November marks Prematurity Awareness Month, but it’s important to keep in mind that this is something that affects families all year-long. In fact, according to the Centers for Disease Control and Prevention, as of 2018, it was reported that one in 10 babies was born too early in the United States.
So what, exactly, causes a baby to be born before their due date? What happens to a baby, both mentally and physically, that is born prematurely? How does care differ for a prematurely born baby and a baby born full-term?
In order to get a better understanding of premature births and babies, we spoke to experts on the subject.
When is a Birth Considered Premature?
According to James E. Moore, MD, Ph.D., the Division Head of Neonatology at Connecticut Children’s Medical Center, “any baby born less than 37 weeks gestation” is considered a premature birth.
Adriann Combs, DNP, NNP, a nurse practitioner at Northwell Health, breaks it down even further: “A preterm birth is considered one less than 37 weeks of pregnancy, while late preterm ranges from 34-36 weeks.” She explains that a moderate preterm is 32-33, very preterm is 28-31, and extremely preterm is anything less than 28 weeks.
What Are the Signs of Prematurity?
“Preterm infants have all of the body systems as a term infant, they are just not fully ready to be functional,” explains Bobby Miller, MD, a pediatrician at Hoops Family Children’s Hospital at Cabell Huntington Hospital.
Premature babies are smaller and tend to have less fatty tissue, and in turn, Combs says, “They can have difficulty with feeding and staying warm on their own.”
These babies also don’t have a mature immune system, “so they can catch an infection even easier than a term infant,” she notes.
This is why going to your OB appointments is critical, so that the doctor knows exactly how many weeks the baby is at birth and compare that to the baby’s size, weight, and physical development.
What Happens When a Baby is Born Prematurely?
During a premature delivery, Dr. Moore says that a pediatric team will be in the delivery room to help take care of the baby.
“After a preterm birth, the baby is closely examined and monitored,” echoes Combs, adding, “In most situations, the baby can be seen and held in the delivery room, as long as the baby is safe.”
When a baby is born at 35 weeks or less gestation, Dr. Moore says the baby will be admitted to the NICU.
How Long Will the Baby Typically Be in the NICU, and What is the Care Like?
“The more preterm, the more help the baby will require,” explains Dr. Moore. This can include needing a breathing tube and ventilation support in order to keep body temperature normal and learning to feed and breathe without extra support.
However, as Combs points out, “Parents are always welcome in the NICU.” In fact, she says they are “encouraged to touch and hold their infants.” Skin-to-skin care is offered, even for very small infants, Combs says, “as long as the baby is deemed stable.”
Dr. Miller says that parents should anticipate that they will go home with their baby around the anticipated due date. “Some may be released a little before that, but it’s a good expectation to set with the parents.”
“The length of stay in the NICU is based on the reason for admission and how the baby achieves the milestones of growth and development,” Combs adds.
What Are the Treatments and Medications a Premature Baby Will Have?
Treatment and medication depend on a variety of factors. When it comes to treatment, Combs says, “It can be temperature support, nutritional support, breathing support and multiple medications that help with lung maturity and fighting infection, among many other reasons.”
In terms of medication, Dr. Miller says that “Babies frequently get antibiotics if there is a concern for infection,” he says, adding that “other medications or surgical procedures depend on what the baby’s clinical condition is.”
What Are the Possible Short-Term and Long-Term Complications for Premature Babies?
Any possible complications depend on how preterm the baby is born, Dr. Moore says. For instance, if the baby is more than 32 weeks at birth, they generally do well once they grow and mature to discharge. “The more preterm babies often need breathing support, IV nutrition, and they are at increased risk for infections plus other potential complications,” he says.
However, each baby is different and just because a baby is born at, say, 27 weeks, doesn’t mean they’ll have the same complications as another baby of the same age.
When it comes to long-term effects, Combs says it depends on factors like how complicated their initial hospital course was. “Preterm infants are followed up carefully to look for subtle signs of slow development or not meeting milestones.”
Dr. Miller says that some of the most common (and most concerning) complications associated with prematurity include respiratory distress, feeding intolerance, and bleeding in the head.
Severely preterm babies may continue to need medications when they go home, Dr. Moore says, and they have a potential for lower IQ and motor development issues as well. But, he notes, this “depends on how complicated the hospital course was.”
However, Dr. Moore points out, “many preterm babies do well” and recommends that any mom who delivers a preterm baby speak to a neonatal specialist so she can get a more accurate risk assessment for their infant.
Can Premature Births Be Prevented? What are the Risk Factors?
One of the most important things a mother can do, Combs says, is to take care of your health before and during your pregnancy. This includes going to all of your doctor or midwife appointments, as scheduled.
When it comes to possible risk factors for premature birth, Combs says one of the biggest indicators is a previous preterm birth. Other risks can include smoking cigarettes, taking unprescribed drugs, having poor nutrition, having an untreated infection, having diabetes, and/or high blood pressure during the pregnancy.