Premature Babies

Premature Babies: A Comprehensive Guide to Their Health and Development

Full term pregnancy is defined as a period between 37 and 42 weeks, when the baby is fully developed. The World Health Organisation classifies babies born before 37 weeks as preterm and categorizes them into three categories:

• Mildly Preterm– Delivered between 32-37 Weeks (around 80% all premature babies).
• Moderately Preterm– Delivered at 28-31 Weeks (approximately 11% of premature babies).
• Extremely Preterm– Delivered before 28 weeks of gestation (around 9% all premature babies).

In Australia, if the baby does not survive and is born before the 20th week or weighing less than 400g, it is generally referred to as a miscarriage.

What it Means to their Health

In most cases, babies born prematurely are healthy and thriving. However, some babies (especially those who are extremely preterm) do not survive. This is because their body and organs are not developed enough to function outside the womb.

It is considered that 24 weeks of gestation is the “safe” age for delivering a premature child. However, around one-third of these babies will still suffer from a disability like cerebral palsy or intellectual disability. The closer a child is born to its due date, the lower the risk of health problems.

Premature babies can suffer from several medical conditions.

• Lung disease or breathing difficulties (due to immature lungs)
• Feeding problems (caused by inability to swallow and suck)
• Unable to regulate body temperature
• Sleep apnoea is when breathing stops for an extended period.
• Bradycardia is a slowing down of the heartbeat.
• Jaundice is a yellowing of the skin caused by an immature liver.

This is why premmies’ age is based on their ‘adjusted’ age, which is the chronological age less the difference between birth date and due date. According to studies, premmies reach motor milestones at the same age as full-term infants (using adjusted ages) and most will catch up in size within the first 12 months.

Characteristics of Babies Born Prematurely

A premature baby may weigh less than 5 pounds (2.26 kilograms) when they are born. Medical advances have given children who are born more than two pounds three ounces (one kilogram) and after 28 weeks of pregnancy a good chance of survival. Eight out of 10 of these babies have no long-term problems.

What Your Premature Baby Looks Like

• The sooner your baby is born, the smaller and slimmer she will be. Her head will also appear larger in comparison to her body.
• Her skin will appear thinner and transparent with so little body fat. You can see the blood vessels underneath. She may also have fine hair called lanugo on her shoulders and back.
• She will look more angular and sharper than she would have at full term. She won’t be covered in the white vernix that protects her at birth because it’s not produced until late pregnancy. You don’t need to worry; she will eventually look more like a newborn.
• Your premature baby may get cold at normal room temperature because she lacks protective fat. She will be placed in an incubator, also called an isolette, or a special heating unit called a radiant heater immediately after her birth. The temperature can be set to keep the baby warm.
• She’ll likely be transferred to the NICU after a quick check in the delivery room.

What Your Premature Child Acts Like

• Your premature baby may also cry softly or not at all and have breathing problems. It is due to her immature respiratory system.
• Her breathing problems can lead to serious health issues if she is more than two months early. This could be because her other undeveloped organs are not getting enough oxygen. To prevent this, doctors will monitor her breathing and heartbeat with equipment known as a cardio-respiratory monitoring device.
• She may need extra oxygen or special equipment, such as a ventilator. Another breathing assistance technique, called CPAP, may also be temporarily used to help her breathe.

  

Why do Babies arrive Prematurely?

Although the causes of premature births are often unknown, several factors can increase the risk. These include maternal health and lifestyle. The following factors can increase the risk:

• High blood pressure
• Diabetes
• Severe illness
• Multiple births, including twins and multiple babies
• Previous preterm births
• Severe urine infection
• Smoking, alcohol or other drugs
• Extreme stress
• Heavy Physical Work
• IVF and assisted reproductive technology
• Car accident or bad fall?

There is no way to predict or prevent a premature birth. However, if the mother goes into early labour, hospital treatment can sometimes delay the birth.

Complications

Not all premature infants have health problems. Being born prematurely can lead to short- and long-term health problems. The earlier a child is born, the greater the chance of complications. Birth weight is also important.

Certain problems are obvious from birth. Some problems may not be apparent until later.

Short-term Complications

In the first week, complications of premature delivery may include:

• Breathing Problems. Premature babies may have difficulty breathing because their lungs are not fully developed. The baby may not be able to breathe enough if the lungs of the infant lack the substance that allows them to expand. It is called respiratory distress syndrome.

  Preterm babies often have breathing pauses, or apnea. By the time an infant leaves the hospital, apnea is usually gone. Some premature babies develop bronchopulmonary dysfunction, a lung disorder that is less common. The babies need oxygen for several weeks or even months. However, they usually outgrow the problem.

• Heart problems, Low blood pressure, and patent ductus artery (PDA) are two common heart conditions that affect premature babies. PDA An opening exists between the pulmonary arterial and the aorta, two vital blood vessels. This heart defect closes by itself. It can cause heart problems if left untreated. This occurs when the heart cannot pump blood as efficiently as it should. Fluids, medications and blood transfusions may be needed to treat low blood pressure.
• Problems with the brain. Risk of brain bleeding increases the earlier the baby is born. It is known as an intraventricular haemorrhage. Most hemorrhages have a mild impact and will resolve quickly. Some babies have brain bleeding of a larger size that can cause permanent brain damage.
• Temperature control problems. Premature babies can lose body heat quickly. The stored fat in their bodies is not as high as that of a fully-term baby. They can’t produce enough heat to compensate for the heat lost by their skin. Hypothermia can occur if the body temperature falls too low.

  Hypothermia can cause breathing problems in premature babies and lower blood sugar levels. Preterm babies may also use all the energy they gain from eating to keep warm. It’s for this reason that smaller premature infants need additional heat at first, such as a warmer.

• Digestive problems. The digestive system of premature infants is more likely to be underdeveloped. This can cause problems like necrotizing Enterocolitis (NEC). This can lead to problems such as necrotizing enterocolitis (NEC). NEC The cells that line the bowel walls are damaged. This can occur in premature babies once they begin feeding. Breast milk is the only food that premature babies receive. NEC.
• Blood Problems. Premature infants are at risk for blood problems, such as anemia or newborn jaundice. Anemia is a condition where the body does not have enough red blood cells. In the first few months of life, red blood cells slowly decrease in newborns. This drop can be more pronounced in premature infants. The skin and eyes of newborns with jaundice appear yellow. The baby’s blood is too yellow from the liver or red cells. This substance is called Bilirubin. There are many reasons for jaundice, but preterm babies are more likely to get it.
• Problems with metabolism in premature babies. Metabolic problems are common among premature babies. This is the process that the body uses to convert food and drinks into energy. Some premature babies have very low blood sugar levels. It can be because premature babies have less blood sugar stored than full-term infants. Premature infants also have a harder time converting their stored blood sugar into active, more usable forms of sugar.
• Immune System Problems. Premature babies often have an immune system that isn’t fully formed. This can increase the risk of illness. A premature baby’s infection can spread quickly to the bloodstream, causing a potentially life-threatening condition called sepsis.

  

Long-term Complications

Premature birth can lead to long-term health problems, including:

• Cerebral Palsy. This group can cause problems in movement, muscle tone, or posture. This can be caused by an infection or poor circulation. The condition can also be caused by an injury to the newborn baby’s brain. This could happen early in pregnancy or when the child is young.
• Learning difficulties. Premature infants are more likely than full-term babies to fall behind on milestones. A child born prematurely who is of school age may have a higher risk of learning disabilities.
• Problems with vision. Retinopathy of Prematurity is a disease that affects premature infants. The retina, the light-sensing tissues at the back of the eye, can become affected by this condition when the blood vessels grow and swell too much. These overgrown vessels can scar the retina, causing it to move out of position. The retinal detachment occurs when the retina is pulled from the back of your eye. This can cause vision loss and blindness if left untreated.
• Hearing Problems. Premature infants are at a greater risk of hearing loss. Before they leave the hospital, all babies should be checked for hearing problems.
• Dental problems. Preterm infants may have more enamel defects than full-term babies. Infants who are born prematurely or very early may also have teeth that develop more slowly.
• Mental health and behavior problems. Early-born children are more likely to experience mental health issues, developmental delays, or behavioral problems than those born at full term.
• Long-term health problems. Premature infants are more likely than full-term babies to experience long-term health problems. More illnesses, asthma, and feeding issues are likely to occur or persist. A premature infant is also at a higher risk for sudden infant death syndrome. When an infant dies, usually while sleeping, for unknown reasons.

List of Preventions

Preterm births are often caused by unknown causes. Some things can be done to reduce the risk of preterm delivery, such as:

• Progesterone, a hormone involved in pregnancy. If you have had a preterm baby in the past, a lab-made version may lower your risk of a second premature birth. The risk of preterm delivery may also be reduced if your cervix is short. The cervix, or lower end of the woman’s uterus that opens up during labor to allow the baby to be born, is called the cervix.
• Cervical cerclage. It is a pregnancy surgery. If you have a shorter cervix or a previous preterm birth, your provider may recommend it.

  The cervix will be closed using a strong suture. The uterus may receive extra support. When it is time to deliver the baby, the suture will be removed. You should ask your doctor if you are advised to avoid vigorous exercise during your pregnancy.

Staying in bed does not help to prevent preterm delivery. The risk of blood clots and muscle weakness can be increased by bed rest. Preterm births may even be more likely if you are on bed rest.