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Premature Infant What is premature birth? Why is premature birth a problem? What causes premature birth? What kind of treatments might a premature infant need? Does premature birth cause long-term problems? What can you expect when you take your baby home? Is this topic for you? This topic is for people who want to know what to expect when a baby is born early. For information about early labor, its causes, and its treatment, see the topic Preterm Labor. What is premature birth? Pregnancy normally lasts about 40 weeks. A baby born 3 or more weeks early is premature. Babies who are born closer to their due dates tend to have fewer problems, if any. Babies who are born closer to 32 weeks (just over 7 months) may not be able to eat, breathe, or stay warm on their own. But after these babies have had time to grow, most of them can leave the hospital. Babies born earlier than 26 weeks (just under 6 months) are the most likely to have serious problems. If your baby was born very small or sick, you may face a hard life-or-death decision about treatment. Doctors and nurses often call premature babies "preemies." Why is premature birth a problem? Babies who are premature may not be able to feed by mouth, breathe without stopping, or stay warm. Their bodies simply need more time to fully develop and grow. After they outgrow the problems caused by being born too soon, most babies can safely go home from the hospital. When a baby is born too early, his or her major organs are not fully formed. This can cause health problems. Any premature baby can have medical problems. But those who are born before 32 weeks are more likely to have more serious problems. Having a premature baby may be stressful and scary. To get through it, you and your partner must take good care of yourselves and each other. It may help to talk to a spiritual advisor, counselor, or social worker. You may be able to find a support group of other parents who are going through the same thing. What causes premature birth? Premature birth can be caused by a problem with the fetus, the mother, or both. Often the cause is never known. The most common causes include: * Problems with the placenta. * Pregnancy with twins or more. * Infection in the mother. * Problems with the uterus or cervix. * Drug or alcohol use during pregnancy. What kind of treatments might a premature infant need? Premature babies who are moved to the neonatal intensive care unit (NICU) are watched closely for infections and changes in breathing and heart rate. Until they can maintain their body heat, they are kept warm in special beds called isolettes. They are usually tube-fed or fed through a vein (intravenously), depending on their condition. Tube-feeding lasts until a baby is mature enough to breathe, suck, and swallow and can take all feedings by breast or bottle. Sick and very premature infants need special treatment, depending on what medical problems they have. Those who need help breathing are aided by an oxygen tube or a machine, called a ventilator, that moves air in and out of the lungs. Some babies need medicine. A few need surgery. Breast milk can give a baby extra protection from infection. So your hospital may urge you to pump your breast milk and bring it in for at least the first few weeks after the birth. NICU doctors and nurses are specialists in premature infant care. If your premature baby is in NICU, you can learn a lot from the medical staff about how to take care of your baby. Does premature birth cause long-term problems? Before the birth, it is hard to predict how healthy a premature baby will be. But your doctors can prepare you for what may lie ahead. They can base this on your condition and how many weeks pregnant you will be when you give birth. Most premature babies do not develop serious disabilities. But the earlier a baby is born, the higher the chances of problems. * Most premature babies who are born between 32 and 37 weeks do well after birth. If your baby does well after birth, his or her risk of disability is low. * Babies most likely to have long-term disability are those who are born before 26 weeks or who are very small, 1.7 lb (771.1 g) or less. Long-term problems may include intellectual disability or cerebral palsy. What can you expect when you take your baby home? When you're at home, don't be surprised if your baby sleeps for shorter periods of time than you expect. Premature babies are not often awake for more than brief periods, but they wake up more often than other babies. Because your baby is awake for only short periods, it may seem like a long time before he or she responds to you. Premature babies get sick more easily than full-term infants. So it’s important to keep your baby away from sick family members and friends. Make sure your baby gets regular checkups and shots to protect against serious illness. Sudden infant death syndrome (SIDS) is more common among premature babies. So make sure your baby goes to sleep on his or her back. This lowers the chances of SIDS. A premature infant is a baby born before 37 weeks gestation. Causes At birth, a baby is classified as one of the following: * Premature (less than 37 weeks gestation) * Full term (37 to 42 weeks gestation) * Post term (born after 42 weeks gestation) If a woman goes into labor before 37 weeks, it is called preterm labor. Often, the cause of preterm labor is unknown. Multiple pregnancy (twins, triplets, etc.) makes up about 15% of all premature births. Health conditions and events in the mother may contribute to preterm labor. Examples are: * Diabetes * Heart disease * Infection (such as a urinary tract infection or infection of the amniotic membrane) * Kidney disease Different pregnancy-related problems increase the risk of preterm labor: * An "insufficient" or weakened cervix, also called cervical incompetence * Birth defects of the uterus * History of preterm delivery * Poor nutrition right before or during pregnancy * Preeclampsia -- the development of high blood pressure and protein in the urine after the 20th week of pregnancy * Premature rupture of the membranes (placenta previa) Other factors that make preterm labor and a premature delivery more likely include: * African-American ethnicity (not related to socioeconomic status) * Age (younger than 16 or older than 35) * Lack of prenatal care * Low socioeconomic status * Use of tobacco, cocaine, or amphetamines Symptoms A premature infant's organs are not fully developed. The infant needs special care in a nursery until the organ systems have developed enough to sustain life without medical support. This may take weeks to months. A premature infant will have a lower birth weight than a full-term infant. Common physical signs of prematurity include: * Body hair (lanugo) * Abnormal breathing patterns (shallow, irregular pauses in breathing called apnea) * Enlarged clitoris (female infant) * Problems breathing due to immature lungs (neonatal respiratory distress syndrome) or pneumonia * Lower muscle tone and less activity than full-term infants * Problems feeding due to difficulty sucking or coordinating swallowing and breathing * Less body fat * Small scrotum, smooth without ridges, and undescended testicles (male infant) * Soft, flexible ear cartilage * Thin, smooth, shiny skin, which is often transparent (can see veins under skin) Not all premature babies will have these characteristics. Exams and Tests The infant may have difficulty breathing and maintaining body temperature. Common tests performed on a premature infant include: * Blood gas analysis * Blood tests to check glucose, calcium, and bilirubin levels * Chest x-ray * Continuous cardiorespiratory monitoring (monitoring of breathing and heart rate) Treatment When premature labor develops and cannot be stopped, the health care team will prepare for a high-risk birth. The mother may be moved to a center that specifically cares for premature infants in, for example, a neonatal intensive care unit (NICU). After birth, the baby is admitted to a high-risk nursery. The infant is placed under a warmer or in a clear, heated box called an incubator, which controls the air temperature. Monitoring machines track the baby's breathing, heart rate, and level of oxygen in the blood. Infants are usually unable to coordinate sucking and swallowing before 34 weeks gestation. Therefore, the baby may have a small, soft feeding tube placed through the nose or mouth into the stomach. In very premature or sick infants, nutrition may be given through a vein until the baby is stable enough to receive all nutrition in the stomach. (See: Neonatal weight gain and nutrition) If the infant has breathing problems: * A tube may be placed into the windpipe (trachea). A machine called a ventilator will help the baby breathe. * Some babies whose breathing problems are less severe receive continuous positive airway pressure (CPAP) with small tubes in the nose rather than the trachea. Or they may receive only extra oxygen. * Oxygen may be given by ventilator, CPAP, nasal prongs, or an oxygen hood over the baby's head. Nursery care is needed until the infant is able to breathe without extra support, feed by mouth, and maintain body temperature and a stable or increasing body weight. In very small infants, other problems may complicate treatment and a longer hospital stay may be needed. Prematurity used to be a major cause of infant deaths. Improved medical and nursing techniques have increased the survival of premature infants. The longer the pregnancy, the greater the chance of survival. Of babies born at 28 weeks, at least 90% survive. Prematurity can have long-term effects. Many premature infants have medical, developmental, or behavioral problems that continue into childhood or are permanent. The more premature an infant and the smaller the birth weight, the greater the risk of complications. However, it is impossible to predict a baby's long-term outcome based on gestational age or birth weight. Possible Complications Possible complications that may occur while in the hospital include: * Anemia * Bleeding into the brain (intraventricular hemorrhage of the newborn) or damage to the brain's white matter (periventricular leukomalacia) * Infection or neonatal sepsis * Low blood sugar (hypoglycemia) * Neonatal respiratory distress syndrome, extra air in the tissue of the lungs (pulmonary interstitial emphysema), bleeding in the lungs (pulmonary hemorrhage) * Newborn jaundice * Patent ducturs arteriosus * Severe intestinal inflammation (necrotizing enterocolitis) Possible long-time complications include: * Bronchopulmonary dysplasia (BPD) * Delayed growth and development * Mental or physical disability or delay * Retinopathy of prematurity, vision loss, or blindness Questions 1. True/False: Morbidity associated with prematurity is a significant contributor to the infant mortality rate. 2. Strategies to reduce thermal stress at birth should include (mark all correct answers): . . . . a. Keeping the delivery room warm and performing the stabilization under a preheated radiant warmer. . . . . b. Drying the infant and then wrapping them up with the same blanket. . . . . c. In a stable premature infant allowing skin to skin bonding with the mother. 3. Premature infants are at higher risk for hypoglycemia because (choose one): . . . . a. They are born with adequate glycogen stores but have immature homeostatic mechanisms to mobilize glucose. . . . . b. They are born with inadequate glycogen stores but have mature homeostatic mechanisms to mobilize glucose. . . . . c. They are born with inadequate glycogen stores and have immature homeostatic mechanisms to mobilize glucose. 4. Respiratory Problems in premature infants may be secondary to (choose one): . . . . a. Surfactant deficiency . . . . b. Increased chest wall compliance . . . . c. Incomplete alveolar development . . . . d. All of the above 5. Feeding difficulties in premature infants are usually secondary to (choose one): . . . . a. Immature development of the intestinal enzyme systems. . . . . b. Immature neuromuscular development of the intestinal tract. 6. In contrast to term infants, the following statements are true regarding physiologic jaundice in the premature infant in the neonatal period (choose one): . . . . a. Has its onset later, reaches its peak later and has slower resolution. . . . . b. Has its onset earlier, peaks earlier and has earlier resolution. . . . . c. Has its onset earlier, peaks later and has slower resolution. 7. The following statements regarding the persistence of ductus arteriosus are true in the premature infant (choose one): . . . . a. Is one of the most common cardiovascular dysfunction. . . . . b. May be asymptomatic and spontaneously resolve in many. . . . . c. Can be treated with medications. . . . . d. All of the above. 8. Hypoxic-Ischemic brain injury can lead to (choose one): . . . . a. Germinal matrix hemorrhage/intraventricular hemorrhage . . . . b. Periventricular leukomalacia . . . . c. Both . . . . d. None 9. Apnea events in premature infants are usually (choose one): . . . . a. Central because of immaturity of the brain respiratory center. . . . . b. Obstructive secondary to collapse of the upper airway structures and closure of the glottis. . . . . c. Neither a or b. . . . . d. Both a and b. 10. In premature infants, routine immunizations should be (choose one): . . . . a. Administered at a post-conceptual age of two months. . . . . b. Administered at a post-natal age of two months. 11. True/False: The weight of the premature infant is an absolute criterion for discharge from the hospital Answers to questions 1.true, 2.a,c, 3c, 4.d, 5.b, 6.c, 7.d, 8.c, 9.d, 10.b, 11.false |