THE PREMATURE CHILD

THE PREMATURE CHILD

A child that is born before 36 weeks after conception is regarded to be premature, 40 weeks being considered full item (slightly more than 9 months). Another criterion for determining prematurity is that of weight. Any child born weighing less than 5 Ibs. 8 oz. is classified as premature. The closer to full term the fetus is, the bigger and more highly developed will be its organs and body systems. Its chances for survival, therefore, are proportionately increased.

Those born within the 32 to 36-week period will usually weigh from 3½ to 4 pounds. The infant will be weak, but can manage to cry for its food when hungry. Careful supervision and nursing care are needed if the baby is to live. When birth occurs 28 to 32 weeks after conception the fetal infant will weigh about two pounds. An infant of this size at maturity would require constant medical supervision for survival, because it cannot nurse and has particular difficulty maintaining a constant body temperature. A fetal infant born sooner than 28 weeks after conception is not given any chance for survival.

One of the several handicaps that the premature child must overcome is the difficulty of regulating body temperature.  This difficulty results from the large body surface in proportion to its weight. A lack of insulating fat, and an incompletely developed sweating mechanism. The nutritional needs of a normally rapid growing fetus are high. Yet its sucking and swallowing reflexes are weak or absent, and the ability of its digestive tract to handle and absorb foods is often lacking. The premature are also more vulnerable to infectious disease.

The greatest problem the premature baby will encounter, however, is the respiratory difficulty caused by byaline membrane disease (HMD). When babies are born, the inner surface of the lungs contains a surfactant which lubricates these surfaces. After one breath is forced out, this surfactant allows the lungs to expand again to let the next breath in.  Premature babies born with byaline membrane disease are born without this surfactant or lubricating device. Their lungs do not inflate enough, and a struggle for oxygen develops. If the baby lives for three days, he will usually begin to produce surfactant and may survive. The problem, then, has been to prevent brain damage from oxygen deprivation in those first critical days. New medical approaches are now being used to produce a higher survival rate for the baby with byaline membrane disease.

More than half of the neonatal deaths (within a month after birth) are due to prematurity. Some of the causes of prematurity resolve around the mother, with injury, malnutrition, infectious disease, tuberculosis, syphilis, cardiac or diabetic disorders, and toxemia with multiple pregnancy as the most  common. Those causes that are related more closely to the child include malformation of the fetus. Premature separation of the placenta. Rb factor difficulties, as well as a large group of undiagnosed causes. It must be noted that a number of the factors causing premature births are also related to the incidence of stillbirth (birth of a dead child). Prevention of prematurity is considered the basic researched aim. In the meantime, good prenatal care properly utilizing medical information already known is the best guarantee of a healthy child.

(From: J.S. Sinacore and A.C. Sinacore. Introductory Health: A Vital Issue New York Macmillan publishing Co. Inc., 1975.)

  

By Eguriase S. M. Okaka