Premature birth poses many risks for a baby. When a baby is born prematurely the lungs and other organ systems aren’t fully developed, which significantly increases the risk of infection, sepsis, respiratory distress and hypoxic ischemic encephalopathy (HIE) (which can in turn cause intraventricular hemorrhages (IVH) and brain bleeds, and periventricular leukomalacia (PVL)). These birth injuries can lead to other serious problems, such as cerebral palsy, seizure disorders, meningitis, intellectual disabilities, developmental delays, hydrocephalus and motor disorders. The best way to prevent problems associated with premature birth is to prevent the baby from being born preterm. Close monitoring of the mother during pregnancy will enable the physician to detect risk factors for premature birth and preterm premature rupture of the membranes (PPROM) like maternal infection, an incompetent cervix, or abnormal position of the baby (e.g., breech presentation). Infections must be promptly diagnosed and can be easily treated. Medical staff can assist mothers with incompetent cervix using a cervical cerclage (stitches that reinforce cervical muscle) if her pregnancy is at or less than 24 weeks. Mothers with a previous spontaneous preterm birth or short cervix should be given progesterone therapy to help prevent premature birth.
What Measures Can Be Taken to Help my Baby Avoid Breathing Problems?
- Steroids In-utero
- Surfactant Replacement Therapy
- Magnesium Sulfate In-utero
- Antibiotics for Preventing PPROM and Infection
Steroids Given In-Utero May Help Lung Maturity and Development in the Premature Baby
When a baby is born prematurely – or is about to be born prematurely – physicians must make every effort to prevent the serious problems associated with preterm birth (such as respiratory distress, sepsis, brain bleeds and PVL). When a baby is less than 34 weeks’ gestation and the physician suspects preterm birth is imminent, corticosteroids (such as betamethasone) should be given to the mother to reduce the incidence and severity of respiratory distress syndrome (RDS), intraventricular hemorrhages (brain bleeds), sepsis and periventricular leukomalacia (PVL) in the baby. When appropriately given to the mother, corticosteroids help the baby’s lungs and other tissues mature before the baby is delivered. If the baby isn’t born as soon as the medical team had expected, corticosteroid therapy may be repeated. Corticosteroids can provide enormous long-term benefits when given to the baby in the womb.
Providing Surfactant After Birth May Help Lung Development in Premature Babies
Medical staff should provide premature babies with surfactant once delivered. Surfactant is a lipoprotein that helps the lungs be more pliant and able to easily expand and retract. Mature lungs have millions of alveoli (airways). If a baby has insufficient surfactant, the lungs will be stiff and these alveoli can collapse, leading to trouble breathing (even if the baby is on a ventilator). Surfactant helps prevent the alveoli from collapsing at the end of exhalation and helps recruit collapsed airways.
A baby with stiff lungs on a ventilator can become seriously injured. Babies with stiff lungs and respiratory distress are prone to getting lung infections and pneumonia. These conditions can cause the baby to be oxygen deprived, which in turn can cause hypoxic ischemic encephalopathy (HIE), periventricular leukomalacia (PVL) and cerebral palsy. Thus, surfactant is very important for the baby.
If the baby is born before 35 weeks – and especially if the baby is born before 30 weeks – it is especially likely that surfactant replacement therapy will be needed. The first dose of surfactant is typically given right birth, or shortly after breathing problems are revealed. Three doses of surfactant are usually given within a 72 hour period.
Magnesium Sulfate In-Utero Helps Protect the Premature Baby’s Brain
Magnesium sulfate can also be given to the mother to protect the baby’s brain both directly and indirectly. This medication is given while the baby is in the womb.
Premature babies are at an increased risk for brain injury and cerebral palsy. Magnesium sulfate helps protect the baby’s brain from injury and significantly increase the chance that the baby will be born free of cerebral palsy. The medication also decreases the risk of the baby developing other major movement disabilities such as severe motor dysfunction.
Magnesium sulfate protects the baby’s brain in numerous ways:
- It increases cerebral (brain) blood flow
- It has antioxidant effects
- It reduces the level of damaging molecules (cytokines) released in the presence of inflammation
- It reduces neuronal excitability (excitotoxicity), which is damaging to the brain and occurs when the brain experiences trauma, restricted blood flow and oxygen deprivation
- It stabilizes brain membranes
- It prevents large blood pressure fluctuations
When a physician suspects that a mother is going to give birth to a premature baby within 24 hours, they should start to administer magnesium sulfate. The medication is typically administered when the baby is between 24 and 32 weeks of gestation. Magnesium sulfate should be administered to women with preterm premature rupture of membranes (PPROM), preterm labor with intact membranes, or indicated preterm delivery.
Antibiotics Can Prevent Preterm Premature Rupture of the Membranes (PPROM) & Infection
Approximately 4% of all premature births are due to preterm premature rupture of the membranes (PPROM), which can be caused by infections such as chorioamnionitis. PPROM can also cause an infection in the baby; when the membranes rupture (when a mother’s ‘water breaks’), infection in the mother can travel to the baby. Infections can be life-threatening, and place the baby at risk of having sepsis, septic shock, meningitis and cerebral palsy. Both premature birth and infection are both very dangerous for a baby.
Infections in pregnant women must be promptly recognized and treated with antibiotics in order to prevent (a) infection from traveling to the baby and (b) premature birth. If PPROM occurs, medical staff muts promptly provide antibiotics. The longer the time between the rupture of the membranes and delivery of the baby, the more likely infection will occur. The risk significantly increases if labor does not occur within 12 hours of the membrane rupture.
As with any premature birth or suspected premature delivery, standards of care should be followed for administration of corticosteroids, magnesium sulfate and surfactant to help prevent lung problems, hypoxic ischemic encephalopathy (HIE), cerebral palsy and other long-term conditions.
- When PPROM occurs between 34 and 37 weeks, labor usually will be induced. Most experts feel that the risks associated with infection are greater than those associated with premature birth.
- If PPROM occurs before 34 weeks, the situation is more complex. If there are no signs of infection, the physician may try to delay labor with tocolytics (progesterone) until the baby’s lungs are more mature. Medical staff usually administer antibiotics and corticosteroids to aid in lung development. The physician may collect a sample of fluid for analysis to determine if the baby’s lungs are mature. If they are, labor will be induced.
- When PPROM occurs between 32 and 34 weeks, the standard recommendation is less clear. These cases require careful evaluation and frequent reevaluation. Corticosteroids generally are administered in such cases when there is documented fetal lung immaturity and no evidence of chorioamnionitis.
- When PPROM occurs before 32 weeks of pregnancy, it is best to delay delivery. Medical staff should provide a course of corticosteroids.
The key to understanding PPROM is that a premature baby with an infection is much more worrisome than a premature baby. Ideally, the baby should be delivered the hour before the womb and baby get infected. This is difficult to predict, so close monitoring is critical, and signs of infection or changes in the baby’s tests (even subtle ones) should be relied on.
Michigan Premature Birth Lawyers Helping Children Who Have Birth Injuries & Cerebral Palsy
Premature birth puts a baby at risk of having numerous birth injuries. Physicians must recognize risk factors for premature birth and follow standards of care to prevent the baby from being born preterm. If a preterm birth is likely to occur, the baby should be given corticosteroids, magnesium sulfate and antibiotics, if indicated. After birth, surfactant may also be necessary to help with the baby’s lung development. Timing of the administration of these drugs is crucial, which is why the mother and baby must be very closely monitored.
If your baby was born prematurely and has a condition such as hypoxic ischemic encephalopathy (HIE), cerebral palsy, a seizure disorder or periventricular leukomalacia (PVL), contact the award winning birth injury lawyers at Reiter & Walsh ABC Law Centers. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future. Our nationally recognized birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case.
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