Premature birth: on the rise, but something positive you can do

Unfortunately the statistics show that the number of babies born prematurely is (and continues to be) on the rise globally. As a parent-to-be, it is a hugely stressful time and it can often leave you feeling powerless. However, the latest science is suggesting that there are positive things you can do even within the NICU to meaningfully help your baby along the way - we take a look at what, what the science says, and how you can approach this if your baby comes earlier than expected.

The latest figures show that in the US, as many as 1 in 8 are now born prematurely and according to figures published in the highly respected ‘The Lancet’ medical journal, last year saw 15 million babies born pre 37 weeks with that number growing 0.8% per year over the last three decades. Sadly, it remains the single biggest cause of infant death at one month old and below. (1)

The good news is that survival rates for babies born prematurely has increased but unfortunately there can potentially be long term consequences particularly from very early preterm birth.

How can you, as a parent, help if your baby is born prematurely?

Well firstly, how premature matters ie. how far before the 40 week ‘due date’ is the baby born. This is largely divided in the following way:

Term birth: 37-42 weeks

Preterm birth: before 37 weeks

Late Preterm: 34-37 weeks

Moderate Preterm: 32-34 weeks

Very Preterm: 28-32 weeks

Extremely Preterm: less than 28 weeks (2)

Unfortunately being preterm in general can be potentially problematic particularly for brain and lung development amongst other factors.

Why?

When it comes to brain development, there is a large leap forward in development in the third trimester with a four-to-five fold increase in the volume of cortical grey and white matter (2) and by 30 weeks of gestation, the brain has achieved only half of its full-term weight.’

The lungs similarly are very susceptible to injury when immature and large chunks of development occur during the latter stages of gestation.

Here’s some good news:

The latest research published once again in The Lancet showed that as a parent there are potentially things you can do if you baby is born prematurely to help their development. This study demonstrated improvement in outcomes for preterm babies using something called: ‘Family Integrated Care’.

What is this?

‘Despite evidence of improved outcomes from increased parent-infant interaction, parents are not routinely integrated into the caregiver role and are often perceived as visitors in the NICU.’ (3)

It’s all to do with the role you can potentially play alongside your baby’s caregivers within the NICU:

Of course the main aim of the doctors and nurses within the NICU is to support your child medically in the best way they possibly can and many of the advances in care are revolutionary in improving survival. However, this particular research has demonstrated that the role you as a parent can potentially play alongside your baby’s NICU caregivers can be particularly beneficial:

Family Integrated Care:

This particular study demonstrated that by shifting the role of parents from ‘disempowered observers in the NICU to active caregivers’ there were clinically significant improvements in terms of:

  • increased infant weight gain

  • Lower nosocomial infections (ie.infections picked up in hospital environment)

  • Lower parent stress

  • Fewer readmissions

  • Higher breast milk feeding rate

Why are these factors so significant?

Weight gain: Growth has been shown to be an important independent determinant of neurodevelopment outcome and ‘the increased weight gain and enhanced high frequency breastmilk feeding are important improvements in preterm care that might have long term benefits for infant health.’ (3)

Breastmilk: we know there are significant benefits in terms of both gut health and neurodevelopment for preterm and term infants - click here for more. This was echoed by the study: ‘reports indicated that breastmilk feeding improves neurodevelopmental outcomes’ were shown so involving the mother and encouraging breastfeeding wherever possible has been shown to have tangible benefits.

Now, of course it can be tricky directly feeding a premature baby (often they can be too small to feed via the mouth) and often not possible. However, expressing milk to be fed to your baby is a very positive thing to do if you can. Particularly helpful if they can be on your lap (if they’re being tube fed) or if you’re using a syringe and you as a parent can be involved.

Mental Health/stress/trauma: having a preterm baby is highly stressful for both the parents and potentially the child. What this research showed is that incorporating parents more into the NICU care process actually ‘increased the psychological wellbeing of parents...which could translate into better long-term mental health for the infant’s parents and in turn improved parent-infant bonding and enhanced outcomes for the infant’ (3)

Translation: by being more involved directly in your baby’s care research has shown that stress rates could potentially come down. We know that stress is not helpful when it comes to the bonding process and anything that can aid the bonding between parent and child can have a tangible effect improving outcomes .

Not only that, but the study touched upon the fact that if the parent’s are the primary caregiver even within the NICU that brings a ‘more consistent environment which could help protect the infant from trauma associated with the NICU such as isolation, stress and lack of support during painful procedures.’

It also gives more skin to skin and more developmentally responsive care. We do know that the parent’s responsiveness (where possible of course) to their infant is an important determinant of neurodevelopmental outcomes’ which is another reason why reducing parental stress and anxiety helps increase the parent’s connection to the baby and then potentially the developmental outcome of the child.

So, what role did the parents in the study play?

Of course, the above is done where it is possible, unfortunately there can be restrictions on doing this depending on circumstance and level of prematurity of the baby. However, where possible the parents in the study were encouraged to participate in:

  • Bathing

  • Feeding

  • Dressing

  • Skin to Skin care

  • Changing

  • Giving Oral Medication

  • Taking temperature

  • General interaction

They were also given education in terms of how to do this, how to safely be a part of it and made to feel part of the decision making process.

Now, clearly there are limitations here, particularly if your baby is very preterm so you have to operate in any way you possibly can and do not feel bad or guilty if there are limits to how much you can be involved, remember that anything at all is positive no matter how small it may feel. If there are limits, then it is likely because the staff in the NICU are doing everything they can for your child and as your child grows and improves there will be lots more opportunity for more of the above.

However, the underlying message within this research seems to be that if you are a parent of a premature baby dont be afraid to speak up to the NICU and express your desire to participate as much as you possibly can. It can have a potentially positive impact on the outcome for you and your baby.

For more information/details on the study check out the footnotes below.


References:

  1. WILLIAMS CL, TANN CJ: Global perspectives of premature birth across the life course. The Lancet Child & Adolescent Health, April 2019. Vol 3 No. 6 p370-371

  2. GLASS H, COSTARINO A, DAVIS PJ: Outcomes for Extremely Premature Infants: Anaesthesia and A nalgesia. 2015 Jun: 120(6): 1337-1351.

  3. O’BRIEN K, ROBSON K, BRACHT M, CRUZ M: Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multi Centre, multinational, cluster-randomised trail. The Lancet Child & Adolescent Health. 2018: 2: 245-54