A premature birth is a birth that takes place more than three weeks before the baby’s estimated due date. In other words, Premature birth is when a baby is born too early, before 37 weeks of pregnancy have been completed. A normal pregnancy period (fetal development) is about 40 weeks. A developing baby goes through important growth throughout pregnancy – including in the final months and weeks. For example, the brain, lungs, and liver need the final weeks of pregnancy to fully develop.
Depending on how early a baby is born, he or she may be:
• Late preterm, born between 34 and 36 completed weeks of pregnancy
• Moderately preterm, born between 32 and 34 weeks of pregnancy
• Very preterm, born at less than 32 weeks of pregnancy
• Extremely preterm, born at or before 25 weeks of pregnancy
Most premature births occur in the late preterm stage.
Your baby may have very mild symptoms of premature birth, or may have more-obvious complications.
Some signs of prematurity include the following:
• Small size, with a disproportionately large head
• Sharper looking, less rounded features than a full-term baby’s features, due to a lack of fat stores
• Fine hair (lanugo) covering much of the body
• Low body temperature, especially immediately after birth in the delivery room, due to a lack of stored body fat
• Labored breathing or respiratory distress
• Lack of reflexes for sucking and swallowing, leading to feeding difficulties
Problems a premature baby faces –
Babies need a full term in the womb to grow. If they are born too early, they may not completely develop. This can cause serious health problems. Preemie babies tend to have heart, brain, lung or liver issues.
Some of the most common health conditions that affect premature babies are:
• Apnea of prematurity, or temporary pauses in breathing during sleep.
• Bronchopulmonary dysplasia, or underdeveloped lungs.
• Intraventricular hemorrhage, or bleeding in the brain.
• Necrotizing enterocolitis, or inflammation of the intestines.
• Neonatal sepsis, or blood infection.
• Patent ductus arteriosus (PDA), or abnormal blood flow in the heart.
• Retinopathy of prematurity, or underdeveloped blood vessels in the eye.
Premature babies are also at a higher risk of developmental challenges. They may have health issues later in life, including:
• Cerebral palsy.
• Hearing and vision problems.
• Learning disabilities.
• Poor growth.
Premature births can happen suddenly, with no known cause. Sometimes providers have to induce (start) labor early for medical reasons.
Women can also go into premature labor due to:
• Chronic health conditions, such as diabetes or infections.
• Drug or alcohol abuse.
• Rupture of membranes.
• Multiple pregnancies, such as twins or triplets.
• Preeclampsia (high blood pressure during pregnancy).
• Problems with their uterus or cervix.
• Too little time (less than 18 months) between pregnancies.
• Vaginal bleeding due to placenta abruption or infections during pregnancy.
Risk Factors –
You may be at an increased risk for premature birth if you:
• Are African American.
• Are under the age of 20 or over the age of 40.
• Have a family or personal history of preterm births.
• Smoke while pregnant.
• Were underweight before getting pregnant.
After your premature baby is moved to the NICU, he or she may undergo a number of tests. Some are ongoing, while others may be performed only if the NICU staff suspects a particular complication.
Possible tests for your premature baby may include:
• Breathing and heart rate monitor.
Your baby’s breathing and heart rate are monitored on a continuous basis. Blood pressure readings are done frequently, too.
• Fluid input and output.
The NICU team carefully tracks how much fluid your baby takes in through feedings and intravenous fluids and how much fluid your baby loses through wet or soiled diapers.
• Blood tests.
Blood samples are collected through a heel stick or a needle inserted into a vein to monitor a number of critical substances, including calcium, glucose and bilirubin levels in your baby’s blood. A blood sample may also be analyzed to measure the red blood cell count and check for anemia or assess for an infection.
This test is an ultrasound of the heart to check for problems with your baby’s heart function. Much like a fetal ultrasound, an electrocardiogram uses sound waves to produce moving images on a display monitor.
• Ultrasound scan.
Ultrasound scans may be done to check the brain for bleeding or fluid buildup or to examine the abdominal organs for problems in the gastrointestinal tract, liver or kidneys.
• Eye exam.
An ophthalmologist (eye doctor) may examine your baby’s eyes and vision to check for problems with the retina (retinopathy of prematurity).
When premature labor develops and can’t be stopped, the health care team will prepare for a high-risk birth. The mother may be moved to a center that is set up to care for premature infants in a NICU.
After birth, the baby is admitted to the NICU. 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.
A premature infant’s organs are not fully developed. The infant needs special care in a nursery until the organs have developed enough to keep the baby alive without medical support. This may take weeks to months.
Infants usually cannot coordinate sucking and swallowing before 34 weeks gestation. A premature 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 through the stomach.
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 instead of 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.
Infants need special nursery care until they are able to breathe without extra support, eat by mouth, and maintain body temperature and body weight. Very small infants may have other problems that complicate treatment and require a longer hospital stay.
Getting prompt and proper prenatal care significantly reduces the chances of having a premature birth.
Other important preventive measures include:
• Eating a healthy diet before and during your pregnancy.
Make sure to eat lot of whole grains, lean proteins, vegetables, and fruits. Taking folic acid and calcium supplements is also highly recommended.
• Drinking lots of water every day.
The recommended amount is eight glasses per day, but you’ll want to drink more if you exercise.
• Taking aspirin daily starting in the first trimester.
If you have high blood pressure or a history of premature birth, your doctor may recommend you take 60 to 80 milligrams of aspirin each day.
• Quitting smoking, using illegal drugs, or overusing certain prescription drugs. These activities during pregnancy may lead to a higher risk of certain birth defects as well as miscarriage.
• Progesterone supplements.
Women who have a history of preterm birth, a short cervix or both factors may be able to reduce the risk of preterm birth with progesterone supplementation.
• Cervical cerclage.
This is a surgical procedure performed during pregnancy in women with a short cervix, or a history of cervical shortening that resulted in a preterm birth. During this procedure, the cervix is stitched closed with strong sutures that may provide extra support to the uterus. The sutures are removed when it’s time to deliver the baby.
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