Director, Emergency Services, Bikur Cholim Hospital
More letters! Why do miscarriages occur? They can occur for
many reasons, such as trauma to the pelvic or abdominal
region, but more likely is that the fetus was unlikely to
survive in any case due to genetic problems. Occasionally it
can also be from incompetent cervices — the neck of the
womb — or there may be a tendency to this.
Sometimes babies are born early but are not miscarriages
— these are called premature infants, or preemies for
short. In Israel they are called pahgs, and the place
where they are nursed back to health is called a Pahgiya.
In the USA the place where preemies are helped is called
the NICU (Neonatal ICU).
A full term infant comes out between 37-42 weeks. Babies who
stay in longer tend to be heavier, and this may be the case
in babies of mothers with diabetes.
Before 37 weeks is less than full term and every week less
than 37 is more dangerous, with less than 23 weeks being
usually 100 percent fatal.
What is the problem? Basically lack of development. They have
little fat so they need to be kept warm, and that is why they
end up in incubators. They can not suck very well and have a
tendency towards necrotizing enterocolitis, a vicious
intestinal disease, so they must be fed carefully, often
through a tube — called in Israel a zonde, and
in the USA an NG tube.
Jaundice is a common problem, one which we have spoken about
before — and for which UV light is the treatment.
Anemia is a problem as their hemoglobin is very immature, and
the ability to transport oxygen is limited. Transfusions may
be necessary.
Breathing is a special problem. There is a lining to the lung
units called surfactant that allows oxygen to pass through
the lung membrane into the blood system, and in preemies it
is often absent or poorly developed. One of the medical
miracles is that this substance has been synthesized and is
life saving.
Infections are common since such babies have very limited
disease-fighting capability. You have to wear very sterile
clothes before handling such babies.
What causes prematurity? Again, trauma, infection, toxemia of
pregnancy, twins or triplets. Or it can be the mother's
fault: smoking, poor nutrition, and poor prenatal care can be
a cause.
Most preemies do catch up and live normal lives. My medical
experience has found preemies easier to deal with then
teenagers!
Advice on how to keep your brain sharp: I will say this
— stay away from stroke. That is, keep diabetes in
control, as well as blood pressure, and keep exercising your
brain. For our culture this is not much of a problem as the
learning we do is protective. Write me in care of the
Yated.
A message from GlaxoSmithKline, sponsor of this
column. Bactroban is a good medication to fight
superficial infection. This medication was a breakthrough for
impetigo, but it has uses in burns and infected wounds as
well. It has stood the test of time. There have been no
similar drugs made and no need for them. It is the best.
