When Mdm Audrey Lim first saw her twin babies after giving birth to them at just 25 weeks in KK Women’s and Children’s Hospital (KKH), she knew they would face an uphill task to stay alive in the following months. “They had so little flesh on them that they looked two-dimensional. There were also so many tubes and wires going through them. At that moment, I felt so much heartache and helplessness,” said the 38-year-old property agent.
At birth, twins Ethan and Emma Low each weighed just slightly more than 700g. Despite their severe prematurity, the twins survived.
PRETERM BIRTHS INCREASING
It is estimated that about one in 10 babies is born too early. As preterm birth rates rise worldwide, Mdm Lim’s experience is no longer a rare occurrence - even in developed nations with top-notch medical care. A preterm birth is defined as one that occurs before 37 weeks of pregnancy.
The phenomenon has become increasingly more common here, too, said local experts TODAY spoke to ahead of World Prematurity Day on Nov 17.
Premature babies make up about 13.5 per cent of the babies born at KKH. Professor Victor Samuel Rajadurai, head and senior consultant at KKH’s Department of Neonatology, noted an increase in the incidence of preterm births seen at KKH, from 11 per cent to 13.5 per cent in the past decade. The national rate of preterm births has also gone up, from 7.2 per cent to 9.5 per cent, despite low birth rates over the same period, said Prof Rajadurai.
No one knows for sure what triggers premature labour. However, several factors, including older maternal age due to delayed childbearing and the use of fertility treatments, have been known to increase the likelihood.
Assisted reproductive technology is now more commonly performed than before, and that increases a woman’s chance of multiple pregnancy, which is associated with a higher risk of preterm labour, said Associate Professor Su Lin Lin, senior consultant at National University Hospital (NUH) Women’s Centre. The number of in-vitro fertilisation (IVF) cycles done at NUH Women’s Centre has more than tripled in the past decade. About 700 IVF cycles were carried out at its centre last year.
Associate Professor Tan Thiam Chye, senior consultant and head of Inpatient Service at KKH’s Department of Obstetrics and Gynaecology, added that the risk of preterm delivery for twin pregnancies increases three to five times compared with a singleton pregnancy. In a triplet pregnancy, the risk increases to seven to nine times.
Assoc Prof Su said that advances in medicine have also made it possible for women with certain existing illnesses that affect fertility to conceive and go through a pregnancy. Some of these conditions, such as some kidney and autoimmune diseases, are linked to a higher risk of preterm labour.
Several studies have also linked preterm labour to high levels of chronic psychological and physical stress during pregnancy, but Assoc Prof Su said this area needs further research.
Current treatments to delay preterm labour include medication such as progesterone and tocolytic drugs to stop womb contractions, said Assoc Prof Tan. The mother is then given a steroid jab to hasten the baby’s lung development.
In instances of very early preterm labour (less than 24 weeks of pregnancy), the doctor may recommend a cervical cerclage. This is a procedure where stitches hold the cervix closed to prevent a premature birth.
In spite of the medications given to slow down contractions, Mdm Lim - whose twins were conceived naturally - was fully dilated within half a day and nothing could stop her babies from arriving four months early.
According to the World Health Organisation, preterm birth is the leading cause of newborn deaths and the second-leading cause of deaths in children under the age of five. However, modern neonatal intensive care has made it possible for even the tiniest of babies to survive their prematurity. About 90 per cent of premature babies treated at KKH’s Neonatal Intensive Care Unit (NICU) survive and the majority go on to live relatively normal lives, said Prof Rajadurai.
The two smallest survivors at KKH were born about 15 years ago, at 26 weeks, with a birth weight of 435g and 470g. At Khoo Teck Puat-National University Children’s Medical Institute, the lightest survivor was a 26-weeker who weighed 487g at birth in 2007. All three have gone on to lead normal lives.
However, Prof Rajadurai stressed that the above cases are exceptional as outcomes for premature babies born below 23 weeks’ gestation and/or birth weight of 500g are known to be “extremely poor”. Even with modern NICU care, the survival for premature babies born at 25 weeks is between 70 to 75 per cent, said Prof Rajadurai. About 30 per cent may have trouble with development.
After birth, Mdm Lim’s twins spent the first four months of their lives in the hospital battling a host of complications, including infections, liver and breathing problems. “The first year was the hardest because we had to constantly monitor their breathing at home, which could suddenly stop without warning. They were also hospitalised almost every other month due to low oxygen levels,” said Mdm Lim.
Today, the twins are growing well, apart from a few “manageable” health issues, said Mdm Lim. For instance, older twin Ethan has some vision-related problems and is having speech therapy as he stutters.
“Back then, my husband and I practically lived day by day not knowing what will happen to our babies. Now they look like any healthy kids who love to play and jump around. Looking back, we are really fortunate to have access to proper facilities and expertise to save our preemies,” she said.