A team of senior doctors and
nurses will be assembled to receive the preterm baby. The baby will need a
period of resuscitation (to help initiate and stabilize breathing and heart
rate). The baby may be shown to parents before being taken to the neonatal unit
for further treatment and will be started on intravenous fluids, various
medications like antibiotics. The baby will get some 'lines' placed through
veins and arteries in the umbilicus. These are useful to provide fluids and
medicines, monitor blood pressure, do blood tests in the first few days of
life. The baby will get regular blood tests, ultrasound scans of the brain, and
regular updates from your doctor. Your baby may develop various complications
of prematurity. These are detailed in the subsequent section.
Infection
Infection (often called sepsis)
is a common problem in newborn babies due to their small size and presence of
various 'lines' to monitor and treat these babies. Despite the various steps
taken to minimise infections (like strict hand washing by parents and
professionals when touching the baby), infections still occur. The majority of
infections can be cured completely. However, some infections are severe leading
to various complications in the baby. You will often find babies being treated
with strong antibiotics for suspected infection during their stay in the
neonatal unit.
Patent ductus arteriosus (PDA)
Ductus arteriosus is a small
blood vessel connecting two major blood vessels in the heart. This is critical
to the baby's life while being inside the mother's womb. Once the baby is born,
the ductus arteriosus should close in the first few days of life. In premature
babies, the ductus arteriosus may remain open after birth resulting in a
condition called patent ductus arteriosus (PDA). This may not require any
treatment. However, in some babies it may prevent the baby to come off the
breathing machine. In such circumstances, PDA may need treatment with
medications to close it. Rarely, surgery is needed to close the duct.
Chronic lung disease
Premature babies may remain
attached to the breathing machine or require oxygen for a long period of time.
When a premature baby requires ventilation or oxygen at 36 weeks postconceptional age, the
babies are said to have chronic lung disease. This means that the baby's lungs
are severely affected and that the baby is likely to need oxygen for a longer
period of time. These babies deteriorate rapidly even with minor respiratory
infections.
Necrotising enterocolitis (NEC)
This refers to infection and
inflammation of the bowel (intestines). Premature babies are prone to develop
NEC due to their small size and immature bowel. The majority of babies who
develop NEC require a few days of antibiotics and get better. Rarely, some
babies may need surgery to treat their NEC. During the treatment of NEC, the baby's
feeds will be stopped for a few days. To provide nutrition to the baby during
this time, the doctors may need to give a special form of intravenous fluids
called total parenteral nutrition (TPN). This may require placing a special
line called 'longline 'to deliver the TPN.
Brain Haemorrhage
Preterm babies have fragile blood
vessels in their brain. These are likely to bleed easily into the brain. These
are called 'intraventricular haemorrhages'. There is a range of severity of
these haemorrhages – Grade 1 being smallest and Grade 4 being extensive. The
outcome of babies varies depending on the grade of the haemorrhage. Sometimes
the bleeding can be severe leading to a lack of blood flow to certain parts of
the brain. The brain cells in these areas die and are replaced with tiny holes
called 'cysts'. The long-term outcome of these babies depends on the location
of these cysts in the brain. Occasionally, blood clots can block the flow of
brain fluid (called cerebrospinal fluid) from the brain leading to accumulation
of fluid in the brain – a condition called hydrocephalus. This may require
surgery and lead to long-term complications.
