Premature Birth

Birth that takes place more than three weeks before the baby is due is called premature birth.

A normal pregnancy lasts about 40 weeks but in premature birth, it occurs before the start of the 37th week of pregnancy.

There will be lesser time for the baby to develop in the womb and often they will have complicated medical conditions.

Depending on how early the baby is born, the baby may be:

• late preterm – born between the 34th and 36th week of pregnancy;
• moderately preterm – born between the 32nd and 34th week of pregnancy;
• very preterm – born less than the 32nd week of pregnancy;
• extremely preterm – born at or before the 25th week of pregnancy.

Aside from an early date, there are many physical symptoms and complications associated with premature birth.

Your baby does not have the usual amount of time to develop in the womb of the mother.

The signs that the baby’s gestation has been cut short are:

• small size with a disproportionately head;
• respiratory distress or labored breathing;
• fine hair or lanugo that is covering most of the body;
• due to lack of fat stores the baby will have sharper looking less rounded features;
• lack of reflexes for swallowing and sucking which can lead to feeding difficulties;
• low body temperature due to lack of stored body fat.

Mostly babies who are premature will have complications such as respiratory distress syndrome and sepsis. Do not hesitate to ask questions from the members of neonatal intensive care unit or NICU.

The following measurements show the median birth weight, length and head circumference of premature babies at different gestational ages for each sex. Weight, length and head circumference by gestational age for girls:

by Gestational age – Weight – Length – Head circumference:

• 40 weeks --- 7 lbs., 7.9 oz. (3.4 kg) --- 20 in. (51 cm) --- 13.8 in. (35 cm);
• 35 weeks --- 5 lbs., 4.7 oz. (2.4 kg) --- 17.7 in. (45 cm) --- 12.4 in. (31.5 cm);
• 32 weeks --- 3 lbs., 12 oz. (1.7 kg) --- 16.5 in. (42 cm) --- 11.4 in. (29 cm);
• 28 weeks --- 2 lbs., 3.3 oz. (1.0 kg) --- 14.1 in. (36 cm) --- 9.8 in. (25 cm);
• 24 weeks --- 1 lb., 5.2 oz. (0.60 kg) --- 12.6 in. (32 cm) --- 8.3 in. (21 cm).

Weight, length and head circumference by gestational age for boys:

Gestational age – Weight – Length – Head circumference:

• 40 weeks --- 7 lbs., 15 oz. (3.6 kg) --- 20 in. (51 cm) --- 13.8 in. (35 cm);
• 35 weeks --- 5 lbs., 8 oz. (2.5 kg) --- 18.1 in. (46 cm) --- 12.6 in. (32 cm);
• 32 weeks --- 3 lbs., 15.5 oz. (1.8 kg) --- 16.5 in. (42 cm) --- 11.6 in. (29.5 cm);
• 28 weeks --- 2 lbs., 6.8 oz. (1.1 kg) --- 14.4 in. (36.5 cm) --- 10.2 in. (26 cm);
• 24 weeks --- 1 lb., 6.9 oz. (0.65 kg) --- 12.2 in. (31 cm) --- 8.7 in. (22 cm).

About 50 percent of the time, the cause or causes of a premature birth are unknown but problems with the fetus, mother or both might be associated with premature birth.

The hospital staff will have to diagnose for any complications associated with premature birth.

The members of the NICU that are going to take care of your baby include:

• neonatal nurse – registered nurse who is trained for caring of the high-risk and premature newborns;

• neonatal nurse practitioner – experienced neonatal nurse who completed additional training to assist neonatologists;

• pediatrician – doctor who specializes in treating children from birth through adolescence;

• neonatologist – pediatrician who specializes in treatment of newborn health problems;

• pediatric resident – received specialized training in treating children;

• respiratory therapist – respiratory practitioner that assesses respiratory problems and at the same time manages the respiratory equipment;

• pediatric surgeon – a surgeon who specializes in performing surgery to newborns and children;

• pediatric social worker – s professional who will assist you in finding services that you will be needing after the discharge from the hospital.

These people will teach you how to hold, feed and take care of your newborn.

If you are uncertain about your baby’s condition, you can ask the doctors questions such as

• How is my baby’s condition?
• Did anything changed?
• How do these equipments help?
• Why are you giving my baby medications?
• What tests does my baby need?
• When can I hold my baby?
• How long will my baby have to continue tube feedings?
• What can I do to help care for my baby while he is in the NICU?
• When can my baby come home?
• How often do we need to come back after we are discharged?

Your baby may undergo tests and the possible tests include:

• breathing and heart rate monitor – these are monitored on a continuous basis and also the blood pressure too will be monitored;

• fluid input and output – they will monitor how much fluid your baby is getting through feedings and IV fluids and how much he is losing through soiled diapers and blood draws;

• echocardiogram – to check if there are problems in your baby’s heart function;

• blood tests – to check your baby’s glucose, calcium and bilirubin levels in your baby’s blood, this can also be used to measure the blood cell count and check for anemia;

• eye exam – to check if there are problems with your baby’s retina which is done by an ophthalmologist;

• ultrasound scan – this is done to check for fluid buildup or bleeding in the brain or to check the abdominal organs if there are problems in the gastrointestinal tract,

• kidneys or liver; other specialized testing may be needed if your baby develop complications.

To treat complications associated with premature birth, the hospital staff will constantly monitor the baby to ensure good health.

The members of the NICU will provide round the clock care for your baby that includes:

• your baby will be placed in the incubator (enclosed plastic bassinet) – so that your baby will maintain normal body temperature and they will show you how to hold your baby using kangaroo care;

• monitoring your baby’s vital signs – they will monitor your baby’s
  • temperature,
  • breathing,
  • blood pressure
  • and heart rate by taping sensors on your baby’s body and to help your baby breath, a ventilator may be used;

• feeding by tube – with the use of an intravenous (IV) tube your baby may receive fluids and nutrients then after your baby will be given breast milk by placing a tube through his nose into his stomach (NG or nasogastric).Your baby may be able to breastfeed if he is already strong;

• spending time under bilirubin lights – these are set of lights to break down your baby’s excess bilirubin that is building up because the liver cannot process it all;

• replenishing fluids – to make sure that your baby’ fluid are on target, they will monitor his potassium and sodium levels and fluids, theses fluids can be delivered through an IV line If there is not enough fluids;

• blood transfusion – to raise blood volume since your baby may have an underdeveloped ability to make his own blood cells. In some cases, your doctors may give your baby medications to stimulate normal functioning of the lungs, heart and circulation. Some of the possible medications that will depend on your baby’s condition include: a liquid which is called surfactant squirted into the lungs to help them mature;

• antibiotics if there is infection;

• aerosolized or IV for heart rate and breathing;

• patent ductus arteriosus to close heart defect;

• injection in the eye that could cause retinopathy of prematurity by stopping the growth of blood vessels;

• diuretics for the circulation and lungs. In some cases, surgery is required for the treatment of: a feeding problem, they will put a central line;

• nercotizing enterocolitis, the damaged part of intestines will be removed;

• hydrocephalus, they will place a shunt to drain excess fluid;

• retinopathy of prematurity, they will use a laser to limit risks of vision and to reverse abnormal blood vessel;

• patent ductus arteriosus, they will close a blood vessel.

Your baby is ready to go home if he/she

• can breathe without support;
• gaining weight steadily;
• can maintain a stable body temperature;
• free of infection;
• and can breast or bottle feed.

Before going home your baby’s nurse will ask you about

• living arrangements;
• adult relatives and friends to provide help;
• primary pediatric care;
• and other children in the household.

To prevent the risk of premature birth:

Progesterone supplements

These are good for women who already had a preterm birth and have a short cervix or both;

Cervical cerclage

A surgical procedure if the woman who had premature birth before or has a short cervix calcium supplements – having 1,000 mg or more calcium every day to lower the risk of preterm birth and preeclampsia;

Eat a healthy diet even before you get pregnant

Fods that are rich in protein, fruits and whole grains, less fat sugar and processed foods;

Cervical pessary

This is a silicone device that may help support the uterus and it fits around the cervix, this is for women who have short cervix and with just one baby;

Daily low-dose aspirin

60 to 80 mg especially if you have a history of preeclampsia or preterm birth or if you have a chronic high blood pressure;

Reduce chemical exposure

Chemicals used to manufacture many products such as plastic, canned foods, cosmetics, nail polish and hairspray (phthalates), limit your exposure to this to reduce the risk of having premature birth.

There are no homeopathic or alternative remedies for premature babies.

Follow some of these lifestyle tips to prepare your premature baby’s life at home:

• understand how to take care of your baby – before going home, you can ask your doctor where you can have a course in infant CPR. Ask your doctor anything that you want to ask regarding your baby’s condition even possible problems that you might encounter like feeding problems;

• discuss feedings – you can ask the doctors on how to feed a premature baby because premature babies may usually eat less than full term babies, you can ask them how many times in a day you should feed your baby;

• protect your baby’s health – babies who are born premature can acquire infections faster than the full term babies. Avoid going to crowded places such as malls and avoid sick people who wants to visit your baby as he might catch the infection of the sick person. Anyone who comes in contact with your baby should wash their hands first. Your doctor might even recommend palivizumab (Synagis) which is a preventive medication because premature babies are at high risk of serious infection of the lungs and respiratory tract;

• follow a recommended schedule for checkups – ask your doctor how many times in a month you are going to have follow-ups for him to monitor your baby;

• stay on top of vaccinations – ask your doctor when is the right time to give vaccinations to your baby. You can also ask people at your house to follow up on their immunizations to protect your baby, especially the pertussis vaccine;

• monitor for developmental delays – your doctor will also monitor your baby’s disabilities and developmental delays for a few months and if your baby is at risk he will receive further evaluation so he can have early intervention services. It will be emotionally and physically exhausting caring for a premature baby. You may have different emotions towards what is happening and you may feel tired. Here are some of the suggestion that might help you: learn everything about your baby’s condition such as talking to your doctor and reading books or visiting websites that can give you more information about your baby’s condition;
• take care of yourself by take care of yourself by getting rest as much as you needed to and by eating healthy foods;

• establish your milk supply by using a breast pump until your baby can breastfeed;

• accept help from others by allowing your relatives and friends to help you take care of your baby such as cleaning the house or looking after your baby;

• keep a journal so that you can record all that I happening and his every day progress, you can also write your feelings and thoughts in the journal;
• seek good listeners for support by talking to your partner, family and friends even the NICU social worker, you can even ask your doctor if he knows a support group in your area. You can take it one step at a time because caring for a premature baby can be very challenging.

There are several risks and complications associated with premature birth.

Some of the possible risk factors of premature birth include:

• if you had this before;
• having multiple pregnancies;
• conceiving through vitro fertilization;
• an interval of less than 6 months between pregnancies;
• poor nutrition;
• using illicit drugs;
• smoking cigarettes;
• problems with the cervix, uterus or placenta;
• infections especially lower genital tract and amniotic fluid;
• not gaining enough weight during pregnancy;
• being overweight or underweight before pregnancy;
• chronic conditions such as diabetes or high blood pressure;
• multiple abortions or miscarriages;
• physical trauma or injury;
• and stressful life events.

Black women are likely to experience this than women of other races nut with no apparent reasons. Premature babies can have short-term and long-term problems.

Some of the short-term complications that can happen during the first week include:

• breathing problems – the baby may have problems due to an immature respiratory system. He may develop respiratory distress syndrome if he lacks surfactant. He may also develop apnea and bronchopulmonary dysplasia which is a chronic lung disease;

• heart problems – the baby may have hypotension that may require IV fluids, medicines or blood transfusion, or he can have patent ductus arteriosus (PDA) that when left untreated can lead to heart failure;

• brain problems –the baby may develop intraventricular hemorrhage or bleeding in the brain, and in some cases babies may have larger brain bleeding that can lead to hydrocephalus or permanent brain injury;

• temperature control problems – premature babies cannot generate enough heat because  they do not have the stored body fat unlike the full term babies, it can lead to hypothermia if the body temperature dips too low which can lead to low blood sugar and breathing problems;

• gastrointestinal problems – this can lead to necrotizing enterocolitis (NEC) in which the cells lining the bowel walls are injured;

• blood problems – such as infant jaundice is a yellow discoloration in the baby’s skin and eyes because there is an excess yellow colored pigment from red blood cells or liver or anemia meaning the baby does not have enough red blood cells;

• metabolism problems – some babies will develop hypoglycemia because they don’t have enough glycogen compared to the full term babies;

• immune system problems – this can lead to infection that can cause sepsis which is a fatal complication. Long term complications include: cerebral palsy – a posture, movement or muscle disorder because of an infection and inadequate blood flow in the baby’s developing brain;

• impaired cognitive skills – they might have learning disabilities or may lag behind compared to full term babies;

• vision problems – they may develop a disease when blood vessels swell and overgrow in the light sensitive layer of the nerves at the retina which is called retinopathy of prematurity or a retinal detachment which can lead to blindness;

• hearing problems – they are at high risk of hearing loss;

• dental problems – such as tooth discoloration, improperly aligned teeth and delayed tooth eruption;

• psychological and behavioral problems – they may develop ADHD or attention-deficit/hyperactivity disorder;

• chronic health issues – such as asthma, infections and feeding problems may develop or persist or they may even be at risk of SIDS or sudden infant death syndrome.