Preterm Birth & Problems Related to It

Counts Behind the Classifications

An infant is registered to be a Preterm Neonate if s/he is delivered before the arrival of the 37th gestational week. Hence, all deliveries done before the count of 258th day are classified under Preterm Births. About 15 million preterm neonates are born each year, each one being subjected to higher chances of morbidity and mortality. The reason behind a preterm neonate’s alarmingly high vulnerability is the fact that, several crucial organ systems mature between the period of 34 to 37 weeks in a human fetus. Preterm neonates are delivered before they can undergo this developmental phase. Approximately one million neonates die each year due to preterm birth related complications, & a majority of the survivors are left with permanent neurological, respiratory, hearing & visual impairments.

Global Distribution and Prevalence of Preterm Births

  • INDIA: 3519100
  • CHINA: 1172300
  • NIGERIA: 773600
  • PAKISTAN: 748100
  • INDONESIA: 675700
  • USA: 517400
  • BANGLADESH: 424100
  • PHILIPPINES: 348900
  • CONGO: 341400
  • BRAZIL: 279300

WORLD HEALTH ORGANIZATION, 2016-17.

What Induces A Preterm Delivery?

Preterm births have been known to happen due to both medical and non-medical reasons. In most cases, mothers have to undergo preterm deliveries spontaneously, without any traceable reason.

Social Determinants

  • Women, who conceive after 35 years of age or before 16, run the high risk of giving birth to a preterm infant.
  • Women, who survive under poor living conditions, are socially & economically backward have higher chances of undergoing a preterm delivery.
  • Exposure to rigorous physical exercises and prolonged maintenance of the standing posture induce early labor as well.

Medical Determinants

  • Chronic illness during the gestation period causes premature delivery.
  • Contraction of intra-amniotic infection causes inflammation of amnion & chorion due to the ingress of bacteria from the vaginal tract, causing prolonged labor that contributes to preterm births.
  • 60% of twin pregnancy cases & 94% of triplet pregnancy cases in the United States were registered to be preterm births in the year 2005. Therefore, multiple gestation births can be preterm ones, with the running risk of TSS.
  • Mothers with records of pre-existing preterm births in the past run highest chances of delivering a preterm neonate for the second time successively.
  • Cases of uterine malformations & uterine trauma induce early labor.
  • Incorrect positioning of the placenta (Placenta Previa) and abrupt separation of the placenta from the uterus (Abruptio Placentae) can require early deliveries.
  • History of previous cervical surgeries, premature rupture of the membranes and hypertensive disorders raise the chances of preterm births.
  • Abnormal accumulation of fluids in the fetal compartments during gestation (Hydrops) might require early delivery of the infant to prevent infections.

How Widespread is the Threat?

Every single preterm neonate is subjected to a plethora of medical complications. No exception has been registered till the present regarding otherwise. Each preterm neonate finds it difficult to adapt to the extra uterine environment due to the phenomenon of incomplete organ development. Here is list of potential medical conditions preterm neonates are highly likely to contract –

Respiratory Problems:

  • Surfactant deficiency and pulmonary immaturity cause Respiratory Distress Syndrome in Preterm infants. Progression of this medical may result in rising concentration of carbon dioxide in the blood & prolonged cessations of breathing.
  • Lack of movement in the muscles of inhalation during breathing due to incomplete development of the lungs is common in preterm neonates. This condition is called Apnea & it can result in severe oxygen deficiency in the bloodstreams, causing fatal neurological damage within three minutes of unsuccessful inhalation & even neonatal death if the baby is not medically assisted immediately.
  • Abnormal alterations in the cell structures of the lung alveoli and smaller airways affects the preterm neonates breathing function because they are usually born with underdeveloped lungs. This is known as Bronchopulmonary dysplasia and this condition is a continued side-effect of RDS in premature neonates.

Neurological Problems:

  • Development of Postpartum Depression is common during gestation that is likely to end up as preterm births. Maternal depression and mother’s inability to bond with the infant can affect the child’s neurological development & adaptation skills.
  • Preterm labor can induce intracranial hemorrhage inside the fetus’ skull that causes internal bleeding through ruptured blood vessels.

Cardiovascular Problems:

  • The ductus arteriosus fails to close after the birth of preterm neonates whereas this fetal blood vessel seals successfully soon after the birth of term neonates. The open blood vessel fails to shuffle blood between aorta & the pulmonary artery regularly. This condition, called Patent Ductus Arteriosus is more likely to affect preterm neonates with respiratory problems.
  • Open blood vessels may result in the inability to maintain an ideal blood pressure, resulting in Hypotension, that can further lead to oxygen deficiency.
  • Bradycardia is common with preterm neonates, which is characterized by extremely slow heart rate. For a preterm neonate, the normal heart rate is 120-160 and isn’t supposed to go down.
  • The preterm infant can be subjected to cardiac dysfunction & congenital malfunctions.

Hematologic Problems:

  • Preterm infants have chances of early contraction of anemia or may develop it in the later stages of birth as well.
  • Due to poor suck & grasp reflexes, preterm neonates fail to breastfeed as much as it is required to, which dehydrates them severely, building up the bilirubin count inside the neonate’s body. This condition, known as Hyperbilirubinemia, can as much result in cerebral palsy and loss of hearing if bilirubin rises above 29.2mg/dL.

Gastrointestinal Problems:

  • A medical condition called Necrotizing Enterocolitis affects preterm neonates the most. It occurs when the inner tissue linings of the intestines initiate the process of decay, and eventually dies off. This can lead to rupture in the intestinal tubes that may disrupt the entire endocrine mechanism of the neonate.
  • Poor gastrointestinal function in preterm neonates directly results in poor motility of the fluids inside the neonate’s body.

Metabolic & Endocrine Problems:

  • Hypocalcemia may be detected in preterm neonates when his/her serum calcium concentration levels are <7mg/dL.
  • Hypoglycemia may be detected in preterm neonates when his/her serum glucose concentration levels are <30mg/dL. In case the blood glucose concentration is >125mg/dL or serum glucose concentration >150mg/dL, then the infant may suffer from Hyperglycemia.
  • Early symptoms of pale skin, lack of gain in post-neonatal weight and even apnea might indicate the contraction of Late Metabolic Acidosis in a preterm infant.

Problems related to the Central Nervous System:

  • During a typical preterm delivery, the infant suffers through the transition of being in a well guarded intrauterine environment to a highly stimulating & a hostile one. A preterm undergoes through tremendous psychological stress during delivery, resulting in the rupture of his/her delicate, underdeveloped blood capillaries inside the brain. Preterm infants suffer from internal bleeding of the blood vessels into the fluid-filled areas of the brain, which is known as Intraventricular hemorrhage.
  • Inadequate supply of oxygen to the brain of the preterm neonate can result in brain dysfunction. This medical condition is known as Hypoxic-ischemic Encephalopathy.
  • The preterm infant is highly likely to contract congenital malfunctions, and even suffer from seizures and deafness.

Problems related to Renal System:

  • Despite the preterm neonate’s normal blood sugar levels, improper renal functioning leads to excretion of sugar glucose through urine. This renal condition is known as Renal Glycosuria.
  • Preterm neonates also tend to suffer from mild to severe cases of Edema where fluids stray from the bloodstreams and get absorbed by the surrounding tissues, causing rampant swelling in the infant’s body.
  • They might also suffer from incidences of increased serum potassium concentration, creating severe electrolyte disturbance known as Hyperkalemia.

Due to weak & dysfunctional kidneys that fail to acidify the urine, preterm neonates suffer from increased acid accumulation in the body. This condition is called Renal Tubular Acidosis.

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