Premature babies

14April 2023

What is a premature baby?

When a baby is born before 37 weeks of pregnancy, it is called premature baby. Each year approximately 15 million babies are born preterm. Typically preterm babies do not develop completely at birth. They may have health problems and therefore need to stay in the hospital longer than the babies born at the right time. However, due to the improvements in medical care technology, babies born very prematurely have a higher survival rate.

What are the terms used to describe the baby’s birth?

Depending on when(week of pregnancy) the baby is born, your baby’s birth may be described as:

Term	Week of pregnancy
Late preterm	Baby born between 34 and 36 weeks of pregnancy
Moderately preterm	Baby born between 32 and 34 weeks of pregnancy
Very preterm	Baby born at less than 32 weeks of pregnancy
Extremely preterm	Baby born before 25 weeks of pregnancy

The health problems related to premature birth can either last a lifetime or show up at certain stages of a baby’s life. For example,intellectual or developmental disabilities may develop later in childhood.

The earlier the baby is born in pregnancy, the higher are the chances for health problems. Babies that are born before 34 weeks of gestation are the most prone to health problems. However, babies born between 34 and 37 weeks of pregnancy also have a high risk of suffering from health problems associated with premature birth.

Some of premature babies need to spend time in a hospitals newborn intensive care unit (NICU) –

These are a nursery in a hospital where the sick newborn gets specialized medical care.
Babies are kept in the NICU until their organs develop so that they could survive without medical support.
Babies stay in NICU until they can:
- Breathe on their own
- Eat by mouth
- Maintain their body temperature
- Maintain their body weight

What are the symptoms of premature birth?

Due to premature birth, the baby may show mild or severe symptoms. Some of the signs of prematurity include:

A small or enormous head
Fine hair covering a significant portion of the body
Feeding difficulties due to poor reflexes needed for swallowing and sucking
Lack of fat leads to sharper-looking, less rounded features compared to a full-term baby's features.
Lack of fat also leads to low body temperature.

What are the causes of premature delivery?

Following are some of the risk factors that indicate you might need to delivery prematurely:

If you have given birth to a premature baby in your previous pregnancies
If you have multiple pregnancies or twins or triplets
If you conceived through in vitro fertilization
If you smoke cigarettes or use and abuse illicit drugs
If you have some infection, primarily an infection of the amniotic fluid and the lower genital tract.
If you are underweight or overweight before pregnancy
If you have had multiple miscarriages or abortions.
If you have problems associated with your uterus, cervix or placenta
If the interval between your previous pregnancy and your current pregnancy is less than 6 months
If you suffer from chronic medical conditions like diabetes, heart or kidney disease and high blood pressure
If you live in a stressful environment.

Is special medical care essential for premature babies?

Discuss with your health care provider about the health conditions that your baby might be facing or may face as a consequence of premature delivery.

Whether your baby can go home or needs to stay in the hospital depends on the answers to the following questions. If your answer to all of the following queries is a ‘yes’ then it is highly likely that your baby can go home:

Does she/he weight at least 4 pounds
Can they keep themselves warm on their own without the help of an incubator (a clear plastic bed that helps keep your baby warm)?
Can the baby be breastfed or bottle-fed?
Is the baby gaining weight steadily or capable of doing so?
Can the baby breathe on their won?

Occasionally, despite going home, the baby may need special medical equipment, medicine, or other treatment. Your healthcare provider can help you with these things and help you learn how to use them while taking care of your baby at home.

Your doctor may recommend visiting a neonatologist with your baby for regular check-ups after leaving the hospital. A neonatologist is a doctor with a specialty in the treatment and caring for premature babies and children. You can also connect with parent support groups and other resources in your area.

What kind of health problems can premature babies have?

Premature babies can suffer from both short term and long term health complications.

Some of the short term health problems that may affect premature babies include:

Anemia:This is a condition in which a baby does not have enough healthy red blood cells for carrying the oxygen to the rest of the body.
- Results:low levels of oxygen and glucose (sugar) in a baby’s blood, thereby making the proper functioning of the baby’s organs very difficult.
- Causes: premature babies in the NICU undergo regular blood tests. Often they are not able to make new blood cells to replace the cells lost during these tests. This can lead to anemia.
Breathing problems: include:
- Respiratory Distress Syndrome (RDS): The babies lungs cannot make enough surfactant, a substance that avoids small air sacs in the baby’s lungs from collapsing;
- Apnea of prematurity (AOP): This refers to a pause in the baby’s breathing for 15 to 20 seconds or more. It can happen simultaneously with a slow heart rate –bradycardia.
- Bronchopulmonary dysplasia (BPD): This is a lung disease that can develop in premature babies and babies who are undergoing treatment with a breathing machine. Those babies who have BPD have a higher risk of lung infections in comparison to other babies. BPD can also lead to lung damage.
Intraventricular hemorrhage (IVH): In this condition, there is bleeding in the fluid-filled spaces of the brain; these spaces are called ventricles.
Infections of neonatal sepsis: Premature babies are more prone to infections since their immune systems are not fully developed. Infection in premature babies can lead to life-threatening disease – sepsis.
Newborn jaundice: when your baby’s blood has bilirubin in excess when the liver is working improperly or isn’t fully developed.
Patent ductus arteriosus (PDA): in this condition, the heart of the baby is affected since the blood vessel called ductus arteriosus isn’t closed correctly. This duct helps the blood flow around a baby’s lungs before being born. After the baby is born, this duct is no longer needed and should close by itself a few days after birth. However, if it doesn’t flow too much, blood may flow into the lungs leading to heart and breathing problems.
Necrotizing enterocolitis (NEC): This common but serious problem affects the baby's intestines. In this condition, the intestine tissue is damaged or begins to die.
Hypothermia: Premature babies don’t have enough stored body fat like a full-term infant. Therefore if they lose heat, they can’t regenerate enough heat to counteract the loss. If the temperature drops too low, the baby can suffer from hypothermia.

Hypothermia can lead to:

Breathing problems
Low blood sugar levels
The baby using all its energy from food to stay warm

Hence small premature babies need an incubator to stay warm

Hypoglycemia: Premature babies suffer from metabolism-related problems. Due to this, the baby might suffer from a deficiency of blood sugarcalled hypoglycemia.

Following are the long term health effects that your baby may have to face:

Retinopathy of prematurity (ROP): In this condition, the retinas of the baby don't develop entirely after the week of birth. The retina is a tissue layer at the back of the eye. Generally, ROP affects both the eyes.

Alert: While most cases of ROP are mild and do not need treatment, in some instances, these might be severe. Consult your doctor immediately if you notice prolonged vision problems in your premature babies, as a severe ROP might lead to permanent blindness.

Impaired learning: Premature babies have a higher chance of falling behind in their learning process compared to their full-term counterparts. In their childhood, babies born prematurely might develop learning disabilities
Cerebral palsy: This is a disorder of the movement, posture, and muscle tone. It is caused by:
- Infection
- Inadequate blood flow
- Injury to a baby’s developing brain either in the early stages of pregnancy or while the baby is still young and immature.
Hearing problems: Babies born prematurely are more prone to developing hearing loss (varying severities)
Dental problems: Premature babies may have dental issues like:
- delayed tooth eruption
- tooth discoloration
- improperly aligned teeth
Behavioral and psychological issues: Children born prematurely may develop specificbehavioral or psychological problems, including developmental delays.
Chronic health issues: Some of the chronic health issues that may affect the lives of the babies prematurely might include:
- Infections
- Asthma
- Feeding problems

Alert: Prematurely born babies are at a higher risk of sudden infant death syndrome (SIDS) in comparison to their full-term counterparts.

Reference:

By -
Dr. Ruchika Singh

14-April-2023

Premature babies

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