Being born prematurely means that the child isn’t fully prepared for life outside the uterus. They may require support to stay warm, to feed and to breath.
Montevideo, 15 November 2019 (PAHO/WHO-CLAP) – A baby is considered premature if they are born before 37 weeks of gestation. Premature babies arrive without having developed completely in-utero, which makes them more vulnerable to complications than those who are born full-term. Not all premature babies are at risk, but when complications do occur, they are among the leading causes of death in children under the age of 5 and can cause physical, neurological and learning disabilities that have lifelong consequences.
“Being born prematurely means that the child isn’t fully prepared for life outside the uterus. They may require support to stay warm, to feed and to breath,” says Pablo Duran, regional advisor for perinatal health at the Pan American Health Organization´s (PAHO) Latin American Center of Perinatology, Women and Reproductive Health (CLAP, for its acronym in Spanish).
Many of the causes of prematurity are already known. Risk factors include:
- a previous premature birth
- being pregnant with multiples
- adolescent pregnancy
- some chronic conditions like hypertension, diabetes or infections
- smoking, drinking alcohol, drug use, and stress
However, simple, low-cost, effective measures exist that have been shown to reduce deaths and complications associated with prematurity by three quarters. These measures range from feeding the baby with breastmilk to providing care in temperature-regulated environments, ensuring quality, evidence-based care, including the timely detection of health-related complications, and ensuring follow-up during hospitalization and after discharge.
Maternal care and quality health care are essential for the development of all babies, but especially those who are premature.
Measures to prevent premature birth
Preventing premature births is key to reducing negative outcomes. However, the events that trigger the onset of delivery, including premature delivery, are unknown. More than half of premature births occur spontaneously.
But there are measures that can be taken – some of them even before conception- to promote a healthy pregnancy and reduce the chance of babies being born before 37 weeks, including:
Quit smoking, avoid alcohol, drugs & medicines not prescribed
Maintain a healthy weight and keep blood pressure under control
Avoid stressful, violent situations and other forms of abuse
Attend at least eight prenatal appointments during pregnancy
Prevent infections during pregnancy
Avoid working for more than 6 hours standing up
Eliminate elective and non-medically necessary cesarean sections before 39 weeks gestation.
7-year follow-up in Argentina
In Argentina, premature babies received follow-up by health services for up to 7 years. This is led by a pediatrician with the support of a social worker to prevent patients from dropping out. To ensure the continuity of the appointments, “early diagnosis and treatment are key, as is ensuring a mechanism for monitoring premature babies,” says Dr. Patricia Fernández of the National Maternal, Children and Adolescents Department of the Argentine Ministry of Health.
“The idea is that follow-up procedures all take place on the same day, so the patient doesn´t have to keep returning to the health center. In some cases, transport is also provided,” says Fernandez. During follow-up, milk is provided (breastmilk is always prioritized), and child development evaluations are carried out, among other things.
In order to continue this follow-up, the Ministry of Health has created a guide for health care teams containing information on services around the country that provide follow-up services for premature babies, the professionals to whom these patients can be referred, and contact details for patient referrals, consultations or information exchange.
“Rodrigo was born at 27 weeks weighing just 525 grams because I had high blood pressure that put us both at risk. I had to wait until he was two-months-old to touch his little hand, and three-months to hold him for the first time. It was incredibly hard, particularly in the early stages. First, we had to make it through the initial 12 hours, then 24 hours, etc. He was on oxygen for almost 2 months, and little by little started to reach his milestones until he was finally released from the hospital at 4 months. I stayed with him the whole time at the maternal residence in Fernandez Hospital in Buenos Aires and could visit him whenever I wanted. The support from the other moms in similar situations was also extremely helpful.
When we were released from the hospital, my chubby baby weighed almost 3 kilos and looked like a newborn. The following week we returned to the hospital for a checkup, and then had appointments with the pediatricians at Fernandez Hospital every 20 days until he turned 3. After that, we continued going once a month, and now that Rodri is 4, we go every 6 months for follow-up. The only problems he had were with his vision, but he was referred to the eye doctor and they resolved on their own.
My chubby son is doing great: he´s super interactive, relates well with others, speaks very clearly, and has a great memory. His kindergarten is really impressed with him. At first, it was very hard – we had to take it hour by hour so he could adapt, but they took such good care of him, and now he´s doing so well.”
Sabrina Lastra, Argentina
Improving the quality of care in the Dominican Republic
Universal health for all women and babies, in communities and at all levels of care, can help prevent many maternal and neonatal deaths, including those of premature babies. Preventing complications and deaths due to premature birth starts before conception and continues by ensuring a healthy pregnancy. In that regard, a minimum of eight visits with a health professional throughout pregnancy helps to identify and treat risk factors.
For this reason, the National Health Service in the Dominican Republic and PAHO launched a strategy to improve OB/GYN and neonatal care in August of last year. The package introduces changes that reduce the gaps in quality care with the resources that are already available and with organizational leadership. One of the five participating hospitals is the Dominican Women´s Hospital, which is also one of the training centers for neonatal specialists.
“Like every first-time mom, I had to learn to take care of a newborn. However, I also had had to learn how to take care of a premature baby who weighed just 1800 grams. Sila Victoria was born at 35 weeks due to placenta previa. She remained in the Dominican Women´s Hospital for 10 days, five of which she was on a ventilator because she had severe problems breathing. I went to visit Sila every day, sometimes more than once, always waiting to hear about any changes to her health. At the hospital, they told me they wouldn´t call me unless there was a complication with the baby. Each time my phone rang, I got a lump in my throat.
My life has completely changed because I need to take care of the slightest detail, particularly with hygiene, like how I wash her clothes and making sure that anyone who gets near her washes their hands before touching her. Despite the emotional support I´ve had, it´s been very frustrating because I didn´t know what to do with such a tiny baby, but we´ve found our way. Now Sila is 6 months old and even though her care routine hasn´t changed, she doesn´t have any health complications. My biggest wish is that my daughter be healthy, and that she grows up to make a contribution to society… she is what keeps me going.”
Jennifer Toledo, República Dominicana
Kangaroo care in Colombia
Ensuring essential care for each newborn, including skin-to-skin contact and early initiation of breastfeeding, are two pillars of the Kangaroo Care Program that began in 1978 in Colombia. There are currently 54 Kangaroo Care programs that operate under technical guidelines established by the Ministry of Health.
“Thanks to the program, premature babies reach 40 weeks – 9 months - – with adequate height and weight,” says Dr. Natalia Charpak, who is in charge of the initiative in Colombia.
“Fraysa Sharleht arrived earlier than expected. I was only 36 weeks pregnant and still working when I noticed a clear liquid coming out of my body. Since I´m a first-time mom, I didn´t know what was happening. I was very scared, so I called my sister and she said, “your water just broke, get to the clinic now!” Sure enough, it was time for the baby to be born. I was suffering from preeclampsia. They gave me anesthesia, and when I came to, they let me see my daughter for a moment. As she had a low birth weight, she was transferred to an incubator for five long days.
The doctor told me that I would have to do kangaroo care and I became very worried and scared for my baby´s life. I calmed down after they explained that there was no reason to be worried – I just had to have skin-to-skin contact all the time with my daughter and breastfeed her every time she needed it until she reached her ideal weight and height. I´ve been doing kangaroo care for 22 days and it´s been the most beautiful experience of my life. I´m the luckiest mom in the world! It´s a blessing to have her on my chest all day. She feels my warmth and is about to reach 2500 grams. Even though Fraysa is a fragile and innocent baby, she knows things that we could never imagine.”
Luceny Urrutia Quiñones, Colombia
Human milk banks in Honduras
In order to guarantee the best nutrition for babies in Honduras, human milk banks help support families with premature babies. These banks are specialized spaces that receive milk donated by lactating women, where it´s processed, stored, and distributed to babies whose mothers can´t breastfeed. The donation and distribution are done anonymously.
There are currently two hospitals that offer this service in Honduras: the Tegucigalpa University Hospital School, which collects between 30 and 35 liters of human milk each month (enough to feed an average of 6 children) whose goal is to collect 168 liters, and the Mario Catarino Rivas Hospital in San Pedro Sula, which collects around 60 liters each month.
“My babies, Ricci Milagro y Milagro Mercedes were born at six-months with very low birth weights. I was unable to breastfeed as I was in the hospital for 28 days due to problems with my thyroid and high blood pressure, but thank God, I am slowly getting better. Here at the Tegucigalpa hospital for Women and Children, they have provided me with breast milk for my babies and, thanks to the doctors and nurses, they are much better.
The breast milk has helped to increase their weight which is really important for premature babies. I am really thankful for the mothers that donated milk to the bank that has helped my girls.”
Riccy Maribel Murillo, Honduras
“The birth of little Asher Gagdiel was complicated due to my health. When I was seven months pregnant, I suffered an anxiety attack that we think was an early sign of preeclampsia. My first gynecologist didn´t pay attention to my blood pressure so I sought a second opinion from a more experienced gynecologist, who detected it when I was eight months pregnant. Since the health of my baby was at risk, I had an emergency C-section. Asher was just 1800 grams and 42 centimeters long, with a malformation on his lip that hadn´t closed all the way. However, I was able to breastfeed him without any problem and he stayed with me for just four days at the hospital.
Once he returned home to the care and support of his entire family, my son overcame many barriers. He´s a strong child and is now already one-year-old. Thanks to the care and support he received at every appointment, and the attention to his nutrition and vaccines, my little one has developed like any other child. He is currently 60 centimeters tall and weighs 8 kilos. He´s even started to take his first steps – slowly, but surely, and very happily.”
Skarlett Rivera, Honduras
Person-centered care in Uruguay
Reducing invasive technology is one of the recommendations for taking care of premature babies. According to Dr. Fernanda Blasina, one of the neonatal team coordinators at the Montevideo Clinical Hospital “before, babies were born and intubated according to their gestational age or weight, and they weren´t given a chance to breathe on their own. These days you see babies who were born at 25 weeks breathing with just a bit of support. This is individualized care based on what each baby needs. It is a huge achievement and has improved (health) outcomes.”
These changes have also been seen when it comes to nutrition. It´s been shown that early feeding, especially with breastmilk, has benefits in terms of preventing infections and colitis, among other complications. Dr. Blasina highlights that Uruguay has also shifted its care of babies to involve the entire family, even when the babies are hospitalized.
It is this support that´s provided to families and health professionals - good nutrition, access to care, and comprehensive follow-up - that provide a premature baby with a better chance of having a full and healthy life.
“Twenty years ago, I became the mother of a baby who was born at 32 weeks due to preeclampsia. Luna was my first and only child. I was doing my first year of residency in pediatrics when they told me I would have to have a C-section at 32 weeks. I thought “she´s dead.” From what I knew, it would be very difficult for her to survive and thrive. I needed more than 8 hours to recover after having general anesthesia and when I went to meet her, I remember wanting to cry, thinking, “how can we fix this?”.
Luna was lucky to be cared for by a doctor who didn´t intubate her – because back then, they intubated all babies who weighed less than a kilo – they saw she was breathing ok and just gave her oxygen for 12 hours. The next day she was doing so well that they took her off it. Luna was admitted to intensive care and stayed there for two months. I think she was treated in a very modern way 20 years ahead of time.”
Fernanda Blasina, Uruguay