Rethinking premature baby care

After decades of incremental improvements in neonatal wards, you’d expect babies born in recent times to be doing much better than those born 25 years ago.

But surprisingly, new research from University of Melbourne Professor of Neonatal Paediatrics Lex Doyle and his colleagues shows the opposite.

Professor Doyle, who works at the Royal Women’s Hospital in Melbourne, studied children born at 22-27 weeks in 1991-1992, 1997 and 2005.

They looked at how much medical help premature babies received to assist their breathing, from ventilators and other techniques, and then assessed their lung function as eight-year-olds.

Their findings, published in the New England Journal of Medicine, show the 2005 group received more assistance for a longer period than the earlier groups, but their lung function at age eight was worse.

“The differences aren’t huge, but they’re going in the wrong direction,” says Professor Doyle. He says he suspects the extra medical help premature babies now receive to aid their breathing might be the cause, but cautions that further research is needed.

His paper points out that equipment to monitor blood oxygen levels did not exist in the 1970s but is ubiquitous now, meaning clinicians are aware of even slight dips in oxygen, sometimes brought on by a brief pause in breathing.

“The result is pre-term babies are receiving help to breathe for longer, being exposed to more oxygen and their lungs are not quite so good at age eight.

“We have to make sure we use the tools appropriately. Just because they’re there, doesn’t mean they have to be used.”

Extremely premature babies – those born at 27 weeks or less – who survive often do so with the aid of corticosteroids (a class of steroid hormones) given to their mothers before birth. They are also helped by ventilators that assist their breathing, monitoring equipment to check their vital signs, and medicines to prevent their tiny lungs from collapsing after birth.

“Pre-term babies sometimes lack surfactant, a substance that helps prevent their lungs from collapsing, and they can tend to forget to breathe, known as apnoea,” says Professor Doyle.

“They face many hurdles and their treatment is a delicate balancing act.”

To understand why the group of children born in 2005 fared worse than the older children in Professor Doyle’s study, it is necessary…

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