Premature Birth Treatment: Medicines, Diet & Management

How is Premature Birth Diagnosed?

A pregnant woman with suspected preterm labour should be assessed by an obstetrician or an appropriate maternity specialist. Depending on the clinical situation, assessment of preterm birth may include examination of the cervix, monitoring of uterine contractions and fetal heart rate, transvaginal ultrasound to assess cervical length and tests for suspected preterm prelabour rupture of membranes (PPROM). These findings help determine whether preterm labour is likely and whether treatment to delay delivery or prepare for birth is required.

How is Premature Birth Treated Based on Severity?

Treatment depends on how imminent the delivery is, the stage of pregnancy and whether there are complications affecting the mother or baby. The table below explains the main treatment approaches according to the clinical situation surrounding premature birth:

Clinical situation	Main treatment approach
Mild or suspected preterm labour	Observation, maternal and fetal monitoring, assessment of the cervix and tests to determine the likelihood of imminent delivery.
Moderate risk of early delivery	Hospital monitoring and medicines such as antenatal corticosteroids. Tocolytic treatment may be considered when delaying delivery is appropriate.
High risk of imminent preterm birth	Corticosteroids to support fetal organ maturity, magnesium sulphate for eligible pregnancies and preparation for delivery at a suitable hospital.
Severe maternal or foetal complications	Urgent delivery may be safer than delaying labour. Treatment is provided according to the underlying complication.
Premature baby requiring intensive care	NICU or special newborn care, including respiratory support, temperature control, feeding support and treatment of complications.

Types or Stages of Premature Birth and Their Treatment

Premature birth is classified according to gestational age rather than conventional disease stages. Treatment requirements generally become more complex as gestational age at birth decreases, although individual management also depends on the mother's condition and the baby's clinical status. WHO classifies preterm birth into extremely preterm, very preterm and moderate to late preterm categories.

The table below explains how treatment planning may differ according to the gestational age category of premature birth:

Type/Stage of Prematurity	Treatment approach
Extremely preterm: less than 28 weeks	Individualised counselling and delivery planning involving obstetric and neonatal teams. Antenatal corticosteroids and magnesium sulphate may be considered according to gestational age and clinical circumstances.
Very preterm: 28 to less than 32 weeks	Antenatal corticosteroids, magnesium sulphate when indicated, possible short-term tocolysis and delivery planning at a facility with appropriate neonatal care.
Moderate to late preterm: 32 to less than 37 weeks	Treatment depends on the likelihood and timing of delivery, underlying clinical circumstances and maternal or fetal condition. Selected patients may require corticosteroids or other interventions.

Other Treatments for Premature Birth

Other treatments recommended for premature birth are as follows:

Antenatal Corticosteroids Antenatal corticosteroids such as dexamethasone or betamethasone may be given when premature birth is likely to reduce complications associated with fetal immaturity, particularly respiratory complications. WHO recommends antenatal corticosteroid therapy for women at risk of imminent preterm birth when the clinical criteria are met.
Tocolytic Treatment Tocolytic medicines may temporarily delay labour when appropriate, usually to provide time for antenatal corticosteroids to take effect or to allow transfer to a hospital with suitable neonatal facilities.
Magnesium Sulphate Intravenous magnesium sulphate may be administered before an imminent very preterm birth to provide fetal neuroprotection and reduce the risk of certain neurological complications.
Antibiotics Antibiotics may be prescribed when premature birth is associated with PPROM or a confirmed or suspected infection requiring treatment. They are not routinely used for every case of preterm labour. WHO recommends antibiotics for women with PPROM when indicated.
Cervical Cerclage Cervical cerclage may be considered in selected pregnancies with cervical insufficiency or cervical dilatation when the clinical criteria are met. However, it is not a routine treatment for established premature labour.
Delivery If continuing the pregnancy is unsafe for the mother or baby, delivery may be required. The timing and mode of birth depend on gestational age, fetal presentation, maternal condition, fetal condition and other obstetric factors. A caesarean birth is not routinely required solely because of premature birth. WHO does not recommend routine caesarean delivery for the purpose of improving outcomes in preterm newborns.
Neonatal Respiratory Support After premature birth, babies with breathing difficulties may require oxygen, continuous positive airway pressure (CPAP), surfactant therapy or mechanical ventilation according to their respiratory condition. WHO includes CPAP and other respiratory interventions among the recommended approaches for the care of preterm infants.
Thermal Care Premature babies may have difficulty maintaining body temperature and may require an incubator, radiant warmer or other measures to maintain a stable temperature.
Feeding and Nutritional Support Babies who cannot feed safely or effectively may require expressed breast milk through a feeding tube or intravenous nutritional support.
Kangaroo Mother Care This involves prolonged skin-to-skin contact and appropriate feeding support for preterm or low birth weight babies.
Neonatal Monitoring and Support Some premature babies require care in a neonatal intensive care unit (NICU) or special newborn care unit for monitoring and treatment of breathing difficulties, feeding problems, infection, temperature instability or other complications.

Oral Medications for Premature Birth

Oral medicines are not the main treatment for active premature birth or preterm labour. Depending on the clinical indication, an obstetrician may prescribe:

Nifedipine: May be used orally for tocolysis in eligible pregnancies to temporarily delay labour.
Erythromycin: May be prescribed in selected cases of PPROM to reduce the risk of infection.
Other Medicines: May be prescribed when an underlying maternal condition requires specific treatment.

Medicines during pregnancy should be taken only under the supervision of an obstetrician or another qualified healthcare professional. NICE provides specific recommendations on the use of nifedipine for tocolysis and erythromycin for PPROM.

Ayurvedic and Alternative Treatments for Premature Birth

No Ayurvedic or alternative therapy has been established as a substitute for evidence-based treatment of premature birth. It is important to ensure that:

Ayurvedic or herbal medicines should not be used to delay labour without approval from the treating obstetrician.
Alternative medicines may interact with prescribed medicines or have effects that are not adequately established during pregnancy.
Complementary practices should not delay medical assessment or recommended treatment.
Any alternative treatment being considered during pregnancy should first be discussed with the treating healthcare professional.

Home Care for Premature Birth

Home care cannot replace medical treatment for premature birth or suspected preterm labour. It may be appropriate only after an obstetrician has assessed the pregnancy and confirmed that hospital treatment is not currently required, or after the mother and baby have been discharged. The common home care practices recommended are as follows:

Take prescribed medicines exactly as directed.
Attend scheduled antenatal and follow-up appointments.
Follow medical advice regarding physical activity, work and rest.
Maintain adequate nutrition and fluid intake.
Avoid tobacco, alcohol and recreational drugs.
Avoid medicines and supplements that have not been approved by the treating doctor.
Follow instructions on symptoms that require urgent medical assessment.
Follow individual advice regarding sexual activity when cervical or other pregnancy complications are present.

Latest Treatment for Premature Birth

WHO continues to update guidance on the care of preterm and low-birth-weight infants. Its recent clinical practice guidance on KMC reinforces early and prolonged skin-to-skin care as an important component of treatment and supportive care for preterm infants.

How Long Does Premature Birth Treatment Take?

The duration of premature birth treatment varies considerably because some interventions are provided before delivery, while neonatal treatment may continue until the baby can breathe, feed and maintain body temperature adequately. The table below explains the approximate duration of major treatments used before and after premature birth:

Treatment	Approximate duration
Antenatal corticosteroids	Usually completed over approximately 24-48 hours, depending on the prescribed regimen.
Tocolytic treatment	Generally used for a short period when delaying delivery is considered appropriate.
Magnesium sulphate	Usually administered around the time of imminent premature birth. It is not routinely continued beyond 24 hours for fetal neuroprotection.
Antibiotics	Duration depends on the indication, such as PPROM or a confirmed infection.
CPAP	May be required for days or weeks, depending on respiratory maturity and clinical progress.
Mechanical ventilation	May be required for hours to weeks, depending on the severity of respiratory illness.
Tube feeding	May continue for days or weeks until safe and effective oral feeding is established.
NICU care	May last from several days to several weeks or months, depending on gestational age and complications.
Kangaroo mother care	May begin as soon as clinically appropriate and continue regularly during hospital care and after discharge.

Premature Birth Treatment Side Effects

The possible side effects of premature birth treatment depend on the medicine, procedure or type of neonatal support used. The common side effects are as follows:

Antenatal Corticosteroids: May temporarily increase maternal blood glucose levels, which is particularly relevant for women with diabetes.
Tocolytic Medicines: May cause headache, dizziness, flushing, palpitations or changes in blood pressure, depending on the medicine used.
Magnesium Sulphate: May cause flushing, a feeling of warmth, nausea, weakness or dizziness. Serious toxicity is uncommon when appropriate monitoring is provided.
Antibiotics: May cause nausea, diarrhoea, allergic reactions or other medicine-specific effects.
CPAP and Oxygen Therapy: May cause nasal irritation, pressure-related skin injury or other respiratory-support complications.
Mechanical Ventilation: May be associated with airway-related complications and other risks related to prolonged respiratory support.
Surgical Procedures: Procedures such as cervical cerclage may cause bleeding, infection, discomfort or other procedure-specific complications.
NICU Treatment: The risks depend on the medicines, procedures and respiratory or nutritional support required by the baby.

Doctors monitor the mother and baby for treatment-related complications and adjust treatment when necessary.

Lifestyle Changes for Managing Premature Birth Symptoms

Lifestyle measures cannot replace medical treatment for premature birth, but they may support the treatment plan and recovery. Common lifestyle changes recommended by doctors are as follows:

Follow the obstetrician's advice regarding physical activity, work and rest.
Take prescribed medicines as directed.
Maintain a balanced and nutritionally adequate diet.
Avoid tobacco, alcohol and recreational drugs.
Avoid unapproved medicines and supplements during pregnancy.
Attend recommended antenatal and follow-up appointments.
Follow the healthcare team's instructions regarding monitoring and recovery after treatment.

Triggers That Can Worsen Symptoms of Premature Birth

Certain factors may worsen the clinical situation or delay appropriate treatment for premature birth. The common triggers are as follows:

Delaying medical assessment when symptoms of preterm labour occur
Failure to follow prescribed treatment or follow-up advice
Untreated maternal infection
Continued tobacco, alcohol or recreational drug exposure
Poorly controlled maternal medical conditions
Failure to follow recommendations for monitoring or hospital care
Delaying transfer to an appropriate maternity or neonatal facility when advised

Treatment Cost for Premature Birth

The cost of premature birth treatment in India varies considerably according to the hospital, city, gestational age, complications and duration of NICU admission. Mild cases requiring observation and short-term newborn care may involve relatively lower expenses, while severe prematurity requiring prolonged NICU admission, CPAP, mechanical ventilation, surfactant therapy and treatment of complications can result in substantially higher costs. Diagnostic tests, maternal hospitalisation and neonatal procedures add to the overall expense.

Premature birth treatment in India generally costs between ₹2,00,000 and ₹15,00,000 or more, depending heavily on the length of NICU stay in India and the level of medical care required. Exact costs should be confirmed directly with the treating hospital because charges vary widely between government and private facilities.

Does Health Insurance Cover Treatment of Premature Birth in India?

Yes. Health insurance covers hospitalisation and treatments associated with premature birth, including maternity complications and newborn or NICU care, under maternity cover. Coverage may be subject to maternity benefits and newborn coverage. However, waiting periods may apply before a claim for maternity health insurance can be filed.

Besides, regular health insurance plans may not cover treatments and hospitalisation due to premature birth. Hence, policyholders should check the maternity, newborn hospitalisation and NICU coverage with their insurer before treatment.

Frequently Asked Questions (FAQs)

Q1. Can premature birth be treated without hospitalisation?

Ans: Some women with suspected preterm labour may be managed without hospitalisation. This is only possible if delivery is not considered imminent and there are no complications.
Q2. What is the main treatment for premature birth?

Ans: The main treatment for premature birth depends on gestational age and the clinical circumstances. Antenatal corticosteroids, tocolytic medicines, magnesium sulphate and antibiotics may be used when clinically indicated, while the baby may require specialised neonatal care after delivery.
Q3. Can medicines stop premature birth permanently?

Ans: No medicine can reliably stop premature birth permanently once preterm labour has begun.
Q4. Why are corticosteroids given before premature birth?

Ans: Antenatal corticosteroids are given before premature birth to help improve fetal organ maturity and reduce complications.
Q5. How long do corticosteroids take to work for premature birth?

Ans: Corticosteroids begin providing benefit before premature birth, although the greatest benefit is generally achieved when there is sufficient time between administration and delivery. Treatment should not usually be delayed when delivery is otherwise necessary.
Q6. When is magnesium sulphate used for premature birth?

Ans: Magnesium sulphate may be given before an imminent very preterm birth to provide fetal neuroprotection. The decision depends on gestational age, the likelihood of delivery and the clinical circumstances.
Q7. Are antibiotics used to treat premature birth?

Ans: Antibiotics are not routinely prescribed for every case of premature birth or preterm labour. They may be used when PPROM or a confirmed or suspected infection provides a recognised indication.
Q8. Can tocolytic medicines treat premature birth?

Ans: Tocolytic medicines do not cure the underlying cause of premature birth, but they may temporarily delay labour in selected cases. This delay can provide time for antenatal corticosteroids to be administered or for transfer to a facility with suitable neonatal care.

References
- https://saplinghospitals.com/blogs/nicu-charges-in-delhi-cost-breakdown
- https://www.mayoclinic.org/diseases-conditions/premature-birth/diagnosis-treatment/drc-20376736
- https://my.clevelandclinic.org/health/diseases/4498-premature-labor
- https://www.who.int/news-room/fact-sheets/detail/preterm-birth
- https://www.maxhealthcare.in/blogs/causes-of-premature-birth
- https://www.yashodahospitals.com/procedure-cost/neonatal-intensive-care-unit-cost-in-india/