A premature infant is a baby born before 37 completed weeks
of gestation (more than 3 weeks before the "due
date").
Causes :
o At birth, a baby is classified as one of the
following:
o Premature (less than 37 weeks gestation)
o Full term (37 to 42 weeks gestation)
If a woman goes
into labor before 37 weeks, it is called preterm labor.
"Late preterm" babies who are born between 35 and 37 weeks
gestation may not look premature. They may not be admitted to an intensive care
unit, but they are still at risk for more problems than full-term babies.
Health conditions in the mother, such as diabetes, heart disease, and
kidney disease, may contribute to preterm labor. Often, the cause of preterm
labor is unknown. About 15% of all premature births are multiple pregnancies
(twins, triplets, etc.).
Different pregnancy-related problems increase the risk of preterm labor
or early delivery:
o A weakened cervix that begins to open
(dilate) early, also called cervical incompetence
o Birth defects of the uterus
o History of preterm delivery
o Infection (such as a urinary tract infection
or infection of the amniotic membrane)
o Poor nutrition right before or during
pregnancy
o Preeclampsia -- high blood pressure and
protein in the urine that develop after the 20th week of pregnancy
Other factors that increase the risk for preterm labor and a
premature delivery include:
o Age of the moter (mothers who are
younger than 16 or older than 35)
o Being African-American
o Lack of prenatal care
o Low socioeconomic status
o Use of tobacco, cocaine, or amphetamines
Symptoms
The infant may have
trouble breathing and keeping a constant body temperature.
Exams and Tests
A premature infant
may have signs of the following problems:
o Anemia
o Bleeding into the brain or damage to the
brain's white matter
o Low blood sugar (hypoglycemia)
o Neonatal respiratory distress syndrome, extra
air in the tissue of the lungs (pulmonary interstitial emphysema), or bleeding
in the lungs (pulmonary hemorrhage)
o Newborn jaundice
o Severe intestinal inflammation (necrotizing
enterocolitis)
A premature infant will have a lower birth weight than a full-term
infant. Common signs of prematurity include:
o Abnormal breathing patterns (shallow,
irregular pauses in breathing called apnea)
o Body hair (lanugo)
o Enlarged clitoris (in female infants)
o Less body fat
o Lower muscle tone and less activity than
full-term infants
o Problems feeding due to trouble sucking or
coordinating swallowing and breathing
o Small scrotum that is smooth and has no
ridges, and undescended testicles (in male infants)
o Soft, flexible ear cartilage
o Thin, smooth, shiny skin that is often
transparent (can see veins under skin)
Common tests
performed on a premature infant include:
o Blood gas analysis to check oxygen levels in
the blood
o Blood tests to check glucose, calcium, and bilirubin
levels
o Chest x-ray
o Continuous cardiorespiratory monitoring
(monitoring of breathing and heart rate)
Treatment
When premature
labor develops and cannot be stopped, the health care team will prepare for a
high-risk birth. The mother may be moved to a center that is set up to care for
premature infants in a neonatal intensive care unit (NICU).
After birth, the
baby is admitted to a high-risk nursery. The infant is placed under a warmer or
in a clear, heated box called an incubator, which controls the air temperature.
Monitoring machines track the baby's breathing, heart rate, and level of oxygen
in the blood.
A premature
infant's organs are not fully developed. The infant needs special care in a
nursery until the organs have developed enough to keep the baby alive without
medical support. This may take weeks to months.
Infants usually
cannot coordinate sucking and swallowing before 34 weeks gestation. A
premature baby may have a small, soft feeding tube placed through the nose
or mouth into the stomach. In very premature or sick infants, nutrition may be
given through a vein until the baby is stable enough to receive all nutrition
through the stomach. (See: Neonatal
weight gain and nutrition)
If the infant has
breathing problems:
A tube may be
placed into the windpipe (trachea). A machine called a ventilator will help the
baby breathe.
Some babies whose
breathing problems are less severe receive continuous positive airway pressure
(CPAP) with small tubes in the nose instead of the trachea. Or they may receive
only extra oxygen.
Oxygen may be given
by ventilator, CPAP, nasal prongs, or an oxygen hood over the baby's head.
Infants need
special nursery care until they are able to breathe without extra
support, eat by mouth, and maintain body temperature and body weight. Very
small infants may have other problems that complicate treatment and
require a longer hospital stay.
Support Groups
There are multiple
support groups for parents of premature babies. Ask the social worker in the
neonatal intensive care unit.
Outlook (Prognosis)
Prematurity used to
be a major cause of infant deaths. Improved medical and nursing techniques have
increased the survival of premature infants. The longer the pregnancy, the
greater the chance of the baby's survival. At least 90% of babies who are born
at 28 weeks survive.
Prematurity can
have long-term effects. Many premature infants have medical, developmental, or
behavioral problems that continue into childhood or are permanent. The more
premature an infant and the smaller the birth weight, the greater the risk of
complications. However, it is impossible to predict a baby's long-term outcome
based on gestational age or birth weight.
Possible
Complications
Possible long-term
complications include:
Delayed growth and
development
Mental or physical
disability or delay
Retinopathy of
prematurity, vision loss, or blindness
Prevention
The best ways to
prevent prematurity are to:
Be in good health
before getting pregnant
Get prenatal care
as early as possible in the pregnancy
Continue to get
prenatal care until the baby is born
Getting early and
good prenatal care reduces the chance of premature birth.
Premature labor can
sometimes be treated or delayed by a medication that blocks uterine
contractions. Many times, however, attempts to delay premature labor are not
successful.
Betamethasone (a
steroid medication) given to mothers in premature labor can make some
prematurity complications less severe.
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