Premature birth

Alternative Names

Preterm infant, Preemie, Premie

What is Premature birth

Premature birth is a birth that happens after less than 37 weeks of pregnancy. Premature birth does not allow the baby to develop properly. Premature babies, especially those born earliest, often have complicated medical problems.

There are 3 stages of premature birth:

• late preterm, born between 34 and 37 weeks of pregnancy
• very preterm, born at less than 32 weeks of pregnancy
• extremely preterm, born at less than 25 weeks of pregnancy

Signs and symptoms

The signs of premature infant include:

• small size, with a disproportionately large head
• sharper-looking, less rounded features than a full-term baby's features
• thin, transparent, fragile-looking skin
• fine hair (lanugo) covering much of the body
• low body temperature, especially immediately after birth in the delivery room
• labored breathing or respiratory distress
• lack of reflexes for sucking and swallowing, leading to feeding difficulties

Possible complications

Premature birth may lead to some complications in premature infant:

• immature Lungs
• pneumonia
• apnea and bradycardia
• infection
• jaundice
• intraventricular hemorrhage (IVH)
• inability to maintain body heat
• immature gastrointestinal and digestive system
• anemia
• patent ductus arteriosus (PDA)
• retinopathy of prematurity (ROP)
• necrotizing enterocolitis (NEC)
• sepsis

What causes

In most cases the cause is unknown. Multiple pregnancy (twins, triplets, etc.) makes up about 15% of all premature births.

The following health conditions and events in the mother may contribute to premature birth:

• diabetes
• heart disease
• infection (such as a urinary tract infection or infection of the amniotic membrane)
• kidney disease

Different pregnancy-related may also cause this condition:

• an "insufficient" or weakened cervix, also called cervical incompetence
• birth defects of the uterus
• history of preterm delivery
• poor nutrition right before or during pregnancy
• preeclampsia -- the development of high blood pressure and protein in the urine after the 20th week of pregnancy
• premature rupture of the membranes (placenta previa)

Other factors that may cause premature birth include:

• african-American ethnicity (not related to socioeconomic status)
• age (younger than 16 or older than 35)
• lack of prenatal care
• low socioeconomic status
• use of tobacco, cocaine or amphetamines

Prevention

The main measure of prevention prematurity is receiving prenatal care as early as possible in the pregnancy and to continue such care until the baby is born. Statistics clearly show that early and good prenatal care declines the chance of premature birth.

Treatment

At the hospital, the neonatal intensive care unit (NICU) provides care for your premature baby.

Specialized supportive care for your baby may include:

• being placed in an incubator
• monitoring of your baby's vital signs
• having a feeding tube
• replenishing fluids
• spending time under bilirubin lights
• receiving a bood transfusion

Medications that may be given to your baby to promote maturing and to stimulate normal functioning of the lungs, heart and circulation may include:

• a liquid (surfactant), squirted into the lungs to help them mature
• fine-mist (aerosolized) or IV medication to strengthen breathing and heart rate
• antibiotics if infection is present or if there's a risk of possible infection
• medicines that increase urine output (duretics) to help the lungs and, sometimes, the circulation

In some cases it is necessary to use surgery:

• a feeding problem, by placing a central line to deliver IV nutrition
• necrotizing enterocolitis, by removing the damaged part of the intestines
• patent ductus arteriosus, when medications fail to work, by closing a blood vessel near the heart
• retinopathy of prematurity, by using a laser to reverse abnormal blood vessel development and limit further risks to vision
• worsening hydrocephalus, by placing a plastic tube, called a shunt, to drain excess fluid in the brain