Premature Birth

Premature birth refers to a baby born more than three weeks prior to the estimated due date, so they are all births  that occur before the 37th week. Premature babies, particularly those who are born early, can often face complicated medical issues. Prematurity can cause many complications. The risk of complications increases the earlier your baby is born. The age at which a baby is born will determine how old he/she may be.

• Preterm late, born in the final 34-36 weeks of pregnancy
• Moderately Preterm, Born between 32 and 34 weeks gestation
• Very premature, delivered at 32 weeks or less of gestation
• Very preterm, born before 25 weeks.

Preterm births are most common in the later stages of pregnancy.

Signs of Premature Birth

You may notice very subtle symptoms of premature birth or more obvious complications. These are some signs of prematurity:

• A small size with a large head
• A lack of fat stores results in sharper, more rounded features.
• Fine hair (lanugo), covering a lot of the body
• Low body temperature which is due to insufficient body fat, particularly after delivery.
• Respiratory distress or labored breathing
• Inability to use your reflexes for sucking or swallowing can lead to difficulties with feeding

Special care for Premature Birth

Preterm babies will need to be admitted to a hospital in a special nursery unit. Your baby may need to be admitted to either an intermediate care nursery or the neonatal intensive medical unit, depending on how much care he/she needs. Your baby will be taken care of by doctors and specialists who have been trained in caring for preterm babies. Ask questions. You may need to provide extra support for your baby’s feeding and adaptations immediately after birth. Your baby’s care plan can be formulated by your health care team.

Risk factors

It is not always clear what causes premature births, but there are several risk factors for premature birth, such as:

• Premature births in the past
• Pregnancy with twins, triplets, or other multiples
• A gap of six months or less between pregnancies
• In vitro fertilization is used to conceive
• Probleme with the placenta, cervix, or uterus
• To smoke cigarettes or use illicit drugs
• There are some infections, especially of the lower genital tract and amniotic fluid.
• Some chronic conditions such as diabetes and high blood pressure can be caused by their long-term existence.
• Being underweight or overweight before pregnancy
• Stressful life events such as the loss of a loved-one or domestic violence
• Multiple miscarriages and/or abortions
• Trauma or physical injury

Black women are more likely than women of other races to have premature births. Premature birth can occur to anyone. Many women who give birth prematurely have no known risk factors.

Complications of Premature Birth

Although not all premature babies are affected by complications, it is possible to have short-term and long term health issues if you are born too soon. The likelihood of complications increases the earlier a baby is born. The birth weight is also important, and while some problems are obvious at birth, others may not appear until later.

Short-term complications of Premature Birth

The complications of premature birth can be severe in the first few weeks.

Trouble breathing.

Premature respiratory system. The baby may experience respiratory distress syndrome if his or her lungs lack surfactant, a substance that allows the lungs expand. Premature babies can also get bronchopulmonary dysplasia, a type of lung disease. Preterm babies can also experience prolonged breathing pauses, which is known as apnea and other breathing problems.

Heart problems

Premature babies are most likely to experience patent ductus arteriosus and hypotension. PDA A persistent opening between the aorta & pulmonary artery. Although this defect is usually self-limiting, it can cause a murmur or other complications. Low blood pressure can require changes in intravenous fluids and medicines, as well as blood transfusions.

Brain problems.

An intraventricular hemorhage is a bleeding condition that occurs when a baby’s brain is still developing. Most hemorhages are minor and heal quickly. Some babies might have more severe brain bleeding, which can lead to permanent brain injury.

Temperature control problems.

Premature babies can lose body heat rapidly, they do not have the same amount of body fat as a full-term infant and can lose heat quickly. Hypothermia can occur when the body temperature drops too low. A premature baby could experience hypothermia, which can cause breathing difficulties and low blood sugar. A premature infant might also use all the energy from their feedings to keep warm. To maintain their body temperature, smaller premature infants may need additional heat from an incubator or warmer.

Gastrointestinal problems.

Premature infants are more susceptible to developing immature gastrointestinal system, which can lead to complications like necrotizing enterocolitis. Premature babies can develop this potentially fatal condition when the cells that line the bowel walls are damaged. Breastfeeding is the best option for premature babies.

Blood problems.

Babies born prematurely are at high risk for blood problems like anemia or newborn jaundice. Anemia refers to a condition where the body doesn’t have enough red cells. All newborns experience a gradual drop in red blood cells count in the first few months of their lives, but the effect may be more severe in premature babies. A baby’s newborn jaundice is a yellowish discoloration of the skin and eyes. It occurs when the baby’s blood contains too much bilirubin. This yellow-colored substance comes from the liver or the red blood cells. Jaundice can be caused by many things, but it’s more common in preterm babies.

Metabolic problems.

Premature infants often have issues with their metabolism. Hypoglycemia is a condition in which a premature baby may have a low blood sugar level. Premature infants have smaller amounts of glucose stored than full-term babies. Premature infants also have a greater difficulty in converting their stored glucose to more-useful, active forms.

Infections that are not controlled by the immune system.

Premature babies can have a lower risk of infection. Sepsis is an infection that quickly spreads from the baby to the bloodstream.

Long-term complications of Premature Birth

Premature birth can lead to these complications in the long-term:

Cerebral Palsy.

This is a condition that affects movement, muscle tone, and posture. It can be caused either by injury, infection, or inadequate blood flow to the developing brain of a baby while it is still young or immature.

Learning difficulties.

Premature children are more likely than their full-term peers to fall behind in various developmental milestones. A child born too early might have learning disabilities when they reach school age.

Vision problems.

Premature babies may develop retinopathy. This is a condition in which blood vessels overgrow in light-sensitive nerves at the back (retina) of the eye. The abnormal retinal vessels can gradually damage the retina, pulling it out from its original position. It is a condition where the retina pulls away from the back of your eye. This condition can lead to retinal detachment.

Hearing loss.

Premature infants are more at risk. Before going home, all babies will have to have their hearing tested.

Dental problems.

Infants who are critically ill or have had their teeth removed may be at greater risk for developing dental problems such as tooth discoloration, delayed tooth eruption, and misaligned teeth.

Behavioral and psychological issues.

Premature births may lead to behavioral and psychological problems in children as well as developmental delays.

Chronic health problems.

Premature infants are more likely than full-term babies to develop chronic health issues. Feeding problems, such as asthma, infections and asthma attacks, are more common in premature infants. Premature infants are at higher risk for sudden infant death syndrome (SIDS).

How to Prevent Premature Birth

While the cause of preterm delivery is not always known, there are several things you can do to help pregnant women, especially those at higher risk, to lower their chances of having preterm babies.

• Progesterone supplements. Women with a history or short cervix, or both, may be able reduce their risk of preterm labor by taking progesterone supplementation.
• Cervical circumcision. This procedure is performed during pregnancy for women who have a short cervix or who have had a history cervical shortening.The cervix will be closed using strong sutures to provide additional support for the uterus. When it is time to give birth, the sutures are taken out. If you are unable to exercise vigorously during your pregnancy, ask your doctor.

Diagnosing Premature Birth

Your premature baby will be moved to the hospital. He or she might have to undergo several tests. Some tests are ongoing while others may only be done if necessary. If NICU Staff suspects that there is a problem. You may be able to perform the following tests on your baby if he is premature:

Continuous monitoring of your baby’s breathing and heart beat.

Regular blood pressure readings are also done.

Fluid input and fluid output

The NICU The team closely monitors how much fluid your baby receives from intravenous fluids or feedings, as well as how much fluid is lost through diapers that are soiled or wet.

Blood tests.

A heel stick or needle is used to collect blood samples. This allows you to monitor the levels of a variety of important substances such as calcium, glucose, and bilirubin in your baby’s body. An analysis of blood may be done to check for anemia, assess for infection, and measure red blood cell count. If your doctor predicts that multiple blood samples will be required, NICU Staff may place a central umbilical intravenous line (IV) to save you from having to insert a needle every time your baby needs blood.

Echocardiogram.

This is an ultrasound of your baby’s heart to determine if there are any problems. An electrocardiogram is similar to a fetal ultrasound. It uses sound waves and displays moving images on a monitor.

Ultrasound scan.

Usound scans can be used to examine the abdomen for any problems in the liver, kidneys or gastrointestinal tract.

Eye exam.

A doctor who specializes in eye care may examine your baby’s vision and eyes to determine if there are any retina problems (retinopathy or prematurity). Other specialized testing may also be required if your baby has any complications.

Treatment of Premature Birth

Your premature baby will be cared for round-the-clock by the neonatal intensive medical unit (NICU), or special care nursery.

Supportive care for Premature babies

You may be eligible for special supportive care for your baby, such as:

Incubated in an incubator

The baby will likely stay in an enclosed, plastic bassinet (incubator), which is kept warm to maintain normal body temperature. Later, NICU Staff may demonstrate a specific way to hold your baby, known as “kangaroo care” — direct skin-to–skin contact.

Monitoring your baby’s vitals.

Sensors can be attached to your baby’s body for monitoring blood pressure, heart beat, and temperature. To help your baby breathe, a ventilator might be necessary.

A feeding tube.

Your baby may initially receive fluids or nutrients via an intravenous tube (IV). Your baby may later receive breast milk through a tube that passes through his or her nose and into the stomach (nasogastric tube, or NG tube). Breast-feeding and bottle-feeding are possible if your baby is strong enough.

Fluids to replenish.

Your baby will need fluids every day depending on his or her age, medical condition and other factors. These are the NICU Your baby’s fluid levels will be closely monitored by the team. Fluids will be delivered to your baby through an authorized channel. IV line. Your baby might be put under a set bilirubin light for a time to treat jaundice. Your baby’s body will use the lights to help reduce excess bilirubin. The liver cannot process all of it. To help your baby rest better, he/she will wear a protective mask while under the bilirubin light.

Getting a blood transfusion.

This is especially true if you have had multiple blood samples taken for different tests.

Medications

Your baby may receive medication to help with maturing and normal heart, lungs and circulation. The medication you give your baby may vary depending on his condition.

• Surfactant is a medication that treats respiratory distress syndrome.
• Fine-mist (aerosolized) or IV Medication to increase heart rate and breathing.
• Doctors can prescribe antibiotics if they suspect an infection or the risk of infection.
• To manage excess fluid, diuretics (medicines that increase urine output) are used.
• Injection of medication to the eye to stop new blood vessels from growing that could lead to retinopathy of pregnancy
• Patent ductus arteriosus is a medicine that closes the heart defect.

Surgery

Sometimes, surgery may be necessary to address a variety of prematurity-related conditions. Talk to your baby’s healthcare team to learn more about which conditions may need surgery and what type of surgery might be required.

Take your baby home

Your baby is ready for you to take him or her home when you are ready.

• You can breathe on your own without any support
• Maintain stable body temperature
• Can you breastfeed or bottle-feed?
• Is gaining weight steadily
• It is free from infection

Sometimes, doctors can allow the child to return home without meeting any of these requirements. However, it is important that the family and medical team agree on a plan for monitoring and home care. The baby’s health team can help you care for your baby at-home. Your baby’s nurse, or hospital discharge planner, may ask about the following:

• Living arrangements
• Children from other households
• Adult friends and relatives who can help you care for your baby
• Primary pediatric care

Lifestyle and home remedies

You might feel excited, relieved, or anxious when it is time to bring your baby home. You can prepare for your baby’s life at home after leaving the hospital.

Learn how to take care of your baby.

Take a course on infant CPR before you leave the hospital. Ask your baby’s doctor any questions and make sure to take down notes. You should ensure that you are comfortable with caring for your baby. This is especially true if you will need to administer medication, monitor your baby’s vitals or provide supplemental oxygen. Talk to your baby’s caregiver about any symptoms, such as problems with infant feeding or breathing.

Talk about feedings.

Get advice from the medical team on your baby’s needs for formula or breast milk fortifiers. Remember that preterm babies eat less and need to be fed more frequently than full-term babies. Learn how often and how much your baby should eat.

Take care of your baby’s health.

Babies born prematurely are more likely to get serious infections than other newborns. Avoid exposing your baby to crowds and ensure that everyone who comes in contact with your baby is clean. Ask those who are sick to delay their visit until they feel better. Premature babies are at greater risk for serious infections of the lungs and respiratory tract (respiratory syndrome virus or RSV). Your baby’s doctor may recommend palivizumab (Synagis) as a preventive medicine to protect them from this serious infection. Use a recommended schedule to check your baby. Discuss with your baby’s doctor and any specialists your baby may need future appointments. Preterm babies may need to visit their care provider once a week to monitor their growth and medical needs.

Keep up with vaccinations.

Although specialists recommend that medically stable premature babies be immunized according to their chronological age and health, delays in immunizations are not uncommon. Keep your baby’s immunizations up-to-date by working with your baby’s caregiver. You can protect your preterm infants by making sure that all family members are up-to-date on their influenza immunizations. Family members, pregnant women and adult caregivers need to check with their doctor to make sure they are up-to-date on their pertussis (whooping cough) vaccine.

Monitor your baby for developmental delays.

Your care provider may also be able to monitor your baby for any developmental delays or disabilities over the next few months. Babies at high risk of developing developmental delays or disabilities may be referred for early intervention services and further evaluation. These programs are not available to all babies.

Coping and Support

Premature babies can be emotionally and physically exhausting, so it is possible to worry about your baby’s long-term health. You might also feel guilty, angry, or overwhelmed. These suggestions might help you during difficult times.

• Get as much information as you can about your baby’s health. Ask your doctor for recommendations on books and websites that are reliable and good for your baby’s care.
• Take care yourself. Eat healthy food and get enough sleep. You will feel more capable and stronger to take care of your baby.
• Start milk production. Breastfeed your baby until they are able to do so. Ask for assistance from the staff at the hospital. They can help you use the breast pump and provide the necessary supplies to store your milk.
• Ask for help. Let family and friends help you, they can help you care for your children, cook food, or run errands. And doing this allows you to save energy for your baby.
• Keep an account of your baby’s progress. Also record your thoughts and feelings. It may be helpful to include photos of your baby to show how he or she has changed from week to week.
• Find good listeners to support you. Talk to your spouse or partner, your friends, your family, and your baby’s caregivers. Also a social worker can often be extremely helpful. Ask your baby’s caregiver about any local support group if you think it may help you. Because talking to other parents caring for preterm infants is a common practice and it helps alot.

It is an immense task to care for a baby so take each day as it comes and be positive despite the setbacks and worries. Enjoy the bonding time with your preemie.

Prepare for your appointment

You will interact with many caregivers for your baby as a parent of a premature baby admitted to the neonatal intensive car unit (NICU), and this includes:

• Neonatal nurse — Registered nurse with special training in the care of high-risk and premature newborns
• Neonatal nurse practitioner Experienced neonatal nurse trained to support neonatologists caring for newborns
• Pediatrician — This doctor specializes in the treatment of children from birth to adolescence.
• Neonatalologist — A pediatrician specializing in the diagnosis and treatment for newborn health issues
• A pediatric resident — An individual who has received specialized training to treat children
• Respiratory Therapist — A respiratory practitioner who evaluates newborns for respiratory problems and manages their equipment
• Pediatric surgeon A surgeon who is trained in the care of children and newborns.
• Child social worker This professional can help you find various services that may be helpful during and after  admitting your baby to hospital.

You are also an integral part of the care team of your baby by these professionals. You should work with your baby’s caregivers to eventually learn how to care for, hold and feed your baby.

What you can do if you have a premature baby?

Uncertainty can make it scary and so can monitoring equipment. Ask the doctors questions about the condition of your baby. And to help you out, note down these questions you might need to ask:

Important questions:

• What is the condition of my baby? Is there anything new?
• What equipment can I use to help my baby?
• Why is my baby taking medication?
• What tests do my baby require?
• Can I hold my baby when? Do you want to show me?
• For how long my baby need to continue tube feedings for?
• What is the best time to bottle-feed or breast-feed my baby?
• At what age will my baby learn to focus his/her eyes?
• If I have any questions regarding my baby’s care, who should I contact?
• To personalize the incubator for my baby, can I bring in a blanket?
• What can I do for my baby?
• When can my baby come home?
• What should I know about caring after my baby is home?
• How many visits to the doctor can you make after the discharge of your baby?

Don’t Panic

Your baby will be in the nursery, during his/her time there don’t be afraid to ask questions about how you can get more involved with your baby’s care. As a new parent, getting involved with your baby will give you more confidence and make it easier to transition home.