Preterm birth in India: Causes, treatment, and how early care is improving survival of premature babies

An estimated 15 million preterm (<37 completed weeks of gestational age) infants are born annually in the World. More than 60% of preterm infants are born in South Asia and Africa.

In India more than 3.5 million babies are born premature every year. Preterm birth complications are the leading cause of death among children <5 y of age, responsible for nearly 1 million deaths. Three-quarters of these deaths are preventable with cost-effective interventions such as administering antenatal steroids to mother, having trained healthcare personnel for new-born resuscitation, basic care for infections & breathing problems, promotion of kangaroo mother care (baby is carried by mother with skin-to-skin contact & frequent breastfeeding).

Improved conditions of care for premature infants have led to markedly increased survival rates over the last few decades, particularly in very low (<1500 g) and extremely low birth weight (<1000 g) infants. Nutritional measures play a key role in the long-term outcome, health and quality of life of these premature infants.Causes : Maternal medical conditions like Diabetes, CKD,High Blood Pressure, Infections like UTI, Anaemia, Smoking, Mental stress and Genetic Predisposition.

Uterine Anomalies and Cervical incompetence can also lead to preterm Births.Treatment: Preterm babies born before 32 weeks of gestation often have respiratory difficulty and they require respiratory support in the form of CPAP ( Continuous Positive Airway Pressure ) or NIV ( Non-Invasive Ventilation ). These babies often require administration of Surfactant (medicine given to expand lungs). Very sick infants may even require ventilation.

They require regular monitoring of vitals & blood parameters.They require early feeds in the form of mother’s first milk colostrum and Total Parenteral Nutrition (TPN) via central lines until mothers are able to produce more milk. These babies are at high risk of infection and strict infection control measures such as strict hand hygiene are required to prevent infections. Infections are treated with antibiotics.

They need warmer or incubator care to help support the body temperature.

These babies are at risk of apnoea of prematurity and require caffeine, which is a respiratory stimulant. Some sick babies may require medicines to support blood pressure.Initiation of Kangaroo Mother Care (skin-to-skin contact with mother ) and early initiation of Expressed Breast Milk via tube feeds play an important role in getting these babies to full feeds and prevent complications such as growth failure, infections, cognitive impairment etcBesides breast milk these babies require Breast Milk Fortifier to enhance nutritional value of mother’s milk.Outcome : Premature babies are at risk of short term and long term complications such as infections, anemia, growth failure, intraventricular haemorrhage ( bleeding in brain space ) , chronic lung disease, retinopathy of prematurity and range of Neuro disability- mild , moderate & severe. Earlier the gestational age and smaller the baby, more likely the chances of complications. With advances in NICU care , promotion of Breast & Donor Breast Milk & early aggressive enteral nutrition , Intact survival ( survival without long term complications ) of extreme premature babies (<28 wks gestation) has significantly improved in good centres in India.

Many 600-700 g babies are having a reasonable outcome and performing well in school. Prevention : Prevention of preterm births can be done by regular Antenatal check-ups & early identification of risk factors, avoiding alcohol intake and smoking, proper nutrition & hydration during pregnancy. Proper hormonal support during pregnancy, meditation and good mental health plays a vital role in prolonging pregnancy.