Understanding premature birth: Causes, preventions and concerns

In 2020, over 12.4 million babies were born prematurely, accounting for one in every 10 births, as per a report by the World Health Organisation (WHO).

Premature birth, classified by the Mayo Clinic as occurring three weeks before the expected due date, presents various categories, including:

1. Late preterm: babies born between 34 to 36 weeks.
2. Moderately late preterm: babies born between 32 to 34 weeks.
3. Early preterm: babies born between 28 to 32 weeks.
4. Very early preterm: babies born before 28 weeks.

To provide further insights, SinarPlus talked to Damansara Specialist Hospital 2 High-Risk Pregnancy Specialist Dr Imelda Nasreen Nasruddin @ Balchin.

Dr Imelda clarified that "premature birth" refers to births occurring before 37 weeks, not necessarily before the expected delivery date, which is typically set at 40 weeks of pregnancy.

"However, babies are actually mature at 37 weeks of gestation. So, even if delivery occurs earlier than the expected date, it does not necessarily mean that the baby is premature. Instead, it involves babies born before 37 weeks," she said.

Factors leading to preterm birth, Dr Imelda said include maternal and fetal health complications or natural occurrences.

"Women with serious health problems may have to undergo surgery to deliver their babies to save lives.

"For example, a mother who experiences severe bleeding due to a placental abruption," she said.

Maternal health issues, such as severe bleeding from placental abruption or high blood pressure leading to pre-eclampsia, may necessitate early delivery.

Another natural cause of premature birth is cervical insufficiency, where the cervix is too soft to hold the pregnancy.

In addition to health problems or inflammation in the body that cannot be controlled, twin pregnancies also increase the risk of premature birth.

Dr Imelda added that among other factors contributing to this issue are infections during pregnancy.

Those with a history of premature birth may also face the same risks in future pregnancies. In this regard, the expert also outlined several complications of preterm birth. Among them are:

1. Birth process needs to be done through surgery due to the baby's transverse position.
2. Babies born before 32 weeks require ventilation in the neonatal intensive care unit.
3. Babies born less than 27 weeks have a risk of not being saved.
4. Birth before 22 weeks is called a miscarriage because the baby cannot be saved.

Not only that, premature babies have a higher risk of serious health problems such as vision problems, Attention Deficit Hyperactivity Disorder (ADHD), Cerebral Palsy, or disabilities.

As a result, Dr Imelda said that prevention should be done to ensure the mother's health even before pregnancy takes place.

Patients who are overweight are advised to reduce weight before becoming pregnant and seek treatment if they have medical problems.

Mothers also need to practise healthy eating habits to avoid food poisoning.

"Avoid smoking and engage in low-intensity exercises to reduce the risk of high blood pressure and diabetes.

"Those undergoing in vitro fertilisation treatment should avoid intentionally placing more embryos to achieve twin pregnancy," she said.

This is because women pregnant with twins, whether two, three, or four, have a higher risk of facing these problems.

High-risk patients such as asthma, heart, and diabetes patients also need to be closely monitored.

She said those who have a history of naturally giving birth to a premature baby are also advised to seek expert help.

"At KPJ Damansara 2 Hospital, we established the Premature Birth Prevention Centre, the first in Malaysia.

"Trained specialists will assist mothers in preventing premature birth," she said.

Meanwhile, Sultanah Nur Zahirah Hospital Neonatal Paediatric Specialist Dr Nor Zubaidah Kadir said that premature babies have smaller physical sizes.

"Babies born at 25 weeks of gestation may weigh around 500 grams. If they are 30 weeks old, they may weigh one to 1.5 kilograms (kg).

"If born at 32 weeks or more, they may weigh around 2kg," she said.

Because of this, premature babies are born ‘weaker' and require special care because most internal organs are immature and not ready to function on their own.

Most importantly, she said that the baby needs to be protected from bacterial infections.

This situation can occur because the baby has not fully received antibodies from the mother through the placenta throughout pregnancy, especially after the third trimester (28 weeks gestation and above).

"The more premature the baby is born, the lower the level of antibodies in their body. their immune system is also not yet mature," she said.

Body temperature and sugar levels also need to be monitored to avoid the risk of hypothermia and low sugar.

Furthermore, nutrient flow will be administered through intravenous to supply the required nutrients. Breast milk will be given through a tube until the baby can breastfeed directly from the mother.

"The postnatal age must reach at least 35 weeks with a weight of more than 1.7kg before the baby can be brought home.

"Before bringing the baby home, parents need to know the appropriate care for their baby," she said.

Caregivers also need to be mentally prepared because caring for a premature baby is more challenging.

"Parents will be taught some basic neonatal resuscitation techniques to prepare them for any emergencies such as choking or difficulty breathing at home.

"In addition, parents will be counselled on baby safety through the importance of using child car seats correctly.

Furthermore, doctors will also advise parents not to sleep with the baby on the same bed but instead, the baby should be placed in a crib.

To prevent the child from getting sick easily, the child should not be taken to crowded places or meet with unhealthy family members.

If parents are sick, they should wear a face mask.

"To ensure optimal health, premature babies usually need regular treatment until they reach school age, seven or eight years old.

"If diagnosed with problems such as delayed learning or disability, they should undergo proper treatment and therapy," she said.

Experience of mother who experiences preterm births

The sudden slowdown of the baby's movements can be worrying for any pregnant woman and that is the situation Suhaszirina Wahab had to endure.

On the doctor's advice to save her child's life, she had to give birth to her baby through a surgery.

She told SinarPlus that this was not her first experience, as her eldest child was also born prematurely at 30 weeks of gestation.

"My third child was born earlier than the expected due date, at 32 weeks of gestation.

"The baby at that time weighed only 1.5kg and had to be placed in the Neonatal Intensive Care Unit (NICU) for respiratory assistance," she said, recalling her experience of giving birth to a premature baby last year.

After six days of monitoring, the baby was then transferred to a regular ward. However, there was one day that forced the cute little baby to be placed back in the NICU when his oxygen readings decreased.

Suhaszirina said the care of premature babies in hospitals is heavily emphasised.

Mothers need to clean their hands first and are not allowed to wear watches or any jewelry to prevent the baby from being exposed to bacterial infections.

She felt tortured when she saw her baby suddenly being reconnected to wires on the 26th day of his birth.

"His face was pale and weak when I came to visit him. At that time, the doctor told me that my child had bloody stools, and blood tests found a bacterial infection in his intestines," she said, adding that it was believed to be from the milk given to him.

Not only that, his blood and sugar levels also decreased.

As a result, his breastfeeding had to be temporarily stopped and replaced with water, blood, and antibiotics.

"Thanks to God, my premature baby was strong and could be discharged on the 45th day. At that time, his weight was 1.8kg, and he was confirmed to be in good health.

"Before being brought home, the doctor first explained the risks that premature babies may face at home," she said.

She was given an explanation of how to handle the baby if he choked on milk and the steps to take before bringing him to the hospital.

The woman from Pasir Gudang, now residing in Skudai, Johor, was also advised to ensure that her home is always clean from dust and cigarette smoke.

Guests are also not allowed to approach the baby to reduce the risk of the little one getting sick, especially considering his immature lungs.

Among the other challenges Suhaszirina had to face were frequent visits to the health clinic to weigh her baby to ensure he reached 2kg.

"Having a premature baby is quite challenging. Besides needing more meticulous care, there are many doctor's appointments to follow and sometimes they are just a day apart," she said.