Premature birth medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Maternal treatments
There are two tactics that can be used to deal with a potential premature birth: delay the arrival of birth as much as possible, or prepare the prospectively premature fetus for arrival. Both of these tactics may be used simultaneously.
Delaying the premature birth from occurring is typically the most favored option. This gives the fetus or fetuses as much time as possible to mature in the womb. There are a number of techniques that can be used to try to accomplish this. The first resort is usually complete bed rest. Maintaining a horizontal position reduces pressure on the cervix, which may allow it to stay lengthened longer, and avoiding unnecessary movement may reduce uterine irritation, which can lead to contractions. Likewise, proper nutrition and especially hydration are important: dehydration can lead to premature uterine contractions. In a hospital setting, a drug-free IV drip may be used to try to stop premature labor simply by improving the mother's hydration. Lastly, there are anti-contraction medications (tocolytics), such as ritodrine, fenoterol, nifedipine and atosiban, although these do not appear to have more than a short-term effect on delaying delivery.
Premature birth can not always be prevented. Severely premature infants may have underdeveloped lungs, because they are not yet producing their own surfactant. This can lead directly to Respiratory Distress Syndrome, also called hyaline membrane disease, in the neonate. To try to reduce the risk of this outcome, pregnant mothers with threatened premature delivery prior to 34 weeks are often administered at least one course of glucocorticoids, a steroid that crosses the placental barrier and stimulates growth in the lungs of the fetus. Typical glucocorticoids that would be administered in this context are betamethasone or dexamethasone, often when the fetus has reached viability at 23 weeks. In cases where premature birth is imminent, a second "rescue" course of steroids may be administered 12 to 24 hours before the anticipated birth. There is no research consensus on the efficacy and side-effects of a second course of steroids, but the consequences of RDS are so severe that a second course is often viewed as worth the risk.
Treatment for a premature infant
The required care for premature infants differs greatly depending on the child's gestational age, birth weight, and overall maturity. Measures common among extremely premature infants include:
- Placing the infant in a warmer or isolette. Premature infants are easily susceptible to cold-stress or hypothermia and infection, and preventing these is a key priority.
- Infants under 32 weeks typically do not produce enough surfactant in their lungs to enable them to breathe on their own. In these cases, surfactant will be administered to assist them.
- A breathing tube may be inserted in the infant's trachea, and a ventilator and supplemental oxygen may be used.
- Adequate nutrition, via a feeding tube or, in extremely premature infants, intravenously. If a feeding tube is used, expressed breast milk from the mother or a breastmilk bank can be used, which lowers the risk of infections such as necrotizing enterocolitis.
Prematurity is considered a relative contraindication to the use of the following medications: