Premature Babies

Premature babies are often known as preemies, they arrive in the world somewhat earlier than expected. A baby is said to be premature when a pregnancy lasts fewer than 37 weeks, full-term being 38 to 42 weeks.

Having a premature can be scary and many mothers blame themselves, the plain fact is that about half of all women who go into premature labour do so for no known reason. Others may have a medical condition that contributes to early labour. In other words, premature birth can occur for a number of known and unknown reasons, including:

A rupture of your bag of waters (the membranes surrounding your baby).
A cervix that opens (dilates) without contractions (incompetent cervix).
Chronic diseases, including high blood pressure, diabetes, kidney disease and hypothyroidism
An abnormally shaped uterus or a uterus with a benign tumour know as a fibroid
A previous premature delivery.
Smoking, alcohol use or misuse of other drugs
Malnutrition
Pre-eclampsia

Premature babies may have many special needs which is why they often begin their lives after delivery in a neonatal intensive care unit.

Due to many recent advances, more than 90% of premature babies who weigh 800 grams or more (a little less than 2 pounds) survive. Those who weigh more than 500 grams (a little more than 1 pound) have a 40% to 50% chance of survival, although their chances of complications are greater.

Preemie's Needs

Warmth - Premature babies lack the body fat necessary to maintain their body temperature, even when swaddled with blankets. Therefore, incubators or radiant warmers are used to keep the babies warm.

Nutrition - Premature babies have special nutritional needs because they grow at a faster rate than full-term babies and their digestive systems are immature. Breast milk can be pumped by the mother and fed to the premature baby through a tube that goes from the baby's nose or mouth into the stomach. Breast milk has an advantage over formula because it contains proteins that help fight infection and promote growth. Special fortifiers may be added to breast milk (or to formula if breastfeeding isn't desired), because premature infants have higher vitamin and mineral needs than full-term infants. Nearly all premature babies receive additional calcium and phosphorus either by adding fortifier to breast milk or directly through special formulas for preemies.

Health Problems

Premature babies are prone to a number of problems mostly because their internal organs aren't completely ready to function on their own. In general, the more premature the baby, the higher the risk of complications.

Hyperbilirubinemia - a common treatable condition of premature babies is hyperbilirubinemia, which affects 80% of premature infants. Infants with hyperbilirubinemia have high levels of bilirubin, a compound that results from the natural breakdown of blood. This high level of bilirubin causes them to develop jaundice, a yellow discolouration of the skin and whites of the eyes. Although mild jaundice is fairly common in full-term babies (about 60%), it's much more common in premature babies. Extremely high levels of bilirubin can cause brain damage, so premature infants are monitored for jaundice and treated quickly.
Apnoea - is another common health problem among premature babies. During an apnoea spell, a baby stops breathing, the heart rate may decrease, and the skin may turn pale, purplish, or blue. Apnoea is usually caused by immaturity in the area of the brain that controls the drive to breathe. Almost all babies born at 30 weeks or less will experience apnoea. Apnoea spells become less frequent with age.
Anaemia - Many premature babies lack the number of red blood cells necessary to carry adequate oxygen to the body. Premature babies may develop anaemia for a number of reasons. In the first few weeks of life, infants don't make many new red blood cells. Also, an infant's red blood cells have a shorter life than an adult's. Some premature infants, especially those who weigh less than 1,000 grams, require red blood cell transfusions.
Low Blood Pressure - is a relatively common complication that may occur shortly after birth. It can be due to infection, blood loss, fluid loss, or medications given to the mother before delivery. Low blood pressure is treated by increasing fluid intake or prescribing medications. Infants who have low blood pressure due to blood loss may need a blood transfusion.
Respiratory Distress Syndrome - One of the most common and immediate problems facing premature baby is difficulty breathing. Although there are many causes of breathing difficulties in premature infants, the most common is called respiratory distress syndrome (RDS). In RDS, the infant's immature lungs don't produce enough of an important substance called surfactant, it allows the inner surface of the lungs to expand properly when the infant makes the change from the womb to breathing air after birth. Fortunately, RDS is treatable and many infants do quite well. When premature delivery can't be stopped, most pregnant women can be given medication just before delivery to hasten the production of surfactant in the infant's lungs and help prevent RDS. Then, immediately after birth and several times later, artificial surfactant can be given to the infant if needed. Although most premature babies who lack surfactant will require a breathing machine, or ventilator, for a while, the use of artificial surfactant has greatly decreased the amount of time that infants spend on the ventilator.
Bronchopulmonary Dysphasia - is a common lung problem among premature infants, especially those less than 2 pounds at birth. The exact mechanism for this disease is still unclear, but extreme prematurity, severe RDS, infections before and after birth, and the prolonged use of oxygen and/or a ventilator needed to treat a lung disease all play a major role in the development of BPD. Preemies are often treated with medication and oxygen for this condition.
Infection - Infection is a big threat to premature babies because they're less able than full-term infants to fight germs, that can cause serious illness.
Patent Ductus Arteriosus - The ductus arteriosus is a short blood vessel that connects the main blood vessel supplying the lungs to the aorta, the main blood vessel that leaves the heart. Its function in the unborn baby is to allow blood to bypass the lungs, because oxygen for the blood comes from the mother and not from breathing air. In full-term babies, the ductus arteriosus closes shortly after birth, but it frequently stays open in premature babies. When this happens, excess blood flows into the lungs and can cause breathing difficulties and sometimes heart failure. Patent ductus arteriosus (PDA) is often treated with a medication called indomethacin or ibuprofen, which is successful in closing the ductus arteriosus in more than 80% of infants requiring these medications. However, if medical therapy fails, then surgery may be required to close the ductus.
Retinopathies of Prematurity - The eyes of premature infants are especially vulnerable to injury after birth. A serious complication is called retinopathy of prematurity (ROP), which is abnormal growth of the blood vessels in an infant's eye. About 7% of babies weighing 1,250 grams (2.75 pounds) or less at birth develop ROP, and the resulting damage may range from mild (the need for glasses) to severe (blindness).

Once you get your baby home

Premature infants often require special care after leaving the NICU, sometimes in a high-risk newborn clinic or early intervention program. In addition to the regular well-child visits and immunisations that all infants receive, premature infants receive periodic hearing and eye examinations.

Careful attention is paid to the development of their nervous system, including the achievement of motor skills as well as the positioning and tone of the muscles. Speech and behavioural development are also important areas during follow-up. Some babies may require speech or physical therapy as they grow. If you have a premature baby it is important that you get help and support as it can be very scary, the NICU staff and your midwife can give lots of advice but it may also be beneficial to talk to mothers who have been through similar experiences on a site like www.peenyweeny.co.uk