The Premature Baby

Child Health

Dr Shan Narayanan

A premature baby is a baby who is born before 37 weeks. They thus have less time to develop in the mother’s womb in order to adapt to life outside the womb.

The gestation of the baby determines its severity of prematurity. Generally, a baby born

  1. between 34 and 37 weeks is a late premature baby
  2. less than 32 weeks is very premature; and
  3. less than 25 weeks is extremely premature.

The specific cause of premature delivery is not clear, however some factors may increase the risk of premature birth. The more common factors are as follows:

  • Any medical condition affecting the mother’s health significantly such as high blood pressure, diabetes mellitus.
  • Multiple pregnancies (twins/triplets)
  • A history of premature births.

When your baby arrives early, it’s normal to feel scared and overwhelmed as well as joyful. Thus it is important to have an understanding of the issues related to premature babies.

They tend to have more health problems. The more premature they are, the more tendencies to develop complications and have to stay longer in the hospital. They are treated in a specialised area in the hospital called Neonatal Intensive Care Unit (NICU).

Health issues for Preemies include:

Temperature control: Premature babies lose body heat very fast as they have a large surface area and do not have much fat stored. They are thus managed in an incubator or under a warmer.

Breathing: The lungs of a premature baby is immature and can result in breathing difficulties called Respiratory Distress Syndrome. This is more common in babies born before 35 weeks. These babies will need help in breathing, that is, assisted ventilation.

Infection: The immune system is immature thus they are prone to infections. They are treated with antibiotics.

Heart problems: The common heart problems are low blood pressure and Patent Ductus Arteriosus which is persistent opening between the Aorta and the pulmonary artery. If too much blood flows through this opening, the baby may have heart failure.

Brain problems: The more premature the baby, the higher the risk the baby bleeds into the brain called intraventricular haemorrhage. The more severe the bleed, the higher the chances for brain damage and accumulation of fluid in the brain (hydrocephalus).

They are also prone to hypoglycaemia, anemia, jaundice and if they are fed early, especially the very premature baby, may develop infection of the intestine called Necrotising Enterocolitis.

The long term health issues that may be faced by the premature babies are as follows:

  • Cerebral palsy
  • Vision problems
  • Hearing problems
  • Dental problems
  • Learning difficulties
  • Behaviour problems
  • More likely to have chronic health issues such as asthma, feeding problems.

The premature babies often have two ages:

Chronological age is the age of the baby from the day of birth.

Adjusted age is the age of the baby based on his due date. The doctor/nurse use this age when they evaluate the baby’s growth and development. So, if a baby is 8 months old, but was born 1½  months early, his adjusted age is 6½  months.

Most premature babies “catch up” to their peers, developmentally, in two to three years. After that, any differences in size or development are most likely due to individual differences, rather than to premature birth.

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