Every year on November 17, people all across the world celebrate World Prematurity Day.
It all began in 1997 when a German woman named Silke Mader was pregnant and expecting twins at 25 weeks of pregnancy. The babies were delivered early because she developed high blood pressures during her pregnancy. Her baby girl died a few days after birth and her son survived.
In the hospital, there was little information, support or care for her and her babies. She felt that no other parent should ever have to go through such an experience again and so, in 1997 she began her journey by co-founding the European Foundation For The Care Of Newborn Infants (EFCNI).
Since then, their aim has been to meaningfully improve the care and circumstances of preterm babies and their families on a European level.
To strengthen this purpose, they created the International Premature Awareness Day in 2009 which was later renamed World Prematurity Day, after the Preemie Act was launched by March of Dimes in the USA and became law in 2006 requesting federal support for lifesaving research and education about babies born too early.
Babies that are born at less than 37 weeks of pregnancy are considered premature. Every year 15 million babies are born prematurely, which is more than one in 10 of all babies across the world.
On World Prematurity Day, we take a moment to recognize the impact that prematurity has globally as the leading cause of child death under five years of age. We recognize our healthcare professionals who devote their lives to keeping these little ones alive. We recognize the families that are experiencing the anxiety of premature birth and we remember the little ones that could not be saved.
Premature births claim 1,000,000 lives every year with the rate of premature deliveries increasing in many countries.
Guyana has been no exception. On any given day, approximately 70 percent of the newborns admitted to the Neonatal Intensive Care Unit (NICU) at the Georgetown Public Hospital Corporation (GPHC) are premature. They may require support to breathe and feed. They may also need antibiotics to help fight off infections and incubators to stay warm.
After several days, or even weeks, some of these babies go home with their families, but some do not survive. In Guyana we have seen great things happen in the management of our sick babies. Eight years ago we could not provide ventilatory support to keep our babies breathing nor could we provide warmth in incubators or cardiac monitors to evaluate heart rates.
The smaller a baby is at birth, the more vulnerable he is, and the more intense care he will need. A premature baby’s heart, lungs and brain are not fully developed. The smaller the baby is at birth the less developed are his organs. There comes a point where we cannot support a baby that is born too small.
In Guyana, that age of pregnancy is 28 weeks. In more developed countries that age may be 24 weeks or even 22 weeks. We have not accomplished this just yet in Guyana, but it is the goal. One day we want to see a baby born at 22 weeks go home with his parents.
Most preterm babies arrive early and without warning. However, some pregnancies are known to be at risk for ending in a preterm birth due to a maternal or fetal a reason. If this is the case, the doctor in charge of this delivery will prepare by offering advice and medications that can help to improve the outcome of the baby. The obstetrician may suggest treatment that could delay the birth, therefore giving the fetus more time to develop.
In other instances, it is safer to deliver the baby preterm. This was the case for Silki Mader who had high blood pressure during her pregnancy. Prevention is always better than cure and there are steps that women can take to help minimize the risk of giving birth early.
It is important for women to join a prenatal clinic as soon as she knows that she is pregnant. This is the only way that risk factors for preterm labour can be assessed. Stop all cigarette smoking and illicit drug use. Prenatal vitamins as well as a healthy diet are also important.
Women are at a higher risk of having a baby too early if they are undernourished or underweight, particularly if their Basal Metabolic Index (BMI) is less than 19.8 before pregnancy.
Obese women (a BMI more than 30) are at an increased risk for medical intervention that may lead to premature birth. It is unwise to diet during pregnancy, but being physically active throughout pregnancy will boost overall wellbeing and reduce the risk of conditions, such as diabetes and hypertension, which can lead to premature delivery.
Physical abuse or stress from serious life events can also cause a premature delivery. It is important to get help. Confiding in a partner, a friend or seeking advice from a doctor can provide some support needed to help overcome the stress that accompanies having a baby. On the November 26, the Ministry of Human Services and Social Protection will be launching a new hotline “914” for victims of violence.
The prevention of preterm birth and the management of a premature baby are no simple tasks. It involves nurses and doctors that are trained to take care of sick babies. It takes equipment that are made specifically for newborns.
It also takes an efficient primary health care system that is equipped with the knowledge to identify a sick baby when he presents to the clinic and it takes a community of individuals that will motivate and encourage expectant mothers to get the care that she needs in order to have a healthy baby. It therefore takes the support of our entire country to decrease premature births and improve the outcomes of babies that are born too soon.
Dr Leif Nelin, a neonatologist that practices in America and frequently visits GPHC’s NICU once said, “Guyana’s NICU did in eight years what it took NICUs in the US 20 years to accomplish.”
But we still have a long way to go. With the right support, imagine what we can do in the next eight years!
Contributed by Dr. Sara Singh, Pediatrician, Georgetown Public Hospital Corporation (GPHC) on behalf of the Ministry of Health