Preemies: What to expect as parents

w2015-prenatalEvery parent eagerly anticipates the day that they can welcome their child into the world. For some, this day comes earlier than expected.

The duration of a normal pregnancy is 40 weeks, and a premature, or preterm, baby is one that is born before 37 weeks.

In Canada, 1 in 12 babies is a “preemie” baby. The in-hospital preterm birth rate in 2010/2011 was 7.9 per cent. Ontario had the second highest rate at 8.1 per cent.

“There are many cases in which there is no apparent cause for the premature birth, and nothing could have been done to predict or prevent it,” says Dr. JoAnn Harrold, a neonatologist at CHEO.

One of the most important predictors of a premature birth is having delivered a premature baby in the past. Being pregnant with twins and triplets also increases the risk.

Because mothers conceiving through in-vitro fertilization are more likely to have multiple births, they are at a higher risk of going into preterm labour.

Some risk factors related to the mother’s health can be minimized: reduce exposure to cigarettes, alcohol and drugs, and focus on proper nutrition supplemented with prenatal vitamins, iron and folic acid.

Anemia, hypertension and diabetes, as well as certain infections, also increase the risk of premature delivery.

When a “preemie” comes into the world, there may be complications, either short-term — dealt with immediately after birth by hospital staff — or long-term, those for which parents have to be extra vigilant.

One of the most significant possible complications is cerebral palsy. It affects different muscles of the body and manifests in early childhood. It can lead to altered muscle tone, exaggerated reflexes, abnormal muscle movement, difficulty swallowing, speech delay, and impairment of fine motor skills. The rate of cerebral palsy in developed countries is between 2 to 2.5 per 1000 live births.

If a child is born at an increased risk of cerebral palsy, parents are encouraged to attend all scheduled well baby visits and pediatric appointments. The doctor will monitor the child’s growth, muscle tone and strength, co-ordination and posture, motor skills, and sensory abilities, such as vision and hearing.

Because cerebral palsy can have far-reaching consequences, follow-up appointments may include visits to a pediatric neurologist, an orthopedic surgeon, a physical/occupational/developmental therapist, a speech language pathologist, a social worker and a special education teacher. This team-based approach has been shown to yield the best results.

Premature birth can also lead to visual problems. The most common cause of this is retinopathy of prematurity, which occurs in babies born before 30 weeks and is caused by improper retinal vessel development. All very premature babies should be screened for ROP.

Screening appointments are with an ophthalmologist who specializes in neonatal disorders and start as early as four to eight weeks after birth. These appointments are conducted in the hospital before the baby goes home, followed by an appointment after 6-9 months.

Screening and monitoring for ROP are advised until retinal vessels have sufficiently grown, or further treatment is required. Most cases of ROP are mild and do not lead to visual impairment, but proper screening allows for early treatment and reduced impairment in more severe cases.

Parents of preemies should also watch for cognitive delays. Studies comparing school performance in kindergarten students have shown that preemies have an increased risk of school-related problems.

It’s important for parents to schedule regular visits with the pediatrician during the first year of the baby’s life to monitor when the baby achieves developmental milestones. These milestones are important social, language, cognitive and motor skills that a child must achieve in a timely manner. Delayed or inability to achieve these milestones is a strong indicator of future problems.

The survival rate of premature babies has improved significantly over the past few decades because we are now able to safely deliver and care for them. The related health concerns can greatly add to the stress of being a new parent. However, with better management of these complications, we can provide the best possible future for these babies.

Abeer Sami is a medical graduate from the Aga Khan University in Karachi, Pakistan, and has a BSc. in Biochemistry from Carleton University, Ottawa. She is currently with the Public Relations department at CHEO.