Premature births set to rise and care needs to progress
Published on 6 October 2021
In Singapore and around the world, premature births are on the rise.
Defined as birth before 37 weeks, premature births can be costly and dangerous. While moderate preterm babies may be discharged within three to four days, extremely preterm babies – born at less than 28 weeks – can expect to stay four to six months in the hospital, or even longer.
But globally, the prevalence of premature babies is at about 10% and still increasing, said A/Prof Zubair Amin, who is Senior Consultant and Head of the Department of Neonatology at the National University Hospital (NUH).
“In Singapore, the number of premature babies is expected to increase further due to multiple births driven by assisted reproduction, maternal comorbid illnesses, and advanced maternal age,” he explained.
Furthermore, as the standard of neonatal care improves, a larger proportion of extremely premature babies are expected to survive.
But not all these babies will do well. “For example, globally and locally, we are witnessing a steady increase in chronic lung disease because of higher survival of extreme premature babies,” said A/Prof Zubair. “Some of them will need extended support from the hospitals and community.”
Supporting a premature baby is a multi-pronged effort. Preemies have to be kept in incubators to maintain their temperature and humidity, as well as to reduce infection risk. Extremely preterm babies often require respiratory support and round-the-clock monitoring, as their lungs and airways are not fully developed.
In addition, providing adequate nutrition is important for them to develop and grow optimally – for instance, through intravenous nutrition, said Dr Krishnamoorthy Niduvaje, another consultant from NUH’s Department of Neonatology.
This support does not end at the hospital. “Interestingly, a major factor determining the future outcome after the hospital discharge is the level of support from the family,” said A/Prof Zubair. “A supportive family can make a significant improvement in a premature baby’s development.”
Transforming care for preemies
In Singapore, three public hospitals – NUH, KK Women’s and Children’s Hospital, and Singapore General Hospital – specialise in looking after extremely premature babies.
It’s a highly specialised area of medicine that demands years of training and practice, said A/Prof Zubair. Skilled and committed nurses and doctors are essential to advancing the field, and so is cooperation and collaboration between the hospitals.
And while progress in the neonatal care field has been incremental, the team always tries to incorporate innovations in care delivery into their practice.
“Our major focuses in the last five years have been in the areas of infection control, better nutritional management, improvement of breastfeeding practices, respiratory care, and integration of family into the daily care of the newborn,” explained A/Prof Zubair.
As care improves, the field may be poised for change.
For instance, the current practice of resuscitation is pegged to the benchmark of 24 weeks of gestation. But with medical advancements, there might be a need to reconsider this, and possibly provide more options for parents to determine whether to proceed with resuscitation at even earlier gestational age, said A/Prof Zubair.
“An extremely premature baby is more at risk of future neurodevelopmental abnormalities and major complications as compared to a moderately premature baby… however, many of these babies are able to make very significant strides towards catching up.
“We need to be better prepared to deal with the increasing number of such babies who would need extended support from us.”