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Before it’s time

Before it’s time
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First Published: Fri, Aug 15 2008. 12 08 AM IST

Updated: Fri, Aug 15 2008. 12 08 AM IST
For six joyful months, Sarika Bhatt, a 30-plus Gurgaon-based consultant, sailed through her pregnancy. She was marking time in delightful anticipation of her baby’s arrival. Then, in the 26th week (three months before full term), her blood pressure suddenly shot up and protein loss was detected in her urine—signalling a pregnancy-related condition known as pre-eclampsia that can be fatal for mother and child.
A doctor even told a stunned Bhatt: “Forget about your baby. We’ll just focus on saving your life.” But, says Bhatt, “I prayed and had faith in God. Fortunately, I found a doctor who was willing, in spite of the risk, to try to save both me and my baby.” She was given surfactants—to help the baby’s lungs mature quickly—and rushed to Delhi’s Indraprastha Apollo Hospital. There, her baby was delivered through emergency Caesarean section. Little Deetiya was born 700g, put on oxygen immediately and spent three months in the neonatal ICU (see box, right). It was hard at the time for Bhatt to see her newborn daughter so helpless, so fragile.
“The doctor told me that if I seemed upset, the child would sense it,” she says. “So, I refused to cry. Only once, when I saw the doctor’s blood-stained gloves after carrying out a procedure on her, I couldn’t stop my tears...” She adds, “I tried to do my best for Deetiya—expressing my breast milk for her, and just being there.”
Frightening as it may sound, this is becoming increasingly common. The number of premature babies is rising worldwide. In the US, one in eight babies was born premature, according to non-profit organization March of Dimes’ figures in 2007—an increase of almost a third over a decade. In India, too, there seems to be an upward trend. According to a government study, 12% of Indian babies are born premature and 30% are born with low birth-weight.
“Certainly, in my experience, I do feel that the incidence of premature babies is increasing,” says Sabhyta Gupta Vaid, consultant gynaecologist and obstetrician, Artemis Health Institute, Gurgaon. Government mortality statistics show that prematurity is one of the top 10 causes of death in the country.
That’s the bad news. The good news is, with improved care and technology, more and more premature babies are now surviving. Even the risk of problems such babies are likely to suffer is reduced.
Napoleon Bonaparte click here for picture
Stevie Wonder click here for picture
Albert Einstein click here for picture
Charles Darwin click here for picture
Many reasons
Why are some babies born early? There are a number of factors. “The nutritional status of the mother is a major reason. Genital tract infections can also affect the baby,” says Dr Vaid. Other reasons include smoking, alcohol intake, anomalies in the mother’s uterus or cervix, or developmental problems with the foetus. The risk of pre-term birth increases in those carrying twins or triplets.
New Jersey-based Nita Gopalkrishnan knew of the risks since she was carrying twins. So, she was not surprised when she went into premature labour at 29 weeks, even though she had been given magnesium sulphate to prevent this. Her babies were 3lbs (1.4kg) and 3lbs 7 ounce (about 1.6kg), respectively (see box, right).
Greater use of assisted reproductive technology, such as in vitro fertilization (IVF), also appears to increase this risk. So do situations where the mother is under stress. The mother’s age matters, too—being more than 35 or under 17 adds to the problem.
Odds improving
Fortunately, with improved technology, new research findings and care guidelines, the odds for the pre-term baby are improving. Today, according to UK government statistics, a 28-week, 800g baby has a 90% chance of survival, with fewer complications, in a well-equipped neonatal unit.
“Thanks to better equipment for monitoring and care, more pre-term babies and low birth-weight babies are surviving,” says Vidya Gupta, consultant neonatal specialist, Indraprastha Apollo Hospital.
“For example,” she explains, “we have better warmers to keep the babies at the correct temperature, since they cannot maintain their body temperature when they are very small. We have better equipment for ventilating their lungs, and also to monitor their heartbeat, their oxygen levels.”
A few years ago, according to her, the doctors would focus on just keeping the baby alive. Now, the aim is to keep the baby alive with minimal damage.
Prematurity brings about its own set of risks, greater for very early or very small babies. The commonest is cerebral palsy—a disorder that affects body movements. The affects can range from an inability to coordinate limb movements or walk properly, to simply having difficulty with fine motor tasks such as writing or holding a pair of scissors.
Other problems for premature babies include retinopathy of prematurity (ROP). Left undetected and untreated, it could lead to blindness. Musician Stevie Wonder lost his sight to ROP. About a quarter of the babies born before the 30th week have hearing impairments.
“We try to prevent problems through early detection—for example, through echocardiography and ultrasound of the brain,” says Dr Gupta. A range of neonatal experts regularly monitor the child’s eyes, hearing, and look for other possible complications. Detecting and treating problems early means these children can grow up to lead normal or near-normal lives.
Ultimately, technology assists; but most of these children have a strong sense of survival and resilience, too. “I now feel that premature babies are smarter, more perceptive—and real fighters!” says Bhatt. History would agree—Napoleon, Isaac Newton and Charles Darwin were all preemies.
Deetiya was born 700g, only a little bigger than the palm of her mother’s hand. She was put on oxygen immediately; probes plugged to her body monitored her heartbeat and oxygen levels continuously. 
With translucent skin, tiny bones and ribs jutting out initially, she spent the next three months in the neonatal ICU, undergoing blood transfusions, surgeries, and a whole host of interventions. Even after she was brought home, she was regularly monitored by a development and other specialists. That was 2005. Today, she is a healthy, lively three-year-old getting into mischief.
Nita Gopalkrishnan, a New Jersey-based homemaker, was carrying twins. So she already knew she was at high risk of premature labour. At 29 weeks, she gave birth to Sanjna and Satvik, born 3lbs (1.4kg) and 3lbs 7oz (about 1.6kg), respectively. Gopalkrishnan was given steroids before delivery to help the babies’ lungs mature. After birth, despite the precautions, they had breathing problems and were on a ventilator for 2-3 hours. Then they were on the CPAP (continuous positive airway pressure) machine for the next four weeks. They stayed in the neonatal ICU for four weeks and graduated to the SCU (secondary care unit), spending two weeks there. They went through the routine ECGs and MRIs of the head (to check for bleeding). The twins emerged from hospital without complications. Once home, only the parents, Nita and Suresh, could handle the babies—not even their grandparents were allowed near them in order to minimize the risk of infection. Today, at 13 months, they have almost caught up with the activity levels of other children around them.
• Multi-foetal pregnancy (twins or triplets)
• Mother younger than 17 or older than 35
• Nutritional deficiencies in the mother
• History of pre-term labour
• Pre-eclampsia (high blood pressure)
• Earlier spontaneous abortions
• Infections during pregnancy
• Intake of alcohol, tobacco or drugs during pregnancy
• Uterine or cervical abnormalities
• Mother too thin or too fat before pregnancy
• Excessive stress
• Periodontal disease
• Get regular check-ups to detect any problems early on
• Be aware of the signs of pre-term labour
• Treat all urinary tract infections and sexually transmitted infections
• Stop alcohol and drugs and quit smoking
• Reduce stress during pregnancy
• Manage chronic conditions such as diabetes, asthma, hypertension
• Have a nutritious diet rich in folic acid and iron
• Treat periodontal disease
• Maintain optimum weight
Many premature babies grow up to be perfectly normal, but there are some risks of the following:
• Cerebral palsy
• Autism
• Eyesight problems such as retinopathy of prematurity
• Hearing problems
• Brain damage
• Digestive problems
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First Published: Fri, Aug 15 2008. 12 08 AM IST
More Topics: Premature Birth | Mother | Child | Technology | Baby |