Today, prematurity is the leading cause of infant mortality in the world, according to the World Health Organization. In Brazil, the Ministry of Health estimates that about 340,000 babies are born before the 37th week of pregnancy each year – roughly 12% of all births. This means that thousands of families face challenges that begin during pregnancy and continue during the first months of the child’s life.
Experts explain that prematurity occurs for various reasons and that monitoring during prenatal care is essential to reduce the risks. Even when preterm birth occurs, advances in technology and trained teams in neonatology have allowed increasingly young babies to survive and thrive.
Warning signs
Obstetrician-gynecologist Arlie Cleverson, a member of the scientific council of the non-governmental organization Prematurity, explains that one of the most important warning signs is an increase in the frequency and intensity of contractions.
Although Braxton Hicks contractions — known as training contractions — are common toward the end of the second trimester, changes in rhythm and pain should be evaluated.
“This increase is one of the main signs of the risk of premature birth,” he says. Changes in discharge should also be noted, as vaginal dysbiosis can indicate a risk of infection and even premature rupture of water.
Premature babies need intensive care in the first few weeks to ensure their proper growth
How prenatal care identifies and reduces risks
According to the obstetrician, prenatal care can determine early who is at greatest risk of premature birth. Factors taken into consideration include a history of previous prematurity, cervical procedures (eg HPV conization), and uterine abnormalities.
Measuring the cervix with transvaginal ultrasound between 20 and 24 weeks is essential: a cervix smaller than 25 mm greatly increases the likelihood of labor before 34 weeks.
“In these cases, vaginal progesterone is the main means of prevention. When there is insufficiency of the cervical isthmus, the recommendation is to perform a cerclage, which is basically stitching the cervix together and preventing premature birth or miscarriage,” explains Cleverson.
When a baby is born at less than 28 weeks, it is considered extremely premature and requires intensive care. The lung is the most vulnerable organ, and many need respiratory support and the use of surfactant to breathe better.
These children are also at increased risk of cerebral hemorrhage, necrotizing enterocolitis, and infections, which require constant monitoring. Temperature control is another vital measure, as premature babies lose heat quickly, increasing the risk of serious complications.
Progress that increases survival
In recent years, advances in neonatal intensive care units have improved the survival of these babies. Technologies such as more precise monitoring and specific ultrasounds, such as Transfontanelle (a non-invasive imaging test that evaluates the brain of newborns), help in early recognition of problems.
However, one simple resource remains essential: the kangaroo method. Physical contact with parents promotes development and increases the chances of recovery.
Causes of prematurity: what newborns say
Neonatologist Ana Amélia Fialho, from the Maternidad Brasília Hospital, highlights that the causes of prematurity are diverse and are not always related to serious problems. Complications for the mother may occur, such as high blood pressure, diabetes, urinary tract infections, infections of the uterus or amniotic fluid, bleeding due to premature placental abruption and uterine abnormalities.
Fetal factors — such as multiple pregnancies and chromosomal changes — can also hasten delivery. He adds: “The mother’s age before 18 years or after 40 years, and smoking, alcohol consumption and drug use increase the risk of infection.”
The doctor confirms that premature babies need special care in the first months, especially because of the immaturity of their organs. This involves special attention to breathing, risk of infection, brain and retinal development, and nutrition, which is often started intravenously.
Many of them need vitamin, iron and zinc supplements. Furthermore, the vaccination schedule is different, with specific immunizations and specific indications. “There is a specific vaccination schedule for premature babies, with vaccines that help prevent serious reactions,” Fiallo explains.
Weak immunity and prevention of respiratory infections
Weak immunity makes these children more susceptible to respiratory infections. To prevent more serious cases, the pediatrician emphasizes the importance of nercevimab, an immunobiological drug that reduces hospitalizations and complications.
Over time, the reflexes, weight and maturity of the organs become the same as those of other newborns, and care becomes similar. The emptying process also takes place gradually. Premature babies do not go straight home from the intensive care unit: they pass through the infirmary, where they are stabilized until their condition allows them to go home.
Experts confirm that warning signs during pregnancy and adequate prenatal care help prevent premature birth
Even after the mother is discharged from the hospital, she remains with the child every day. After returning home, monitoring babies and newborns — called well-child care — is essential to monitor growth and development.
In addition to the physical challenges, prematurity has a strong emotional impact. Fear, anxiety and insecurity are common, especially when birth occurs very early. Therefore, multidisciplinary care, with psychologists, psychiatrists, obstetricians-gynecologists and paediatricians, is essential during and after hospitalization.
Experts agree that it is possible to reduce the risk of prematurity with proper prenatal care and a trained team. She explains that women who have given birth prematurely do not necessarily have a greater chance of having a premature baby, but those who have previously had a premature pregnancy have an increased risk of the condition recurring.
Follow our Health & Science Editor on Instagram and stay up to date with everything new on the topic!
