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Should Preterm Babies Undergo Unang Yakap?

22 Apr

Some question whether preterm babies should undergo the “Unang Yakap” process because they have difficulty in establishing a good respiratory effort…

Let’s dissect the scenario…

  1. The baby’s digestive system is the first portal of infection via ingestion of offending microorganism.
  2. The intestinal epithelia cells should have a tight junction between each to prevent whatever ingested bacteria to cross through the intestinal barrier. (This illustrates the microscopic structure of the intestines. Photo courtesy of http://truenourishment.com)(This picture illustrates the tight junctions between intestinal cells. Photo courtesy of http://antranik.org).
  1. Newly-born babies (term or preterm) have loose gaps between cells. These gaps enable bacteria or allergens to pass through these cells and cause infection or sensitization respectively.
  2. A baby’s gut, whether term or preterm, is sterile (free of any bacteria) while in utero (inside the uterus). They only acquire bacteria into their gut by aspirating the normal vaginal bacterial flora during vaginal birth and/or direct contact to the mother’s skin, e.g. breastfeeding. Thus, babies born by cesarean section are deprived of these maternal vaginal flora. Furthermore, if these CS-delivered babies are not breastfed, they are devoid significantly too of the maternal skin flora.
  3. A baby must ingest some of the maternal bacterial flora to able to activate its immune system to work. In doing so, the bacteria will stimulate the immune system located at the intestinal wall (gut-associated lymphoid tissue, GALT) to secrete immunoglobulin A (secretory IgA, sIgA) that becomes one of the first line of defenses against intestinal pathogens. Also, this will trigger now the loose gap junctions to tighten, thus “closing” the body’s possible route of entry for bacteria and allergen that can incite infection and allergen sensitization.
  4. Uninterrupted skin-to-skin contact, i.e., no cloth between mother and baby, also enables baby to ingest some maternal skin flora that helps him establish his immune system as well.
  5. Maternal vaginal flora confers better protection to the infant compared to that stimulated by the maternal skin flora.
  6. Babies, whether term or preterm, are able to produce the normal number of immune cells. But the function is not yet mature as it was never challenged by infection while the baby was in utero. If term babies’ immune system is immature, all the more for preterm babies. Immune system is a function of maturity and challenges by exposures to offending organisms.

What happens during preterm birth?

  1. Most preterm babies are born via CS route. Baby get’s dried and stimulated to breath. At times, baby might require endotracheal intubation to help him breath regularly. (Photo courtesy of http://www.enotes.com/neonatal-respiratory-care-reference/neonatal-respiratory-care). Some babies might be too distressed to tolerate skin-to-skin contact with the mother thus are transported immediately to the neonatal ICU for further care. In this regard therefore, babies do not have the benefit of acquiring some bacterial flora from the mother, save for some through the cesarean delivery. Babies then are exposed to the bacterial flora of the care providers in the NICU, namely the physicians, nurses, and midwives, which are way too different from that of the mother.
  2. No matter how ideal a NICU set-up is, there may still be harmful microbes cohabiting the unit. Often than not, these microbes are resistant to strong anti-microbes. Given the fact that the preterm baby’s immune system is immature, non-acquisition or minimal acquisition of maternal bacterial flora, babies are susceptible to infection with these harmful microbes. This infection might lead to the demise of the baby even if he was able to survive respiratory distress.

Should preterm babies undergo “unang yakap?”

Ideally, they should! And they’re the population who would benefit the most from this intervention. Even a brief skin-to-skin contact with the mother will already provide significant help for them, not only from infection but later in establishment of successful breastfeeding. Until they show sign/s of respiratory distress, they should be exposed to the mother.

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Posted by on April 22, 2012 in neonates, Pregnancy

 

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