|A normal pregnancy lasts nine months, or about 38 to 42 weeks. Newborns are considered to be premature if they are born before they are 37 weeks old. Although there are many risk factors that can help to predict which pregnancies are at risk for premature delivery, in most cases, no cause is found.
Among the risk factors that may increase your chances of having a premature baby include:
- Having delivered a previous premature baby, which puts you at a 20-40% of having another premature baby.
- Multiple gestation pregnancies, such as twins, triplets, etc. The risk increases with each additional fetus.
- Placental abruptions and placenta previa are two causes of bleeding that can lead to a premature delivery.
- Having too much (polyhydramnios) or too little (oligohydramnios) amniotic fluid.
- Infections during pregnancy, especially if they spread to the uterus or placenta.
- High blood pressure.
- Preeclampsia, which causes maternal high blood pressure, proteinuria (spilling protein in your urine), and swelling.
- Maternal smoking or use of illicit drugs.
- Maternal malnutrition, especially if it leads to poor weight gain during pregnancy.
- Fibroids, an abnormally shaped uterus and cervical incompetence.
- Becoming pregnant while being treated for infertility, having a previous abortion in the 2nd trimester, and not having prenatal care.
- Problems with the fetus can also lead to a premature delivery, including infections, poor growth and certain birth defects.
If you think you have risk factors for having a premature baby, be sure to discuss them with your obstetrician. You may have to be seen by a perinatologist, who is a doctor that specializes in high risk pregnancies.
If you believe that you are having preterm labor, then you should call your doctor. Among the symptoms of preterm labor include frequent uterine contractions, pain, and increased vaginal discharge, especially if bloody (it may be your mucus plug) or a lot of clear fluid (which can be your water breaking).
If you are in preterm labor, then you will likely be seen in the hospital, where you will be likely started on bed rest and given fluids as an evaluation is done to check on the status of the baby and mother. In some situations labor can be stopped with bed rest and intravenous fluids. In other cases, medications, usually magnesium sulfate or terbutaline may be used. Other treatments may include a cerclage for a weak or incompetent cervix, antibiotics for infections, and fluids for dehydration. It may not be possible to stop your premature labor however.
|It may not be possible to stop your premature labor.
Sometimes your doctor will decide that your baby needs to be delivered prematurely, especially if he has poor growth or if he is in distress. If your baby is less than 34 weeks, then, if possible, you may receive steroids to help his lungs develop more quickly before he is delivered.
Your Premature Baby
If your baby is going to be born prematurely, then you may try and talk with your Pediatrician and/or a neonatologist before the delivery if there is time. If possible, either your Pediatrician or a neonatologist will attend the delivery to take care of the early resuscitation of your new baby. Once stabilized, depending on your baby's gestational age and his medical condition, he will likely be transferred to a Neonatal Intensive Care Unit (NICU). This is usually a simple matter if you are in a larger hospital that has its own NICU, but it may involve transfer to another hospital that has a NICU and services to care for your premature baby.
How early is too early? In general, babies born after 24 to 25 weeks of gestation are mature enough to survive, although they will need a prolonged period of intensive care. Babies born at less than 23 weeks of gestation are usually not mature enough to survive. However, in addition to age, other factors play a role (usually because babies with these characteristics are more mature) and increase the chances that a premature baby will do well, including being female and African American. A premature babies size also can influence how well he will do, with larger babies doing better than smaller babies.
|In general, babies born after 24 to 25 weeks of gestation are mature enough to survive, although they will need a prolonged period of intensive care.
Once your premature baby is born, your neonatologist will help to prepare you for what will come next. It is outside the scope of this article to discuss statistics on survival and outcomes for premature babies. All preemies are individuals, and in addition to his gestational age and size, many other factors are involved in how well he will do, especially how mature his organs are and whether he has other medical problems, such as infections, birth defects, etc. For even the smallest preemies, it is important to keep in mind that almost two thirds of those that survive will either be normal or have only mild or moderate medical problems.
The more mature your baby is at birth, the more likely that it is that he will not have any problems, so that babies born at 26-29 weeks have a much better chance of surviving and growing up either normal or with mild or moderate problems. Babies born at 30-33 weeks usually do even better, and have a very high rate of survival. After 34 weeks, babies are usually only mildly immature and usually do very well.
Except for older infants over 30-33 weeks, many premature babies need to be on a ventilator to help them breath normally. In addition, one of the problems that your premature baby may have on his first few days of life is Respiratory Distress Syndrome (RDS) because of his immature lungs. Babies with RDS are usually on a ventilator and will probably also receive a medication called surfactant to help their lungs.
|Except for older infants over 30-33 weeks, many premature babies need to be on a ventilator to help them breath normally.
In addition to being on a ventilator and/or receiving oxygen, it is likely that your premature baby will also be on antibiotics, because infections are a common reason for premature births. Also, since he likely won't be able to eat for awhile, he will be on intravenous fluids, either through an IV or umbilical central line. Other equipment that you may notice include a special bed with a radiant warmer to help him maintain his body temperature and which may include a cellophane wrapping to minimize the loss of heat and fluids through their thin skin. He will probably also be on a cardiorespiratory monitor with a pulse oximeter to measure the oxygen in his blood, and he may have a feeding tube if he is old enough to eat.
Other problems that your premature baby may have and which are more common in premature babies under 30-33 weeks and uncommon after 34 weeks of gestation are:
- persistent ductus arteriosus (PDA), which is a blood vessel near the heart that normally closes after birth, but which can stay open, especially in premature babies. Many times, a PDA needs to be closed, either with medications or if that doesn't work, then with surgery.
- intraventricular hemorrhage (IVH), which is bleeding in the brain and which can be discovered during routine head ultrasounds. Most bleeding occurs in the first few days of life, and except for larger bleeds (grades 3 or 4), many do not cause any long term problems.
- periventricular leukomalacia (PVL), which is a sign brain damage.
- infections, because they also have immature immune systems
- necrotizing enterocolitis (NEC), which is an inflammation of the intestines that usually doesn't occur until after feedings have been begun. Treatments, depending on how severe it is, can include antibiotics, intravenous nutrition and sometimes surgery.
- retinopathy of prematurity (ROP), which are abnormal blood vessels in the eyes of premature babies and which will be followed by an ophthalmologist.
- apnea and bradycardia (A & Bs) or apnea of prematurity, which occurs when their immature respiratory and nervous system cause them to stop breathing for short periods of time and for their heart rate to drop. This may be treated with stimulation, medications, CPAP, oxygen and/or by being on a ventilator, depending on how often and how long the periods of apnea are.
- anemia or low blood counts, which sometimes require blood transfusions.
- bronchopulmonary dysplasia (BPD) or chronic lung disease (CLD) is diagnosed in babies who still need oxygen after they are four weeks old and/or at 36 weeks gestation. They may need long term treatment with oxygen and medications, including diuretics, bronchodilators and/or steroids and will probably need more calories than infants without BPD.
- premature babies are also at increased risk for inguinal hernias and hydroceles.
When can he start eating? It depends on his gestational age and medical condition. Once feeds are begun, unless he is over 32-34 weeks, then he probably won't be able to nurse of drink from a bottle. Instead, he will likely be fed by gavage feedings, with a tube in his mouth or nose that goes down to his stomach. Even though many premature babies can't nurse at the breast, that doesn't mean you can't breastfeed. You can pump and have the NICU store your expressed breastmilk for when your baby is ready to eat.
When can he go home from the hospital? This also depends on your babies gestational age and overall medical condition. In general, most infants aren't ready to be discharged until some time around your original due date. So for a baby born at 26 weeks, that can mean three months in the hospital. In general, your baby will need to be gaining weight, breathing well on his own (although he may need oxygen), and eating to be able to leave the NICU. Among the doctors that may continue to see your child after he is discharged from the NICU include your Pediatrician, an ophthalmologist, and possible a pulmonologist and/or a developmental pediatrician.
|Most infants aren't ready to be discharged until some time around your original due date and once he is eating and gaining weight, and breathing well on his own (although he may need oxygen).
What problems will he have? In addition to having the problems described above, premature babies, especially those under 30-32 weeks are at risk for having mild to moderate medical problems, including bronchopulmonary dysplasia (BPD), learning disabilities, problems with their hearing and vision, and/or mild cerebral palsy. Some will have more serious medical conditions, including blindness, deafness, severe cerebral palsy, and mental retardation. Keep in mind though, that many premature babies grow up without any problems at all.
Preemie Internet Resources:
- Preemies.Org: "was established to help parents of premature infants find other parents using various Internet resources such as the PreemiesChat room. It's very comforting to find so many parents and professionals on the Internet who know how difficult it is to have a baby in the NICU."
- American Association for Premature Infants: "an organization dedicated to improving the quality of health, developmental and educational services for premature infants, children and their families."
- Premature Baby - Premature Child: "a volunteer website from our family for your family. Our goal is to benefit children by providing parents with information they need to care for their preemies."