Understanding Premature Birth:
Neonatology Insights from Dr Lalitha Gundamraj
neonatology
Dr Lalitha Gundamraj has specialized in neonatology and has 23 years of experience. She has expertise in taking care of premature babies, who are born during the time period from mid-22 weeks to term babies who have any type of medical conditions, and upto 40-42 weeks of pregnancy. This blog highlights the main takeaways from her session, where she discussed common concerns related to neonatology.
Complications in premature babies:
Delivering the baby at 30 weeks is not just being premature. The development of all the organs will occur in babies during the pregnancy phase. Premature babies are at increased risk of developing neurological conditions, breathing problems, and even cardiovascular conditions. They may even need medications for low blood pressure.
The immune system in premature babies is not well developed, which puts them at increased risk for infections. When compared to a full-term baby, their response to bleeding or clotting is different. Respiratory function can also be affected in these babies, which makes the oxygenation difficult. Using X-rays, it is possible to determine the expansion of the lungs. This situation is scary and can trigger anxiety in individuals.
Monitoring of the baby’s health in the NICU:
Babies weighing between 400-1000 grams have separate and customized smaller equipment such as breathing tubes, and feeding tubes that match their size. They will need continuous monitoring of heart rate, breathing rate, oxygenation and blood pressure. It is also possible to provide minimally invasive ventilation for these immature babies. The management of small babies requires a collaborative approach of doctors, respiratory therapists, dieticians, and nurses.
How long are premature babies kept in NICU?
The length of the stay can vary depending on the condition of the baby, such as the level of prematurity. Prior to discharge, babies should be able to breathe without requiring any additional support, feed without needing feeding tubes, and have stable vital signs. There is a possibility of long-term health problems based on their clinical history and progress in NICU..
If the baby is born at 22-35 weeks, there can be chances of certain deficits with varying levels of severity, and they may need close follow-up. There can be a delay in developmental milestones.
To improve treatment outcomes, parental education is important. Parents should be made aware of what to expect and what resources they need. Hence, proper monitoring is required to improve the prognosis.
Aspiration of mother’s milk:
It is important to check whether babies are choking or grunting during feeding. These are termed as feeding or breathing difficulties. The signs can be detected during the newborn period.
The babies should display normal patterns like sucking, swallowing, and latching on to the bottle or mom’s breast during nursing. A follow-up with the pediatrician can help to track the normal expected activities of babies. It is crucial to know whether the baby is lethargic or how much urine and stools the baby is passing.
If any of the alarming signs, like feeding, or breathing difficulties or signs of digestive disorders arise, immediate pediatric consultation is required.
Respiratory distress syndrome:
Respiratory distress syndrome arises due to inadequate production of surfactant. The surfactant are produced naturally by the lungs, and it is deficient in babies who are born prematurely, especially those under 37 weeks.
The condition is more severe when babies are even more premature. For babies, who are born below 32 weeks, medication called surfactant can be provided through a breathing tube that is placed into the trachea. Currently, less invasive techniques can be used to minimize injury. During the procedure, it is important to inspect, follow and address any complications that may arise.
The long-term problems associated with RDS depend on several factors, such as the level of free maturity, doses of surfactants, and how long they have been on the ventilator. If the baby’s breathing becomes normal within days, the chances of the development of long-term risks are low.
Prenatal corticosteroids can be recommended to mothers who are diagnosed with high-risk conditions. The prescribed corticosteroids can improve the functioning of the lungs.
Yellowish discoloration in the baby’s skin and eyes:
Yellowish discoloration can be a sign of jaundice that results from the excessive production of a substance called bilirubin. It is produced due to the excessive load, and breakdown of blood cells. Several factors, such as age of baby, passing of stools/urine, feeding habits, level of bilirubin in the blood, etc, can determine the intensity of the condition.
Long-term jaundice can cause complications due to the presence of bilirubin within the deeper brain nuclei. Intensive phototherapy, IV hydration, and triple phototherapy can help to manage the symptoms. Sometimes, exchange transfusion in ICU settings.is necessary.
Hypoxic ischaemic encephalopathy (HIE):
HIE occurs when there is a decrease in oxygen and blood supply. The babies might not cry after birth due to low levels of oxygen. Early recognition of symptoms is important for therapeutic interventions or medications to become effective.
This condition might have started before birth. The placenta is connected to the baby through the umbilical cord. If the cord is wrapped around the neck or if it is ruptured, there can be placental abruption or severe sepsis. The baby can go into a severe shutdown due to reduced blood supply/oxygen levels. All the blood cells, like RBCs, platelets, can be consumed. Malignant hypothermia maintains the babies at a low temperature, which is lower than the expected temperature. It is indicated for a period of three days (72 hours).
Hence, prenatal monitoring around delivery is important. Based on herapeutic hypothermia/whole body cooling is indicated for babies in the second or third stage of the condition.
Septal defects in babies:
Ultrasound can detect abnormalities in the baby during pregnancy. For example, septal defects in the heart can be diagnosed during pregnancy. Mostl septal defects do not require surgery right at birth. Most of the babies undergo changes in pressure within the lungs. Proper monitoring is essential to understand the condition and its progress.
With the help of a congenital heart defect screen, oxygen saturation can be detected. In moms who had good prenatal care, congenital heart defects can be recognised before birth. The recurrence rate depends on the type of defect.
Low blood sugar levels in newborns:
Low blood glucose levels can affect neurodevelopmental outcomes. Motherothers who had diabetes during pregnancy might be under dietary control or medicines. In this case, there is a chance of hypoglycemia in babies. It is acceptable to have borderline blood glucose within the first two days. But close monitoring is required to prevent prolonged hypglycemia and related complications.
Supplementing breast milk with additional calories can help to maintain a normal range of blood glucose.e. If the symptoms are persistent, an endocrinology consultation is required.
Babies with neonatal hypoglycemia can feel lethargic, and they may not wake up for regular feedings. Normally, babies will have a rhythm in feeding, waking up, peeing, pooping, etc. When blood sugar levels become low, they may feel sleepy.
It is important to control gestational diabetes through proper medications. Medications should not cause detrimental effects on the baby.. There are specialists like maternal fetal medicine doctors to manage high-risk conditions. Monitoring of glycosylated hemoglobin (HbA1c) and glucose in pregnant women is crucial for the overall health of the baby.
Conclusion:
Dr Lalitha Gundamraj’s session offered valuable insights regarding the relevance of prenatal care for newborns. The treatment outcomes of premature babies have improved with the help of less invasive approaches. Proper monitoring of the symptoms can enhance quality of life.
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