Premature birth is the leading cause of death in children under the age of five worldwide.

Babies born too early may have more health issues than babies born full term, and are also more susceptible to long-term health problems affecting the brain, lungs, hearing or vision. Premature birth continues to be a global health issue and concern. It is estimated that 14.9 million babies are born before 37 weeks of gestation every year, 1 in 10 babies is born premature globally.

Close follow up for these children is important as it allows for detection of issues that may require early intervention. Early intervention has been shown to minimise the effects of disabilities and optimise the child’s potential.

In November's 'Ask the Specialist' forum, Dr Khoo Poh Choo, Deputy Head and Senior Consultant from the Department of Neonatology at KK Women's and Children's Hospital (KKH), a member of the SingHealth group, answers your questions about premature babies.

This As​k The Specialist forum has closed. Thank you for your interest and participation.

1. Question by Chironix
For premature baby especially micro-preemies, how likely will they suffer from eczema ? Will they outgrow it?

Answered by Dr Khoo:
Hi Chironix,
Preterm babies may have an increased risk of some health issues, but eczema is not one of them. Preterm babies do not have an increased risk of eczema compared to term babies. In fact there is evidence that the extremely preterm infants - babies born before 28 weeks of pregnancy - which include micropremmies tend to have a lower risk of eczema compared with term babies (babies born after 37 weeks gestation).

2. Question by StellaThk
Hi Dr Khoo, 
My baby is born a 24 +4 weeker, CA 4 mo; AA 7 mo. He has reflux and will cough on a daily basis. Is this a reflux cough? Is there anything as parents we could do to alleviate his cough? Typically at what CA would they outgrow this? Thank you for your time to review my qns.

Answered by Dr Khoo:
Hi StellaThk,
Gastroesophageal reflux is a common condition that affects many premmies in their infancy and cough can be one of the symptoms. However cough in any infant especially a premmie can also be due to a number of other conditions, for example conditions related to their lungs, heart or even due to postnasal drip.

If your baby is having a persistent cough, it would be advisable to bring him to his doctor for a check-up to find out the cause and importantly to ease the symptoms.

Gastroesophageal reflux occurs due to the transient relaxation of the lower oesophageal sphincter – which is a muscle that is at the end of the oesophagus before the stomach. This muscle opens to allow the food to enter into the stomach and it tightens after the food passes through to prevent the stomach contents from going back up.

In premmies, this muscle is immature and does not work as well in tightening up once the milk has flowed through and hence the stomach contents can go back up the oesophagus and this can cause a number of symptoms like frequent forceful vomiting, irritability, refusing to feed and even choking, gagging or cough. 

You may want to seek specialist advice for your son. His doctor will review the type of milk he is on and the volume. He might benefit from positioning by keeping him in an upright position after feeds, he might also need smaller volume feeds more frequently. On some occasions, medications can also be used to help alleviate the symptoms and rarely surgery may also be needed.

It is hard to predict the exact age when your premmie will outgrow their reflux but generally as they mature and get stronger, the muscles controlling the sphincter also get stronger and tend to work better. Most babies’ reflux resolve by the corrected age of one year but this can vary as we know that every baby is unique in their own way.

Hope this has helped to answer some of your queries.

About Dr Khoo Poh Choo

Dr Khoo is the Head of the Neonatal Ambulatory Service, as well as Deputy Head and Senior Consultant in the Department of Neonatology, KK Women’s and Children’s Hospital (KKH).

Her main clinical areas of interest are in the long-term follow-up of premature and Very Low Birth Weight (VLBW) infants and she is currently in charge of KKH’s VLBW follow-up programme.

Dr Khoo is also the Director of the Universal Newborn Hearing Screening (UNHS) programme in KKH. She was awarded the SingHealth Health Manpower Development Plan award in year 2011 to undergo training in Canada on the “Early Developmental Screening and Health Related Quality of Life in High Risk Children including Very Low Birth Weight (VLBW) Children and Adolescents” and is also a recipient of a Singapore Ministry of Health, Health Sector Development Programme award in year 2014 for a project on the “Multidisciplinary Developmental Follow Up of the High Risk Infants”.

Dr Khoo's passion lies with KKH’s Early Bird Baby Club, a parent support group for premature infants and their families. She established the teaching programme for parents and caregivers of premature infants to help them in their preparation to take their babies home after their hospital stay. She has chaired and organised the World Prematurity Awareness events in Singapore in collaboration with the Light Weight Club Support Group in Singapore General Hospital and National University Hospital’s Neonatal Department since 2015.

Because #healthiswealth #healthforgood

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