Prematurity

DEFINITION

Prematurity is a condition in which a baby is born before 37 weeks of pregnancy (more than 3 weeks before the expected date of delivery).

About 12% of babies are born in a state prematurely. Many babies born a few weeks ahead of time should not experience any problems related to prematuritasnya. However, the more premature the baby is born, the baby is more vulnerable to a variety of serious complications and even life threatening.

Premature infants who have organs are not fully developed, which may not be ready to function outside the womb. As a result, infants at high risk for the disorder after birth. Prematurity (especially extreme prematurity) is a major cause of problems and death in newborns.

CAUSE

The causes of preterm birth is usually unknown. However, the risk of preterm birth is higher in pregnant women who:

- Pregnancy in women younger (less than 18 years)

- Pregnancy in older mothers

- Lower socio-economic group

- Irregular prenatal care

- Pregnancy doubles / twins

- The state of poor nutritional

- Having a weight under or over before pregnancy

- It has not resolved the infection, such as urinary tract infections or sexually transmitted diseases

- Abusing drugs (eg, amphetamines or cocaine), drinking alcohol, or smoking

- History of preterm labor in a previous pregnancy

- Having a serious or chronic illness, such as heart disease, kidney disease, diabetes mellitus, preeclampsia or eclampsia

- Obtain physical trauma

- Having abnormalities in the uterus or cervix

- Never a few times to have a miscarriage or abortion

- Premature rupture of membranes

- Placenta previa (abnormal location of the placenta)

SYMPTOMS

Physical description of premature infants:

·         Small size

·         Low birth weight (usually less than 2.5 kg)

·         Head of the relatively large size compared to the baby's body

·         Little fat under the skin so the skin looks wrinkled

·         Veins under the skin looks

·         The lines on the soles of the feet is still small

·         The presence of fine hair on many parts of the body (lanugo)

·         Ear soft, with little cartilage

·         In the boys, the scrotum (scrotum) is small and has little crease, and the testicles may not descend on extremely premature infants

·         In baby girls, the labia majora not cover the labia minora and clitoris looks great

·         Abnormal breathing patterns, where breathing is rapid and shallow, and can attack a short stopping breathing

·         Sucking and swallowing reflexes are weak and have not coordinated

·         Cries weak

·         Lack of physical activity and weak muscle tone

·         Almost always sleep all day

The symptoms found in premature newborns are often associated with the various organs that have not fully developed. Premature babies can also experience difficulty in maintaining body temperature and blood sugar levels. Newborns generally have a low body temperature, especially immediately after birth. In addition, the baby's immune system is still not perfect.

Complication

The lower the gestational age (the more premature babies), then the risk of complications increases. In addition, the risk of complications is also dependent on the presence of several causes of prematurity, such as infections, diabetes, high blood pressure or pre-eclampsia in the mother. Some of the complications that can occur include:

-Brain development is not perfect, so it could happen:

·         Irregular breathing patterns and could happen stopping breathing

·         Difficulties to align drink and breathe

·         The risk of bleeding in the brain, usually occurring during delivery or when there are problems in breathing.

-The development of the liver and the gastrointestinal tract are not perfect, so it can cause a variety of problems, among others:

·         Frequent spit up (regurgitation)

·         Severe intestinal disorders (necrotizing enterocolitis), in which the intestines can become inflamed, tissue death, and even perforated.

·         Yellow (jaundice), due to the accumulation of bilirubin due to liver function has not been perfect. Bilirubin levels that are too high can even cause damage to the baby's brain (kernicterus).

-The development of the immune system is not perfect, so the risk for infection.

-Kidney development are rudimentary, so that the baby can be difficult to regulate the levels of salt and water in the body.

-Lung development are rudimentary. Premature babies often do not produce adequate amounts of surfactant. Consequently during breathing, the lungs can occur deflate and Respiratory Distress Syndrome.

-Difficulty to keep blood sugar levels

-Difficulties to maintain body temperature. Premature babies tend to lose body heat more quickly, especially when exposed to cold environments. Therefore, the baby's body temperature needs to be maintained with engine warmers or incubators.

DIAGNOSIS

Diagnosis based on physical description and gestational age at birth. Ulstrasonografi examination of the fetus during early pregnancy and newborn physical examination can be performed to determine gestational age.

Several tests that can be performed on premature babies, among others:

- Chest X-ray to see lung maturity

- Eye examination

- Blood gas analyzer

- Blood sugar levels

- Blood calcium levels

- Levels of bilirubin

TREATMENT

Therapy given to premature babies in the form of handling the complications that occur, for example, respiratory distress syndrome and high bilirubin levels.

Nutrition for extremely premature infants can be intravenously until they can start getting food intake. Food initially began to be given through a tube inserted into the baby's stomach, until the baby can suck and swallow well. Breast milk is the best food for premature babies.

Premature babies are very rapid heat loss and have difficulty in maintaining body temperature, so they are usually placed in an incubator. In addition, babies may need the help of a respirator and supplemental oxygen.

PREVENTION

One of the most important steps in preventing prematurity is to start doing prenatal care as early as possible and continue to carry out regular checks during pregnancy.

REFERENCE

- K, Arthur E. Prematurity. Merck Manual Home Health Handbook. 2009.

- L, Kimberly G. Premature Infant. Medline Plus. 2011.

- Mayo Clinic. Premature Birth. 2011.