Advances in Pre-Natal and Neonatal Care
Improving Outcomes for Smallest Babies
This year, an estimated 400,000 in-fants will be born too early and too
small. And while physicians and researchers are still searching to uncover
the causes of premature birth, advances in both pre-natal care and neonatal
care are improving the long-term outcome for many of these babies.
Nilima Karamchandani, M.D., chief, Division Neonatology at The Western
Pennsylvania Hospital, was among the first doctors in Pittsburgh to even
attempt to save a baby born earlier than 26 weeks.
"It's really been an evolution over the last 20 years in how
we approach caring for these extremely premature infants," she said.
"Today, more and more of these babies are surviving and doing so
with fewer of the devastating complications."
About 12 percent of all pregnancies result in a premature birth, which
is defined as birth before 37 weeks gestation. Studies suggest the four
most common causes of premature birth are: maternal or fetal stress that
may cause the body to produce hormones that weaken the membranes; bleeding
as a result of problems such as placental abruption in which the placenta
peels away from uterus; certain infections; and stretching of the uterus
as a result of multiple fetuses. However, about half the cases of premature
birth go unexplained.
"We still have a lot to learn about premature birth, which is why
it is so important for women who are pregnant to make sure they get involved
in a quality pre-natal care program so that any potential complications
can be managed effectively," said Robert Guthrie, M.D., director,
Division of Neonatology at Allegheny General Hospital.
Among some of the most important advances are improved methods, including
the use of tocolytic drugs, to stop premature labor and give the baby
more time to mature. Women who go into premature labor or who are likely
to go into pre-term labor also are routinely given steroids to help the
baby's lungs mature.
Giving the baby as much time as possible to mature in utero is critical
to help reduce complications from early birth. Among these complications
are an increased risk of cerebral palsy, vision and hearing problems,
bleeding in the brain, learning disabilities and chronic lung problems.
The incidence of these complications has decreased as a result of several
advances in treating premature babies.
"Our goal as physicians and health professionals is to improve the
survival of these babies, but also to improve their quality of life,"
Dr. Karamchandani said. "We also follow these babies for two years
after they are born to help with continued development and to help resolve
any lingering lung problems."
Both Dr. Karamchandani and Dr. Guthrie point to the use of surfactant
as one of the most significant developments. Surfactant is a milky substance
that is instilled into the baby's lungs shortly after birth to help
the lungs expand. It has helped to reduce mortality in premature babies
by about 40 percent.
Another important advance is the high-frequency, oscillating ventilator
that can send small puffs of oxygen to the baby's lungs at a rate
of 300 to 400 times per minute. In comparison, an adult ventilator will
send oxygen only 20 to 30 times per minute. The high-frequency ventilator
helps to reduce damage to the lungs.
A third advance is the use of inhaled nitric oxide in some premature infants.
A study showed that inhaled nitric oxide in larger premature babies helped
in cases of persistent pulmonary hypertension, which occurs when the blood
vessels in the lungs are too constricted to allow enough oxygen to circulate
through the body. The nitric oxide helps to relax the blood vessels and
allow more oxygen to get into the lungs. Another study published this
year, however, indicated the effectiveness of this therapy in very small
infants was less than believed.
On the less technical side, neonatologists and neonatal nurses are much
more aware of how lighting, sound and touch can help a newborn thrive.
Many neonatal intensive care units are designed to provide the babies
with an environment that will help limit the noise and light that can
stress the baby. Music therapy and kangaroo therapy also are routinely
employed to help the baby feel secure and calm.
Because not all hospitals have expertise in caring for these small babies,
women who enter labor early are often transported to hospitals equipped
with Level III neonatal intensive care units. The neonatologists and neonatal
nurses from these units are available 24 hours a day to attend to the
special needs of preterm infants.
Women who are pregnant who believe they may be going into labor early
are encouraged to call their doctor immediately and seek admission to
a hospital that can handle the delivery. Some warning signs to look for
are:
- Contractions (your abdomen tightens like a fist) every 10 minutes or more often
- Change in vaginal discharge (leaking fluid or bleeding from your vagina)
- Pelvic pressure—the feeling that your baby is pushing down
- Low, dull backache
- Cramps that feel like your period
- Abdominal cramps with or without diarrhea
