GYN CHRONICLES the babies had both lost weight . Not being medical personnel , they were not aware that this was expected to happen and being severely premature infants had very few fat stores so this made the situation even worse . The rain had not stopped pounding and unfortunately 3 days after birth Odongo breathed his last . It was too much for the young couple . Now the bigger child had died , what was the hope for tiny Apiyo . Getting Milk was a challenge due to all the extreme pressure ; I think the only time I ’ ll say thank God for formula .
With God ’ s grace somehow Apiyo was resilient , she started gaining weight and somehow Mrs . Odero was able to get breast milk . It was over 3 months of daily hospital visits , expressing milk , Mr . Odero would joke that he was milking his wife like a cow but after all the great care from the hospital team , a lot of patience and following doctor ’ s orders and most importantly God ’ s healing touch Apiyo was finally able to go home .
This is the story of parents with premature babies even if not all of them are twins . There are about 15 million babies born prematurely each year accounting for 1 in every 10 deliveries . Preterm birth complications are the leading cause of death in children under the age of five . Almost 75 % or three quarters of these deaths could be prevented with current cost-effective interventions .
So , what is prematurity or a preterm birth ? Preterm is defined as babies born alive before 37 weeks of pregnancy are completed . They are categorized as : extremely preterm ( less than 28 weeks ); very preterm ( 28 to 32 weeks ); and moderate to late preterm ( 32 to 37 weeks ).
You can tell by this classification why obstetricians are fixated with how many weeks the baby is . I tell my mums whatever you do just get to 28 weeks because unless the baby has some severe abnormality from 28 weeks with good neonatal care we should be able to get the baby home . Caveat : we still prefer if the baby can get to term any day .
Why are babies born preterm ? In most cases , an early delivery occurs spontaneously for no known reason . Sometimes , the doctors are forced to do an early delivery due to problems / complications with the pregnancy . The risk factors include : Having had preterm birth previously ; Pregnancy with more than one child ; In vitro fertilization ; Uterus , cervix or placenta problems ; Cigarette smoking and drug usage ; Drinking alcohol ; Being pregnant with a baby with certain birth defects ; Infection of amniotic fluid or lower genital tract ; Condition such as blood pressure and diabetes ; Multiple abortions or miscarriages ; Trauma ; Stressful events such as domestic violence ; Pregnancies at an age below 17 or after 35 .
“ There are about 15 million babies born prematurely each year accounting for 1 in every 10 deliveries . Preterm birth complications are the leading cause of death in children under the age of five . Almost 75 % or three quarters of these deaths could be prevented with current cost-effective interventions “
Prevention ? Being an obstetrician our strategies begin prior to conception . This is not a new concept “ preconception care ”, however this is yet to catch on in this country . Women who are planning to conceive should go in for a visit and get screened .
The visit ideally screens for genetic disorders , Sexually transmitted infections , and chronic diseases such as Anaemia , Diabetes , Asthma and so on and for those with complications in a previous pregnancy . Patients are encouraged on lifestyle modification such as exercise , diet and refraining from smoking , alcohol and other drug use . All women planning for a baby should be on folic acid supplementation to reduce chances of some defects in the nervous system , what we call neural tube defects , such as hydrocephalus or spina bifida . Prospective parents are also offered immunization and screening for intimate partner violence and gender based violence , as well as psychosocial counselling on parent readiness .
Once the woman has conceived , she needs to start antenatal care which should be a minimum of 8 visits throughout the pregnancy where the provider will do all that is done in preconception care if this has not been done and in addition carry our basic examination and tests . Something as simple as blood pressure monitoring can affect the outcome of the pregnancy .
For those patients with imminent preterm birth , to improve chances of survival for the baby , administration of antenatal steroids is a must . This has shown to greatly improve lung maturity for the neonate and reduce chances of complications with the digestive system and bleeding in the brain . Magnesium sulphate can also be given to protect the brain and its cognitive development .
If the babies are born preterm , they require warmth and early detection and treatment of complications . Kangaroo mother care has been carried out with much success . This involves the skin to skin contact with the mother , father or caregiver who is carrying the infant . Depending on complication and degree of prematurity the infants can be offered care in incubators , phototherapy , CPAP , parenteral feeds , exchange transfusion , dialysis and so on .
Covid-19 brought severe challenges in management of preterm infants and because of this the theme for this year was “ Zero Separation ! - with a tag line Act now ! Keep parents and babies born too soon together ”.
I ’ d like to end this article with my very special thanks and appreciation to all parents of preterm children for their dedication in trying to ensure their precious bundles make it despite the difficult situation they are exposed to . ■
MAL 45 / 21 ISSUE 17