A brief glance around a maternity ward is enough to convince anyone that all babies, including, come in all shapes and sizes. For example, about one in fourteen babies weigh less than 2.5 kg (5.5 lb) and are called low birth weight babies. Some babies are small because they are born prematurely; others are mature, that is full-term, but have not grown very well in the womb. The word ‘premature’ is only used for babies who are born more than three weeks before the expected time. Babies born just one or two weeks early generally behave normally, and, in fact, most who reach thirty-five weeks do well and rarely run into difficulty.
The earlier a baby is born, the greater the risk. The medical profession is especially concerned about the few who may be born as much asthree months before their time because they are obviously not yet ready for life outside the womb. Such babies are less active than full term babies. lt is as if they save all their energy in order to grow, but it may be several weeks before they are strong enough to suck. Some degree ofis common between the third and fifth day, especially if the baby’s delicate skin suffered a few bruises at birth.
Premature babies find it difficult to keep themselves warm at first because the insulating layer of fat under the skin is very thin. Compared to a mature baby, the premature baby’s skin is also thin and has quite a red tinge to it. The fine downy hair (‘lanugo hair’) seen on the sides of a premature baby’s face, shoulders and back soon disappears as the baby gets older.
With very premature babies, breathing is the main concern. Some have brief spells, medically termed ‘apnoeic attacks’, when they forget to breathe. In this instance the baby is reminded to breathe by a nurse firmly stroking the skin of the baby’s arms or legs. Other babies, with very immature lungs, labour over breathing for several days after birth. During this time they may well need oxygen.
The medical profession now knows a lot about how best to care for. For the first weeks the baby is nursed in a warm incubator, with his chest unclothed so that a watch may be kept on his breathing. Usually a special mattress is used which picks up a baby’s breathing movements and sets off a ‘bleep’ if he forgets to breathe for a few seconds. Babies who are small because they have not grown very well in the uterus are quite different from premature babies. They are much more active and can usually suck very well. Some, in fact,
feed hungrily as if they are making up for lost time.
For low birth weight babies a close watch must be kept on the level of sugar in the blood during the first week. In some, it can become quite low and cause the baby to be unwell. Midwives can measure the blood sugar very simply on a single drop of blood. If the level is low it is sometimes necessary to ‘feed’ a sugar solution into a small vein. We can now be much more optimistic about the future for premature and small babies because, with modern methods of care, most survive and grow up as normal children. However, we look forward to discovering more about the prevention of premature birth and the causes of poor growth in the uterus.