Prematurity

A baby born before 37 weeks of
pregnancy is considered premature or born too early. Other terms used for prematurity
are preterm and preemie. The number of premature births in the U.S. increased from
1990
to 2006, declined until 2014, and has since been rising again. Twins and other multiples
are more likely to be premature than single birth babies. 

Many premature babies weigh less
than 5 pounds, 8 ounces (2,500 grams). They may be called low birth weight. Risks
of
prematurity are higher for younger, lighter babies. But even older, heavier preemies
are
still at risk.

Premature birth may have a number
of causes. About 2 out of 3 premature births are because of  issues that directly
cause
early labor and birth, such as those listed below. Other problems can make the mother
or
baby sick and need early delivery. Sometimes the exact cause for a premature birth
is
unknown. This can be true even though the mother may have done everything right during
the pregnancy. 

Four things that may cause premature labor are:

  • Being pregnant with more than one baby
  • Bleeding or other problems with the uterus
  • Stress
  • Infection in the uterus or elsewhere in the body

Many women have no known risk factors for premature birth. But several things can
make premature birth more likely.

Women with these risk factors are more likely to deliver early:

  • Having had a past preterm labor or
    birth
  • Getting pregnant within a short time (less than a year) after having had a baby
  • Being pregnant with more than one
    baby
  • Having an abnormal cervix or uterus
  • Being younger than 16 or older than 35
  • Being African American
  • Having health problems such as high
    blood pressure, diabetes, heart disease, or kidney disease or high levels of social
    and psychological stress
  • Smoking
  • Using illegal drugs such as cocaine

In addition, women who develop any of the following problems during pregnancy are
more likely to deliver early:

  • Infections
  • High blood pressure
  • Diabetes
  • Blood-clotting problems
  • Problems with the placenta
  • Vaginal bleeding

Certain developmental problems in
unborn babies can also lead to premature birth.

How a premature baby looks and acts
depends on how prematurely they are born. The following are the most common symptoms of
a premature baby:

  • Small size. Premature babies often
    weigh less than 5 pounds, 8 ounces.
  • Thin, shiny, pink, or red skin
    depending on how early the baby was born. You may be able to see veins through the
    skin.
  • Little body fat
  • Little scalp hair. But the baby may
    have lots of soft body hair (lanugo) depending on how early the baby was born
  • Weak cry and trouble breathing due to
    underdeveloped lungs
  • Low muscle tone
  • Male and female genitals are not yet
    fully developed

The symptoms of prematurity may
seem like other health conditions. Make sure your child sees their healthcare provider
for a diagnosis.

A baby born before 37 weeks of pregnancy is considered premature or born too early.
Prematurity is defined as:

  • Early term
    infants.
    Babies born between 37 weeks and 38 weeks, 6 days. These babies are
    early but not premature.
  • Late preterm
    infants.
    Babies born between 34 weeks and 36 weeks, 6 days.
  • Very
    preterm.
    Babies born at or below 32 weeks.
  • Extremely
    preterm.
    Babies born at or below 28 weeks.

Treatment will depend on your child’s symptoms, age, and general health. It will also
depend on how severe the condition is.

Treatment may include:

  • Corticosteroid medicine given to the
    mother before a premature birth to help the baby’s lungs and other organs grow and
    mature
  • Watching the baby’s temperature, blood
    pressure, heart and breathing rates, and oxygen levels
  • Temperature-controlled bed or
    incubator
  • Oxygen given by mask or with a breathing machine called a ventilator
  • IV (intravenous) fluids, feedings, or medicines
  • Special feedings with a tube in the stomach if a baby can’t suck
  • X-rays or other imaging tests
  • Skin-to-skin contact with the parents (kangaroo care)

Premature babies are cared for by a neonatologist. This is a doctor with special training
to care for newborns. Other specialists may also care for babies, depending on their
health problems.

Premature babies are born before
their bodies and organ systems have fully matured. These babies are smaller than they
would have been if they were born at full term. They may need help breathing, eating,
fighting infection, and staying warm. Extremely premature babies, those born before
28
weeks, are at the greatest risk for problems. Their organs and body systems are not
ready for life on their own outside the mother’s uterus. And they may be too immature
to
function well even with intensive care support.

Some of the problems premature babies may have include:

  • Keeping their body temperature steady
    or staying warm
  • Breathing problems, including serious
    short- and long-term problems
  • Blood pressure problems due to immaturity of various organ
    systems (especially low blood pressure in early hours and days)
  • Blood problems. These include low red
    blood cell counts (anemia), yellow color to the skin from breaking down red blood
    cells (jaundice)
  • Kidney problems due to immaturity
  • Digestive problems, including
    immature absorption and digestion. Most premature babies need intravenous IV
    nutrition for some time at birth. In some cases there may be inflammation and death
    of parts of the intestine (necrotizing enterocolitis). Babies are often not able to
    feed by mouth until closer to their due date and will need tube feedings. The best
    feeding is mom’s own milk. If this isn’t possible, donor human milk from a milk bank
    is the safest alternative.
  • Nervous system problems, including
    bleeding in the brain or seizures
  • Infections

Premature babies can have long-term health problems as well. Generally, the more premature
the baby, the more serious and long-lasting the health problems may be.

More babies are surviving even though they are born early and are very small.  But
it is best to prevent preterm labor if possible.

It’s important to get good prenatal care while you are pregnant. Your healthcare provider
can help find problems and suggest lifestyle changes to lower the risk for preterm
labor and birth. Some ways to help prevent prematurity include:

  • Stopping smoking if you smoke. You should stop smoking before you are pregnant.
  • Finding out if you are at risk for preterm labor
  • Learning the symptoms of preterm labor
  • Getting treated for preterm labor

Your healthcare provider may give
you the hormone progesterone if you are at high risk for preterm birth. Progesterone
can
help if you have had a past preterm birth. 

Premature babies often need time to catch up in both development and growth. In the
hospital, this catch-up time may mean learning to eat and sleep, as well as steadily
gaining weight. Babies may stay in the hospital until they reach the pregnancy due
date. They may be cared for in a neonatal intensive care unit (NICU).

Talk with your baby’s healthcare provider about when your baby will be able to go
home. In general, babies can go home when they:

  • Have no serious health conditions
  • Can stay warm in an open crib without
    added heat
  • Take all feedings by mouth,
    maintaining their expected growth rate
  • Have no recent periods of not breathing (apnea) or low heart rate

Before discharge, premature babies
need an eye exam and hearing test to check for problems linked to prematurity. You
must
be able to give care, including medicines and feedings, before your baby can go home.
You will also need information about follow-up visits with the baby’s healthcare
provider and vaccines. Many hospitals have special follow-up healthcare programs for
premature and low-birth-weight babies.

Even though they are otherwise
ready to go home, some babies still have special needs. This includes things such
as
extra oxygen or tube feedings. You will learn how to take care of your baby if they
need
these things. Hospital staff can help set up special home care.

Ask your baby’s healthcare
provider about staying overnight in a parenting room at the hospital before your baby
goes home. This can help you adjust to caring for your baby while providers are nearby
for help and reassurance. You may also feel more confident taking your baby home when
you know infant CPR and safety.

Premature babies are at increased
risk for SIDS (sudden infant death syndrome). You should always put your baby down
to
sleep on their back.

  • Babies born before 37 weeks of
    pregnancy are considered premature or born too early.
  • Many premature babies also weigh less
    than 5 pounds, 8 ounces (2,500 grams). They may be called low birth weight.
  • Premature babies can have long-term
    health problems. In general, the more premature the baby, the more serious and
    long-lasting the health problems may be.
  • Prenatal care is a key factor in
    preventing preterm births and low-birth-weight babies.
  • Premature babies are at increased risk
    for SIDS (sudden infant death syndrome).

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
    or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child.
    Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose
    for that visit.
  • Know how you can contact your child’s provider after office hours. This is important
    if your child becomes ill and you have questions or need advice.