Premature babies often known as preemies, are babies born earlier than the full term infants. Pre-maturity occurs when a pregnancy lasts fewer than 37 weeks, while full term infants are born at 40-42 weeks after conception. Age in premature babies is often based on the number of weeks after the baby is conceived, up until the baby is 40 weeks old, which is the average age of a full term baby.
There are many causes of pre-term delivery. This includes but not limited to the, the mothers life style choices during pregnancy, smoking, drinking alcohol, using drugs, poor eating habits, physical stress, poor prenatal care, Sometimes, the causes could be extraneous and totally not within the control of the mother. The mother could have a hormonal imbalance, a structural abnormality of the uterus, a chronic illness, an infection or several other possible causes that are unknown. Age of the Mother is also a factor as there may be complications with pregnancies before 19 years of age or over 35 years.
Premature babies have a lot of special needs that make their care very different from those babies born at full term. It is for these reasons, that premature babies born in developed countries start their lives after delivery in the neonatal intensive Care unit (NICU). The NICU is designed to provide an atmosphere that simulates the womb by providing the basic needs of warm, nutrition, and monitoring of proper growth and development. With continuing technological advancement, a greater proportion of premature babies born with low birth weight survive.
Basic Needs of Premature Babies.
Warmth
Premature babies lack the bodily fat necessary to maintain their body temperature, even when swaddled with blankets. This is the reason for using incubators.
Incubators are made of transparent plastic covers that are electronically controlled to generate warmth, decrease the chance of infection and limit loss of bodily fluid.
Nutrition
Premature babies have special nutritional needs because they grow at a faster rate than full term babies and yet their digestive systems are not fully developed. Premature babies are usually born with low weight between 500 to 2500 grams. The major challenge here is to bring the weight to a tolerable level of up to 5lbs at the time the baby is leaving NICU. Breast milk remains an excellent source of nutrition, but premature babies are too immature to feed directly from the breast or bottle until they are 42 to 34 post-conceptional weeks old. Premature babies therefore need to be fed slowly and gradually with increasing quantities of breast milk that are at different times fortified to provide adequate nutrition. Breast milk is usually pumped by the mother and fed to the baby through a tube that is passed through the baby’s mouth or nose into the stomach. Breast milk is preferred (where the mother is able to provide) to formula because it contains proteins that help fight infection and promote growth. Premature babies also receive supplemental doses of vitamins because they have higher needs for vitamins than full term babies. Regular blood tests are also conducted to monitor blood glucose levels, salt, potassium, calcium, and other blood chemicals and minerals to ensure that they are all within the normal range
Common Health Problems of Preemies
Premature infants are prone to a number of problems, mostly because their internal organs are not fully developed and matured to function on their own. Studies have shown that the more premature the infant, the higher the risk of complications.
Hyperbilirubinemia
A common treatable condition of premature babies is hyperbilirubinemia. Infants with hyperbilirubinemia have high levels of bilirubin, a compound that results from the natural breakdown of blood. This high level of bilirubin causes them to develop jaundice, a yellow discoloration of the skin and whites of the eyes. Although mild jaundice is fairly common in full-term babies, it's much more common in premature babies. Extremely high levels of bilirubin can cause brain damage. Premature infants are monitored for jaundice and treated quickly, before bilirubin reaches dangerous levels. Jaundiced infants are placed under lights that help the body eliminate bilirubin. Rarely, blood transfusions are used to treat severe jaundice.
Apnea
Apnea is another common health problem in premature babies. During an apnea spell, a baby stops breathing, the heart rate may decrease, and the skin may turn pale, purplish, or blue. Apnea is usually caused by immaturity in the area of the brain that controls the drive to breathe. Almost all babies born at 30 weeks or less will experience apnea. Apnea spells become less frequent with age.
In the NICU, all premature babies are monitored for apnea spells. Treating apnea can be as simple as gently stimulating the infant to restart breathing. However, when apnea occurs frequently, the infant may require medication (most commonly caffeine or theophylline) and/or a special nasal device that blows a steady stream of air into the airways to keep them open.
Anemia
Many premature infants lack the number of red blood cells necessary to carry adequate oxygen to the body. This complication, called anemia, is easily diagnosed using laboratory tests. These tests can determine the severity of the anemia and the number of new red blood cells being produced.
Premature infants may develop anemia for a number of reasons. In the first few weeks of life, infants don't make many new red blood cells. Also, an infant's red blood cells have a shorter life than an adult's. And the frequent blood samples that must be taken for laboratory testing make it difficult for red blood cells to replenish. Some premature infants, especially those who weigh less than 1,000 grams, may require red blood cell transfusions.
Low Blood Pressure
Low blood pressure is a relatively common complication that may occur shortly after birth. It can be due to infection, blood loss, fluid loss, or medications given to the mother before delivery. Increasing fluid intake or prescribing medication treats low blood pressure. Infants who have low blood pressure due to blood loss may need a blood transfusion.
Respiratory Distress Syndrome
One of the most common and immediate problems facing premature infants is difficulty breathing. Although there are many causes of breathing difficulties in premature infants, the most common is called respiratory distress syndrome (RDS). In RDS, the infant's immature lungs don't produce enough of an important substance called surfactant. Surfactant allows the inner surface of the lungs to expand properly when the infant makes the change from the womb to breathing air after birth. Fortunately, RDS is treatable and many infants do quite well. When premature delivery can't be stopped, most pregnant women can be given medication just before delivery to help prevent RDS. Then, immediately after birth and several times later, artificial surfactant can be given to the infant. Although most premature babies who lack surfactant will require a breathing machine, or ventilator, for a while, the use of artificial surfactant has greatly decreased the amount of time that infants spend on the ventilator.
Bronchopulmonary Dysplasia
Bronchopulmonary dysplasia (BPD) is a lung reaction to oxygen or a ventilator needed to treat a preemie with a lung infection, severe RDS, or extreme prematurity. Preemies are often treated with medication and oxygen for this condition.
Infection
Infection is a big threat to premature infants because they're less able than full-term infants to fight germs that can cause serious illness. Infections can come from the mother before birth, during the process of birth, or after birth. Practically any body part can become infected. Reducing the risk of infection is why frequent hand washing is necessary in the NICU. Bacterial infections can be treated with antibiotics. Other medications are prescribed to treat viral and fungal infections.
Patent Ductus Arteriosus
The ductus arteriosus is a short blood vessel that connects the main blood vessel supplying the lungs to the aorta, the main blood vessel that leaves the heart. Its function in the unborn baby is to allow blood to bypass the lungs, because oxygen for the blood comes from the mother and not from breathing air. In full-term babies, the ductus arteriosus closes shortly after birth, but it frequently stays open in premature babies. When this happens, excess blood flows into the lungs and can cause breathing difficulties and sometimes heart failure. Patent ductus arteriosus (PDA) is often treated with a medication called indomethacin, which is successful in closing the ductus arteriosus in more than 80% of infants requiring this medication. However, if indomethacin therapy fails, then surgery may be required to close the ductus.
Retinopathy of Prematurity
The eyes of premature infants are especially vulnerable to injury after birth. A serious complication is called retinopathy of prematurity (ROP), which is abnormal growth of the blood vessels in an infant's eye. About 7% of babies weighing 1,250 grams or less at birth develop ROP, and the resulting damage may range from mild (the need for glasses) to severe (blindness). The cause of ROP in premature infants is unknown. Although it was previously thought that too much oxygen was the primary problem, further research has shown that oxygen levels (either too low or too high) play only a contributing factor in the development of ROP. Premature babies receive eye exams in the NICU to check for ROP.
After the NICU
Premature infants often require special care after leaving the NICU, sometimes in a high-risk newborn clinic or early intervention program. In addition to the regular well-child visits and immunizations that all infants receive, premature infants receive periodic hearing and eye examinations.
Careful attention is paid to the development of the nervous system, including the achievement of motor skills like smiling, sitting, and walking, as well as the positioning and tone of the muscles.
Speech and behavioral development are also important areas during follow-up. Some premature infants may require speech therapy or physical therapy as they grow up. Infants who have experienced complications in the NICU may need additional care by medical specialists.
Also important is support of the family. Caring for a premature infant is even more demanding than caring for a full-term infant, and the high-risk clinics pay special attention to the needs of the family as a whole.
Updated and reviewed by: Joel Stenzel, MD
Date reviewed: July 2004
Originally reviewed by: Michael Spear, MD
Studies
Extreme preemies likely to face disabilities: study
CBC News
BOSTON - Despite medical advances, premature babies are still more likely to die or face significant learning and physical disabilities by the time they reach school age, a new study has found. more...
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