Premature babies: What do you need to know about it?

22 June 2020

by Dr Hasmawati Hassan

Premature babies are newborn babies born before 37 weeks. Every year, World Health Organization, estimated 15 million babies are born preterm. That is 1 in 10 babies. Worldwide, Preterm birth complications are the leading cause of death among children under 5 years of age whereby yearly 1 million preterm died.  Preterm births are rising around the world and more than 60% of preterm births occur in Africa and South Asia.

In Malaysia, about 12.3% deliveries are preterm birth which are about 500,000 preterm babies yearly. Malaysia National Neonatal Registry (data 2015) showed out of 280,764 livebirths, about 3060 (24.5%) are prematured (<32 weeks) and 3415 (27.3%) are less than 1500 g birthweight.

Premature, small, or sick babies account for nearly 80% neonatal deaths. They are at greater risk of long-term complications and death. They require specialized care by a highly skilled team of healthcare professionals. For these babies, it is not enough to just survive, we need them to thrive which means strengthening the healthcare system. (Stefan Peterson, Chief of Health for the United Nations Children’s Fund (UNICEF

Why are babies born prematurely?

The cause of premature birth is unknown in about half of all cases. Sometimes labor starts on its own without warning. Even if you do everything right during pregnancy, you can still give birth early. However, some of the reasons babies are born prematurely include:

  1. multiple pregnancy (twins or more)
  2. a history of premature birth
  3. the mother has a problem with her uterus or cervix
  4. the mother gets an infection
  5. the mother has a medical condition that means the baby must be delivered early, such as pre-eclampsia
  6. the mother has a health condition like diabetes
  7. Risk factors in your everyday life- Smoking, drinking alcohol, using street drugs or abusing prescription drugs, chronic stress in your life, low socioeconomic status, domestic violence (This is when your partner hurts or abuses you. It includes physical, sexual and emotional abuse).
  8. Exposure to air pollution, lead, radiation and chemicals in things like paint, plastics and secondhand smoke.

Can you reduce the risk for preterm labour and premature birth?

Yes, we may be able to reduce the risk for early labour and birth. But some risk factors are things you cannot change e.g previous history of premature birth. Here’s what you can do to reduce your risk for preterm labor and premature birth:

  1. Ensure that you have a healthy weight before pregnancy and gain the right amount of weight during pregnancy. 
  2. Do your first prenatal care checkup as soon as you think you’re pregnant.
  3. Do not smoke, drink alcohol, use street drugs or abuse prescription drugs. 
  4. Get treatment for chronic health conditions like high blood pressure, diabetes, depression and thyroid problems.
  5. Protect yourself from infections. Take vaccinations that can help protect you from certain infections. . 
  6. Reduce your stress. Eat healthy foods and do something active every day. Ask family and friends for help around the house or taking care of other children.
  7. Space out your pregnancy. Wait at least 18 months between giving birth and getting pregnant again. Use birth control until you’re ready to get pregnant again. If you’re older than 35 or you’ve had a miscarriage or stillbirth, talk to your healthcare provider about how long to wait between pregnancies.

What will happen during the preterm birth?

It is best for Premature babies to be born at a hospital that has a Neonatal Intensive Care Unit (NICU) or transfer to another hospital with NICU.

During labour, medicines are given to stop the contractions for a while. This allows you to be transferred to another hospital if necessary. You may also receive injections of Corticosteroids 12 to 24 hours before the birth to help your baby’s lungs function more efficiently.

Premature babies can be born very quickly through the vagina (Spontaneous vaginal delivery). However, in some cases the doctor may decide it is safest to deliver the baby via Caesarean.

A Neonatal (newborn) team from the Neonatal unit will be there for the birth. As soon as the preterm baby is born, they will properly assess and care for the baby possibly using a neonatal (baby) resuscitation bed. The team will keep your baby warm and help them to breathe with an oxygen mask or breathing tube, and possibly medicine. Some babies need help to keep their heart beating with cardio-pulmonary resuscitation (CPR).

Once your baby is stable, they may be transferred to the NICU or Special Care Nursery (SCN).

Things that can happen for a Preterm baby in NICU or SCN


Some common issues for premature babies include:

  1. Breathing problems e.g Respiratory Distress Syndrome
  2. Heart problems e.g Patent Ductus Arteriosus
  3. Problems in their digestive tract
  4. Jaundice
  5. Anaemia
  6. Infections

In NICU (Neonatal ICU) /SCN, the preterm babies will be monitored properly for these problem and treated accordingly. The best nutrition is breastmilk and mothers are encouraged to give express breastmilk or breastfeeding the preterm baby if sucking is good. Practices that are known to be effective in preventing or treating neonatal infection in these babies, include: Infection control eg. handwashing, breastfeeding early and sustained, Kangaroo Mother care, Catheter care, Appropriate use of antibiotics.

Kangaroo Mother care is a method of care of preterm infants. The method involves infants being carried, usually by the mother, with skin-to-skin contact. Kangaroo Mother care have the advantage of reducing sepsis by 43%, reducing hypothermia by 77%, reducing hospital acquired infection by 58%, reducing death by 40% and improving breastfeeding better with baby gaining more weight and early discharge by 2.4days. Mothers are encouraged to do Kangaroo Mother care to improve the baby’s warmth, weight gain and developmental.

Once the feeding is established, baby is free of problems, baby is gaining weight and mother is confident in taking care of her baby at home, the preterm baby can be discharge when reaching weight of more than 1.8- 2 kg. The preterm baby will then have follow-up consultations for neurodevelopmental assessment and wellbeing.

This article was written by Dr Hasmawati Bt Hassan, Consultant Paediatrician and Neonatologist at Sunway Medical Centre Velocity.