weeks of pregnancy are called Preemies. In India, out of 26 million live births annually, 3.5 million are preterm and if we see globally the figure goes 15 million. India is at the top of 10 countries contributing 60 percent of the premature babies in the world (WHO report: Born too soon). The studies have shown that worldwide the preterm birth related complications is the number one killer of young children, accounting for 1.1 million deaths out of 6.3 million deaths of children under the age of 5. However, about 75 percent of these lives could be saved without expensive, high technology care. The babies who born between 32-37 weeks of pregnancy constitutes 12.6 millions out of 15 millions baby born preterm and has the survival chances of greater than 95 percent. In most of the cases they survive if essential newborn care is adopted, where the baby should be kept warm, clean, and well-fed. There are three low-cost interventions that are very effective, but are not commonly used.
The First one is Steroid injections. Dexamethosone, a steroid used to treat asthma, helps speed up the development of the baby’s lungs. This could be given to mothers in preterm labour, at a cost of only US$1. Two shots can stop premature babies from going into respiratory distress when they are born. This can prevent about 400 000 deaths annually. Second method is Kangaroo Mother Care. Using this technique, the tiny infant is held skin-to-skin on the mother’s chest. This keeps the baby warm and facilitates breastfeeding. Keeping preterm babies warm is important because their tiny bodies lose heat rapidly, making them highly vulnerable to illness, infection, and death. This could prevent around 450 000 deaths annually. In addition, basic antibiotics can save lives, such as amoxicillin to treat pneumonia and injection antibiotics to fight serious infections. Various initiatives have also been put to devise various low-cost neonatal care facilities like incubators, respiratory aid, monitoring system etc. Better care of the preemies definitely has a rewarding effect on the survival and health babies. In the last 5 years the infant mortality has dropped almost by two third (which is also the Millennium Development Goal 4 of WHO), however, the number is still large and need further improvement. There are many social organisations across the globe to support the preemies and create awareness and education.
Another aspect of reducing the stress of birth on these tiny-tots is to implement ways that help the mother to reach the full term or near full term of pregnancy. Population studies have shown that the pregnancy term directly correlates with the survival rate and the health of the child. If the period of pregnancy is less than 22 weeks the survival chances are between 2-15 percent; the chances increase significantly with each week. Statistically, pre-term birth in 23 weeks has 15-40 percent of survival rates, at 25 weeks it is 55-70 percent, and by 32 weeks it is more than 95 percent. However, the major hurdle is a high degree of unpredictability in the pregnancy outcome. It is a dynamic process where there is a huge transition in the physiology of mother and child. It is quite possible that expecting mother who will appear normal today might develop clinical symptoms in pregnancy-related complications with a need for immediate interventions by the following week. Critically observing the weight gain and blood pressure every week might hint the onset of a complication. Though it is important to facilitate safe pregnancies by understanding the process in its entirety, unfortunately what we know even from advanced research is just the tip of the iceberg. Among the identified devils that lead to preterm delivery, one of the most common and avoidable causes is malnutrition.
Expecting mothers have special requirements for nutrients in addition to the extra calories, proteins, and fibers to maintain both their and the baby’s health. The deficiency in the essential nutrient leads to various pregnancy-related complications, developmental defects, and spontaneous preterm delivery. It has been experimentally shown that mineral deficiency like iron leads to anaemia and an anaemic pregnancy often terminates into preterm delivery due to preterm PROM (premature rupture of membrane) or spontaneous preterm labour.
Unavailability of early diagnostic methods for pregnancy-related complications is another major reason for preterm deliveries. In most of the cases, detection is based on clinical symptoms like high blood pressure for one of the notorious pregnancy related complication, namely, Preeclampsia. However, the onset of this condition is much earlier with almost 9-11 weeks delay between the initiation of the condition and its clinical manifestation. As a result, it is usually too late to intervene or manage the condition, forcing a necessary premature delivery as the only means to save the life of the mother and child.
Therefore, early and precise diagnostic measures are the important requirement for the maternal and child health. It has been found to be underweight, obesity, diabetes, high blood pressure, smoking, infection, age (either under 17 or over 40), genetics, multiple pregnancy (twins, triplets, or more), and pregnancies spaced too close together often results in preterm delivery.
(Dr. Sumona Karjee Mishra is a Social Innovation Immersion Programme Fellow at DBT-BIRAC KIIT-TBI. Views expressed are personal.)