Prematurity

Prematurity is defined as birth before 37 weeks gestation. Many successful and famous people were born prematurely, including Albert Einstein. The more premature the baby, the worse the outcomes. Resuscitation in babies under 500 grams or 24 weeks gestation should be carefully considered, as outcomes are likely to be very poor.

The WHO classify prematurity as:

  • Under 28 weeks: extreme preterm
  • 28 – 32 weeks: very preterm
  • 32 – 37 weeks: moderate to late preterm

 

Associations

  • Social deprivation
  • Smoking
  • Alcohol
  • Drugs
  • Overweight or underweight mother
  • Maternal co-morbidities
  • Twins
  • Personal or family history of prematurity

 

Management Before Birth

There is a dramatic improvement in prognosis with each additional week of gestation, particularly in very premature babies. In women with a history of preterm birth or an ultrasound demonstrating a cervical length of 25mm or less before 24 weeks gestation there are two options of trying to delay birth:

  • Prophylactic vaginal progesterone: putting a progesterone suppository in the vagina to discourage labour
  • Prophylactic cervical cerclage: putting a suture in the cervix to hold it closed

Where preterm labour is suspected or confirmed there are several options for improving the outcomes:

  • Tocolysis with nifedipine: nifedipine is a calcium channel blocker that suppresses labour
  • Maternal corticosteroids: can be offered before 35 weeks gestation to reduce neonatal morbidity and mortality
  • IV Magnesium sulphate: can be offered before 34 weeks gestation and helps protect the baby’s brain
  • Delayed cord clamping or cord milking: can increase the circulating blood volume and haemoglobin in the baby

 

Issues In Early Life

  • Respiratory distress syndrome
  • Hypothermia
  • Hypoglycaemia
  • Poor feeding
  • Apnoea and bradycardia
  • Neonatal jaundice
  • Intraventricular haemorrhage
  • Retinopathy of prematurity
  • Necrotising enterocolitis
  • Immature immune system and infection

 

Long Term Effects

  • Chronic lung disease of prematurity (CLDP)
  • Learning and behavioural difficulties
  • Susceptibility to infections, particularly respiratory tract infections
  • Hearing and visual impairment
  • Cerebral palsy

 

Last updated January 2020
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