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Premature babies

premature; prematurity; early; born; prematurely; preterm; immature; lungs; respiratory; distress; syndrome; Bronchopulmonary; dysplasia; infection; bleed; bleeding;

Not all pregnancies go as planned. Some babies are born too early – prematurely or preterm. A preterm baby is one born before 37 completed weeks of pregnancy.

Contents

About 8.5% of babies are born prematurely, mostly between 32 and 37 weeks. About 1.5% of babies are less than 1.5 kg at birth. Survival may be possible by 23-24 weeks of pregnancy but being born this early is very risky.

It is not always clear why a baby is born early, but it is a little more common if you:

  • Have had a preterm birth before
  • Have high blood pressure that has developed during pregnancy
  • Have diabetes
  • Have a multiple pregnancy (twins or more)
  • Have had poor dental care
  • Have had infections such as a urinary infection
  • Have smoked or used drugs or alcohol during the pregnancy

The outcome for a premature baby depends largely on how early he or she is born. The shorter the pregnancy, the more immature the baby's organs and tissues are at birth and the more specialised the medical or nursing care he or she will need.

Almost all babies born more than eight weeks early (before 32 weeks of pregnancy) need highly specialised care in a Neonatal (Newborn) Intensive Care Unit until they have developed enough to breathe and feed without special medical and nursing help.

Babies born between 32 and 37 weeks may only need care within a special care nursery. They may not in the beginning be able to suck well and they may need some breathing help.

The overall outcomes for premature babies are good. However there are risks to being born early.

Some of the information in this topic comes from a booklet called 'Birth before 32 weeks - Premature outcomes booklet' developed by the NSW Pregnancy and Newborn Services Network.

There is also a lot of information on the Raising Children Network Website 'Premature babies'.

For very premature babies (babies born before 34 weeks) it is best for the baby to be born at a hospital where there is a unit that provides special care for premature babies. You may need to be transferred to a different one than you planned to give birth at. If the baby is born at a hospital that does not have this special care your baby will need to be transferred to another hospital by an emergency transport service. You will probably be able to be transferred to that hospital yourself so that you can be with your baby.

There is more about Neonatal Intensive Care in the section about Premature babies on the Raising Children Network

Before the birth

Very premature birth is usually due to complications of pregnancy such as premature labour, rupture of membranes, bleeding, high maternal blood pressure or growth problems of the baby.

There is more about this in the topic 'Premature (pre-term) labour'.

Some medications can help stop contractions and labour for a short time. This may delay labour long enough to allow treatment to help prepare your baby for birth or, if needed, for you to be transferred to another hospital.

Drugs called corticosteroids can help a premature baby's immature lungs to function better and can also help protect against bleeding into the brain. They are given to the mother before the baby's birth by injection. Two doses 24 hours apart are given.

Will the baby survive?

Each extra week of time spent in the mother's womb increases the likelihood of survival. By 27 weeks most very premature babies who receive care in a neonatal intensive care will survive (over 90%), but fewer babies born before this time will survive.

There are information sheets accompanying the 'Birth before 32 weeks booklet' about birth at different weeks.

The body systems of a very premature baby are not fully ready for life outside the womb. There are three main problems that can threaten a baby's survival:

Immature lungs

Most babies born before 30 weeks, and many born before 32 weeks will need some help with breathing. Before birth, if there is time, the mother can be given corticosteroids which can help the baby's lungs mature so that breathing is easier. After birth the baby can be given a substance called surfactant which is missing from a premature baby's lungs.

The baby may also need ventilation (where a machine does the work of breathing) or CPAP (Continuous Positive Airway Pressure) where the baby does the work of breathing with some extra air pressure to keep the baby's lungs open.

However even with these treatments some babies will not survive because there is not enough oxygen getting into the baby's blood stream. 

There is more about this problem (called respiratory distress syndrome) on this website

Most babies are breathing air normally by the time they go home, but some will need extra oxygen because they have developed chronic lung disease (broncho-pulmonary dysplasia).

For more information about broncho-pulmonary dysplasia have a look at this website - Victorian Neonatal ehandbook http://www.health.vic.gov.au/neonatalhandbook/index.htm 

Bleeding in the brain

Bleeding into or around the brain, called intraventricular haemorrhage, is very rare in babies born after 30 weeks of pregnancy, but it occurs in about 1 in 5 babies born before 30 weeks. Usually the bleeding causes no brain damage, but in a few babies the bleeding can be larger and cause brain damage or death.

Infection

Premature babies are more likely to get infections because their body's defence system is not fully developed. Most infections can be treated, but sometimes treatment does not control the infection and the baby does not survive.

Feeding a premature baby

In the early period after birth almost all very premature babies need glucose, salt, water and other nutrients via a drip. More mature babies may be able to feed via a tube through the mouth into the stomach.

Breastmilk is the best food for babies, and even when a baby is very immature a mother can express breastmilk and store it so that when her baby is able to absorb milk some can be fed through a tube into the stomach. Babies start to suck well between 34 and 36 weeks and breastfeeding can often be started then.

There is more information on the Raising Children's Network - Breastfeeding premature babies in the NICU

How long will a baby need to stay in hospital?

Most premature babies are ready to go home about the time that they were due to be born, or a little earlier than this.

The time that babies stay in intensive care depends on how early they were born and how sick they have been. Some babies need less than a week in intensive care, but some may need up to 10 weeks (or rarely more). Babies then are moved to a special care nursery so they can grow and mature. They are usually able to go home when they can suck well.

Have a look at the topic Going home with your premature baby on the Raising Children Network site.

Development

Problems with development are unusual in babies born only a few weeks early, but a few babies born before 30 weeks will have problems with eyesight, hearing, movement and understanding. Eyesight and hearing problems may be mild, but a very few babies may have blindness or profound hearing loss. Some very premature babies develop cerebral palsy and learning problems. About two thirds of these children will have mild problems but one third have more severe problems and they may not be able to live independently.

Going home ... What next?

This booklet has been developed by neonatal physiotherapists from the Women’s and Children’s Hospital, Lyell McEwin Health Service and Flinders Medical Centre in South Australia who work with premature babies and their families. It is a guide for parents of premature babies on the best ways of helping babies develop at home in the first six months. 
Download PDF document icon Going home ... What next? What next - Developmental advice for families of premature babies in the first six months

National Support Line (Australia)

Miracle Babies Foundation 
http://www.miraclebabies.org.au/ 

24 hour national support line available to families of premature and sick newborns.
1300 622 243

References

NSW Pregnancy and Newborn Services Network
'Premature outcomes booklet'

Women’s and Children’s Hospital, Lyell McEwin Health Service and Flinders Medical Centre in South Australia. 
Going home ... What next? 

Victorian Neonatal ehandbook 
http://www.health.vic.gov.au/neonatalhandbook/index.htm 

MedlinePlus 'Neonatal respiratory distress syndrome'
http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/001563.htm   

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see your doctor or midwife.

 

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