Prematurity

Premature births account for most of the neonatal morbidity and mortality.

The incidence of infants born before term in the Philippines is about 11-12 percent. Preterm birth is defined as the birth of a baby before the completed 37 weeks of gestation. Furthermore, births less than 28 weeks of gestation are called as extremely premature, 28-32 weeks of gestation are referred to as very preterm and 32 to less than 37 weeks age of gestation are the moderate or late preterm.

Globally, the Philippines ranks 8th in the incidence of preterm births, with India being the number 1 followed by China,  Nigeria, Pakistan, Indonesia, USA, Dominican Republic of Congo and Brazil.

This preterm birth is a one syndrome condition with many causes such as 1st trimester bleeding, infection and stress.

Preterm infants have difficulties in adapting to extrauterine life. Respiratory distress is seen since they have immature lungs. Infections, jaundice, cold stress and hypoglycemia are also seen and usually are the common problems.

In the webinar, I listened to the other night, Dr Jose B. Salazar, a Pediatric Neonatologist, stated that the number one cause of neonatal deaths in the Philippines (2017) is related to preterm birth complications (31%).

The management of preterm babies is a collaboration among the obstetricians, pediatricians- neonatologists  and other subspecialists. The following are the long-term impact of Preterm birth on Survivors:

1. Physical: 

    a. visual impairment

    b. hearing impairment

    c. chronic lung disease of prematurity

    d. long- term cardiovascular ill- health and non-communicable disease

 2. Neuro-developmental /behavioral:

    a. mild disorders of executive functioning

    b. moderate to severe global development delay

    c psychiatric/ behavioral sequalae

3. Family, economic and  society

    a. impact on family

    b impact on health service

    c intergenerational

In the Pediatric side, the World Health Organization and the Department of Health strongly reiterated the different approaches to prevent preterm births and to reduce deaths among premature babies. Dr Jose Salazar emphasized the importance of essential newborn care such as:

1. immediate drying of the premature baby upon delivery with the use of a clean and dry cloth

2. skin-to -skin contact. In this, the stable baby is placed in a prone position on the mother’s abdomen or chest skin-to-skin

3. non-separation of baby from mother and the initiation of breastfeeding

4. proper cord clamping and cutting