Early Birds: How to Care for Premature Babies

As expectant parents we meticulously plan and prepare for the birth of our baby. But for many parents their child will enter the world much earlier than they had thought, arriving simply too early.

What do Albert Einstein, Winston Churchill and Stevie Wonder have in common?

They were all ahead of their time, and in more ways than one. Besides being innovators, these three all made an early entrance into life. Einstein arrived three weeks ahead of schedule, Wonder six, and Churchill by two months.

Medicine has progressed considerably since, nonetheless, science still has a long way to go in explaining, predicting and preventing prematurity, which affects about eight per cent of births.

Premature babies are born before 37 and after 24 weeks of pregnancy. While most go on to lead normal lives, others – like Stevie Wonder – develop health problems. His blindness was caused by retinopathy of prematurity, in other words, his eyes had not developed properly.

A birth is considered ‘term’ if it occurs anywhere between 37 and 40 weeks. Preemies, as they are known, may require special care. The general rule is: the earlier the birth, the higher the risk.

Scientists do not fully understand the reasons why some women do not carry to term, which is why units like the Preterm Surveillance Clinic within Guys & St Thomas Foundation Trust are so crucial.

According to Tommy’s, the national charity funding research into premature birth, stillbirth and miscarriage, 30 per cent of premature births are spontaneous and unexplained. A further 30 per cent occur in the case of multiple births. Tommy’s funds research into prematurity at the clinic, as well as at two other centres in Manchester and Edinburgh.

The charity’s health campaigns director Jacqui Clinton says, “One in 13 babies are born prematurely in the UK, yet we still don’t know what causes babies to arrive too soon in the majority of cases. It’s thought that around a third are caused by infections, and yet more are caused by problems with the cervix, but there is still a long way to go before we will know for definite what causes each baby to be born prematurely.

“While more and more premature babies are surviving, they are still at risk of serious health problems from chronic lung diseases to sight loss, hearing loss and cerebral palsy. There are some things women can do to reduce their risk, such as not smoking or drinking alcohol, but this isn’t the only answer and our research focuses on finding a way to predict and prevent a woman from giving birth prematurely.”

“We also look at pre-eclampsia which is life threatening for women and babies, and often means that a baby needs to be delivered early before they are fully developed. Our aim is to reduce prematurity, give more babies the best possible start in life and ultimately save babies’ lives.”

Jenny Carter, a research midwife at the Preterm Surveillance Clinic, explains that early labour is often brought on by a combination of factors. Those at risk include women who have had a previous premature baby, as well as those who suffered a late miscarriage (14 – 24 weeks).

She says, “If a woman has had a lot of her cervix removed in a procedure like a colposcopy, it could put her at risk of having an early baby.”

She adds, “One of the things we do think plays a part is stretching, and in women who are carrying more than one child the uterus will be stretched so much that it triggers labour.”

For the premature baby, the dangers will depend on how early they are. Near term babies (34 – 36 weeks), can have trouble with blood sugar levels, blood pressure and may not feed well. Moderately premature babies (32 – 34 weeks) will experience the same, as well as possibly mild breathing problems. Hypothermia and infection could also occur.

Babies born before 27 weeks will be transferred to a neo-natal intensive care unit as their lungs are not fully developed. They will be incubated to avoid hypothermia and infection. Babies born between 28 and 31 weeks face the same dangers, but are less likely to become severely ill.

Viability occurs at 24 weeks, which means babies born before that are highly unlikely to survive. According to the 2008 EPICure study, just seven per cent of those born at 22 weeks live, compared with 42 per cent at 24 weeks and 78 per cent at 26 weeks.

Partially funded by Tommy’s, the Preterm Surveillance Clinic has reduced premature birth rates by more than 10 per cent since its inception more than a decade ago.

“We determine women at risk and try and stop them from going that way again,” says Jenny, who works alongside clinic founder Professor Andrew Shennan.

“It’s very individualised care. Our philosophy is surveillance, but if it looks like labour might happen early we try and stop it.”

A woman who goes into labour at 24 weeks may be required to have two steroid injections between 12 and 24 hours apart – but if there is not enough time, the baby requires further treatment. Others will be given a cerclage, or ‘the stitch’. This long-established practice effectively ties a knot in the cervix.

Often, the main role of the clinic and others like it, is to provide reassurance.

Jenny says, “We see women who have lost babies at up to 22 weeks so they are really anxious.”
“Our job is to keep baby in as long as possible. Babies tend to do better in than out, but there are some times where they need to come out.”

The message is: if in doubt, check it out. “We would rather be careful than face the possible consequences of not coming in,” says Jenny.

✽ Tommy’s offers a free booklet entitled ‘Having a premature baby’. To obtain a copy or for further information visit www.tommys.org or call 0800 0147 800.

Dana Walfisz never made it into her maternity clothes.

When she was just 26 weeks pregnant, she went in to labour and gave birth to daughter Erin. Now a happy and healthy ten-year-old, Erin weighed just 1lb 8oz and spent the first three months of her life in a neonatal care unit.

You might have thought lightning couldn’t strike twice, but three years later Dana’s second pregnancy went a similar way. Labour kicked in at 25 weeks, but Max was not as lucky as his sister.

The day after he was born Max’s tiny lungs collapsed and he had a huge bleed on the brain, which left him with cerebral palsy. Most of his first year was spent in and out of hospital, undergoing various procedures including brain surgery.

Today Max, seven, is a happy, chatty boy who attends the same mainstream school as his sister, but he still cannot walk unaided and regularly receives a range of treatments, including a ground-breaking type of physio known as spider therapy.

Even now, Dana does not really know why her children arrived so early.

She says, “It’s just one of those things. They told me after Erin that there was no reason I should have this again, but people who have had a premature baby are more prone to it.”

Dana says, “Max, he surprises us every day and amazes us with what he can do. We thought he could possibly be in a wheelchair for the rest of his life.”

“If he carries on going to spider therapy I totally believe that he will walk independently within the next year or two just because he’s got so far so quickly.”

Freddie Warbrook McGill was born almost 12 weeks early in May 2011.

Despite being cared for at the Royal Free Hospital, his mother delivered him at the William Harvey Hospital in Ashford, Kent, which was where the nearest available incubator was located.

For 35 days, anxious and exhausted parents Ross and Jenni, both teachers, made the 86 mile trip to visit him. Finally, five weeks later, Freddie was transferred to Barnet Hospital, just four miles away from home. After a further six weeks later, he was finally discharged home.

The couple took hundreds of photographs of their tiny miracle, one of which shows Freddie wearing his father’s wedding ring up around his shoulder.

“For the first year he had colds all the time but he’s been really strong for a long time,” says Ross.
In the early days he was about three months behind other children developmentally, but it was never serious.

The doctors have no concerns now.”

Freddie’s arrival had such a profound impact on the couple’s lives, that Ross decided to start blogging about being the parent of a premature baby – and has been doing so ever since.”

“There was no reception in the hospital and we were constantly trying to update family and friends on the situation. So I decided to start writing a blog to update everyone at the same time,” he says.

✽ To read more about Freddie’s incredible journey visit freddiemcgill.blogspot.co.uk