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Premature Birth

Babies born before the 37th week of gestation are born prematurely. Premature newborns are sometimes given the nickname “preemies”. Mothers who have their baby prematurely are often scared and nervous. It is true that premature newborns face an increased chance of having one or more complications. The risk of complications increases the earlier the baby is born. Any complication that a premature newborn experiences will be treated in the neonatal intensive care unit (NICU). Below is a list of the most common complications that a premature newborn may face.

Immature Lungs – Most babies have mature lungs by 36 weeks of gestation. However, this may not be true for all babies since every baby develops at a different rate. If a mother and her health care provider know that she may be delivering early, amniocentesis may be performed to check the maturity level of the lungs. In some cases, an injection of steroids can be given to the baby before delivery occurs. This can help speed up the development of the lungs. The biggest concern when it comes to premature labor is the development of the newborn’s lungs. Here are a few complications that can occur with immature lungs:

Respiratory Distress Syndrome (RDS) causes harsh, irregular breathing and difficulties due to the lack of a certain agent in the lungs called surfactant, which helps prevent the lungs from collapsing. Treatment involves one or more of the following: supplemental oxygen (through an oxygen hood), use of a respirator (ventilator), continuous positive airway pressure, endotracheal intubation and in severe cases, doses of surfactant.
Transient tachypnea is rapid shallow breathing. This can occur in both premature babies and full term babies. Recovery usually occurs within 3 days. Until the newborn has recovered, feedings may be altered and in some cases intravenous feedings may be done. There is usually no other treatment necessary.
Bronchopulmonary Dysplasia (BPD) occurs when a baby’s lungs have shown evidence of deterioration. Unfortunately, when preemies are put on a ventilator (also known as respirators) their lungs are still immature and sometimes can not withstand the constant pressure of the respirator. Preemies that have been on a respirator for more than twenty-eight days are at risk for developing BPD. Preemies do recover from this but it may take some longer than others.

Pneumonia – Due to all of the complications with premature-related respiratory problems, pneumonia can occur. Pneumonia is an infection in the area of the lung involved in the exchange of carbon dioxide and oxygen and causes inflammation which reduces the amount of space available for the exchange of air. This results in inadequate amounts of oxygen to the body. Treatment involves antibiotics as well as supplemental oxygen and intubation. If this is left untreated, it can evolve into a deadly infection or lead to sepsis or meningitis.

Apnea and Bradycardia – Apnea is the absence of breathing. In the NICU an alarm will sound if your newborn has an irregular breathing pattern which consists of intervals of pauses longer than 10-15 seconds. Bradycardia is the reduction of heart rate. An alarm will also sound if your newborn’s heart rate falls below 100 beats per minute. Usually a little tap or simple rub on the back helps remind the preemie to breath or brings the heart rate up.

Infection – A premature baby may not be ready to fight off certain infections and for his own protection he is placed in an incubator to provide protection against potential infections.

Jaundice – A yellowish skin color caused by the buildup of substances in the blood called bilirubin. Treatment involves being placed under a bilirubin light called phototherapy. This may last approximately one week to 10 days.

Intraventricular hemorrhage (IVH) – Babies born at less than 34 weeks have an increased risk of bleeding in their brain. This happens because immature blood vessels may not tolerate the changes in circulation that take place during labor. This can lead to future complications such as cerebral palsy, mental retardation and learning difficulties. Intracranial hemorrhage occurs in about 1/3 of babies born at 24-26 weeks gestation. If preterm labor is identified and is inevitable, there are medications that can be given to the mother to help lessen the chance of severe intracranial hemorrhage in the newborn.

Inability to maintain body heat – A premature baby is born with little body fat and immature skin which does not allow him or her to maintain body heat. Treatment involves warmers or incubators to help them keep warm.

Immature gastrointestinal and digestive system – Premature newborns are born with gastrointestinal systems that are too immature to absorb nutrients safely. Therefore they receive their initial nutrients through intravenous (IV) feeding which is called total parenteral nutrition (TPN). After a few days, newborns may be fed through a tube with breast milk or formula because the newborn may still not be mature enough to swallow or suck on their own.

Anemia – This is a medical condition caused by abnormally low concentrations of red blood cells. Red blood cells are important because they carry a substance called hemoglobin, which carries oxygen. Most newborns should have levels higher than 15 grams. However, preemies are at a high risk of having low levels and are at risk for anemia. If the anemia is severe, treatment involves transfusion of red blood cells to the newborn.

Patent Ductus Arteriosus (PDA) – This is a cardiac disorder that causes breathing difficulties after delivery due to an open blood vessel, called the ductus arteriosus. During fetal development the ductus arteriosis is open to allow blood to be diverted from the lungs into the aorta since the baby does not breathe until after delivery. A fetus makes a chemical compound called prostaglandin E which circulates his or her blood keeping the ductus arteriosus open. At a full term birth, levels of prostaglandin E fall and cause the ductus arteriosus to close, allowing a baby’s lungs to receive the blood they need to function properly once they have entered the world. With preterm labor, the prostaglandin E may stay at the same level causing an open ductus arteriosus. Treatment involves a medication that stops or slows the production of prostaglandin E.

Retinopathy of Prematurity (ROP) – This is a potentially blinding eye disorder. It affects most preemies between 24-26 weeks gestation and rarely does it affect preemies beyond 33-34 weeks gestation. There are many different stages and treatment depends on severity and may include laser surgery or cryosurgery.

Necrotizing Enterocolitis (NEC) – This condition occurs when a portion of the newborn’s intestine develops poor blood flow that can lead to infection in the bowel wall. Treatment includes intravenous feeding and antibiotics. Only in severe cases is an operation necessary.

Sepsis – This is a medical condition in which bacteria enters the blood stream. Sepsis often brings infection to the lungs and therefore can lead to pneumonia. Treatment involves antibiotics.