Health

Premature Birth.

Premature birth.

A premature birth is a birth that takes place more than three weeks before the baby’s estimated due date. In other words, a premature birth is one that occurs before the start of the 37th week of pregnancy.

Premature babies, especially those born very early, often have complicated medical problems. Typically, complications of prematurity vary. But the earlier your baby is born, the higher the risk of complications.

Depending on how early a baby is born, he or she may be:

▪️Late preterm, born between 34 and 36 completed weeks of pregnancy.

▪️Moderately preterm, born between 32 and 34 weeks of pregnancy.

▪️Very preterm, born at less than 32 weeks of pregnancy.

▪️Extremely preterm, born at or before 25 weeks of pregnancy.

Most premature births occur in the late preterm stage.

Symptoms.

Your baby may have very mild symptoms of premature birth, or may have more-obvious complications.

Some signs of prematurity include the following:

1. Small size, with a disproportionately large head.

2. Sharper looking, less rounded features than a full-term baby’s features, due to a lack of fat stores.

3. Fine hair (lanugo) covering much of the body.

4. Low body temperature, especially immediately after birth in the delivery room, due to a lack of stored body fat.

5. Labored breathing or respiratory distress.

6. Lack of reflexes for sucking and swallowing, leading to feeding difficulties.

Signs and Symptoms of Preterm Labor.

In most cases, preterm labor (labor that happens too soon, before 37 weeks of pregnancy) begins unexpectedly and the cause is unknown. Like regular labor, signs of early labor include—

▪️Contractions (the abdomen tightens like a fist) every 10 minutes or more often.

▪️Change in vaginal discharge (a significant increase in the amount of discharge or leaking fluid or bleeding from the vagina).

▪️Pelvic pressure—the feeling that the baby is pushing down.

▪️Low, dull backache.

▪️Abdominal cramps with or without diarrhea.

If you have any signs or symptoms of preterm labor, call your healthcare provider right away.

Risk factors.

Often, the specific cause of premature birth isn’t clear. However, there are known risk factors of premature delivery, including:

▪️Having a previous premature birth.

▪️Pregnancy with twins, triplets or other multiples.

▪️An interval of less than six months between pregnancies.

▪️Conceiving through in vitro fertilization.

▪️Problems with the uterus, cervix or placenta.

▪️Smoking cigarettes or using illicit drugs.

▪️Some infections, particularly of the amniotic fluid and lower genital tract.

▪️Some chronic conditions, such as high blood pressure and diabetes.

▪️Being underweight or overweight before pregnancy.

▪️Stressful life events, such as the death of a loved one or domestic violence.

▪️Multiple miscarriages or abortions.

▪️Physical injury or trauma.

For unknown reasons, black women are more likely to experience premature birth than are women of other races. But premature birth can happen to anyone. In fact, many women who have a premature birth have no known risk factors.

Complications.

While not all premature babies experience complications, being born too early can cause short-term and long-term health problems.

Generally, the earlier a baby is born, the higher the risk of complications. Birth weight plays an important role, too.

Some problems may be apparent at birth, while others may not develop until later.

Short-term complications.

In the first weeks, the complications of premature birth may include:

▪️Breathing problems. A premature baby may have trouble breathing due to an immature respiratory system.

▪️Heart problems. The most common heart problems premature babies experience are patent ductus arteriosus (PDA) and low blood pressure (hypotension).

▪️Brain problems. The earlier a baby is born, the greater the risk of bleeding in the brain, known as an intraventricular hemorrhage.

▪️Temperature control problems. Premature babies can lose body heat rapidly. They don’t have the stored body fat of a full-term infant, and they can’t generate enough heat to counteract what’s lost through the surface of their bodies. If body temperature dips too low, an abnormally low core body temperature (hypothermia) can result.

▪️Gastrointestinal problems. Premature infants are more likely to have immature gastrointestinal systems, resulting in complications such as necrotizing enterocolitis (NEC).

▪️Blood problems. Premature babies are at risk of blood problems such as anemia and newborn jaundice.

▪️Metabolism problems. Premature babies often have problems with their metabolism. Some premature babies may develop an abnormally low level of blood sugar (hypoglycemia). This can happen because premature infants typically have smaller stores of stored glucose than do full-term babies. Premature babies also have more difficulty converting their stored glucose into more-usable, active forms of glucose.

▪️Immune system problems. An underdeveloped immune system, common in premature babies, can lead to a higher risk of infection. Infection in a premature baby can quickly spread to the bloodstream, causing sepsis, an infection that spreads to the bloodstream.

Long-term complications.

In the long term, premature birth may lead to the following complications:

▪️Cerebral palsy. Cerebral palsy is a disorder of movement, muscle tone or posture that can be caused by infection, inadequate blood flow or injury to a newborn’s developing brain either early during pregnancy or while the baby is still young and immature.

▪️Impaired learning. Premature babies are more likely to lag behind their full-term counterparts on various developmental milestones. Upon school age, a child who was born prematurely might be more likely to have learning disabilities.

▪️Vision problems. Premature infants may develop retinopathy of prematurity, a disease that occurs when blood vessels swell and overgrow in the light-sensitive layer of nerves at the back of the eye (retina).

▪️Hearing problems. Premature babies are at increased risk of some degree of hearing loss. All babies will have their hearing checked before going home.

▪️Dental problems. Premature infants who have been critically ill are at increased risk of developing dental problems, such as delayed tooth eruption, tooth discoloration and improperly aligned teeth.

▪️Behavioral and psychological problems. Children who experienced premature birth may be more likely than full-term infants to have certain behavioral or psychological problems, as well as developmental delays.

▪️Chronic health issues. Premature babies are more likely to have chronic health issues — some of which may require hospital care — than are full-term infants. Infections, asthma and feeding problems are more likely to develop or persist. Premature infants are also at increased risk of sudden infant death syndrome (SIDS).

Prevention.

Although the exact cause of preterm birth is often unknown, there are some things that can be done to help women — especially those who have an increased risk — to reduce their risk of preterm birth, including:

▪️Progesterone supplements. Women who have a history of preterm birth, a short cervix or both factors may be able to reduce the risk of preterm birth with progesterone supplementation.

▪️Cervical cerclage. This is a surgical procedure performed during pregnancy in women with a short cervix, or a history of cervical shortening that resulted in a preterm birth.

During this procedure, the cervix is stitched closed with strong sutures that may provide extra support to the uterus. The sutures are removed when it’s time to deliver the baby.

Diagnosis.

After your premature baby is moved to the NICU, he or she may undergo a number of tests. Some are ongoing, while others may be performed only if the NICU staff suspects a particular complication.

Possible tests for your premature baby may include:

▪️Breathing and heart rate monitor.

▪️Fluid input and output. The NICU team carefully tracks how much fluid your baby takes in through feedings and intravenous fluids and how much fluid your baby loses through wet or soiled diapers.

▪️Blood tests. Blood samples are collected through a heel stick or a needle inserted into a vein to monitor a number of critical substances, including calcium, glucose and bilirubin levels in your baby’s blood. A blood sample may also be analyzed to measure the red blood cell count and check for anemia or assess for an infection.

▪️Echocardiogram. This test is an ultrasound of the heart to check for problems with your baby’s heart function. Much like a fetal ultrasound, an electrocardiogram uses sound waves to produce moving images on a display monitor.

▪️Ultrasound scan. Ultrasound scans may be done to check the brain for bleeding or fluid buildup or to examine the abdominal organs for problems in the gastrointestinal tract, liver or kidneys.

▪️Eye exam. An ophthalmologist (eye doctor) may examine your baby’s eyes and vision to check for problems with the retina (retinopathy of prematurity).

If your baby develops any complications, other specialized testing may be needed.

Treatment.

The neonatal intensive care unit (NICU) or special care nursery provides round-the-clock care for your premature baby.

Supportive care.

Specialized supportive care for your baby may include:

▪️Being placed in an incubator. Your baby will probably stay in an enclosed plastic bassinet (incubator) that’s kept warm to help your baby maintain normal body temperature. Later on, NICU staff may show you a particular way to hold your baby — known as “kangaroo” care — with direct skin-to-skin contact.

▪️Monitoring of your baby’s vital signs. Sensors may be taped to your baby’s body to monitor blood pressure, heart rate, breathing and temperature. A ventilator may be used to help your baby breathe.

▪️Having a feeding tube. At first your baby may receive fluids and nutrients through an intravenous (IV) tube. Breast milk may be given later through a tube passed through your baby’s nose and into his or her stomach (nasogastric, or NG, tube). When your baby is strong enough to suck, breast-feeding or bottle-feeding is often possible.

▪️Replenishing fluids. Your baby needs a certain amount of fluids each day, depending upon his or her age and medical conditions. The NICU team will closely monitor fluids, sodium and potassium levels to make sure that your baby’s fluid levels stay on target. If fluids are needed, they’ll be delivered through an IV line.

▪️Spending time under bilirubin lights. To treat infant jaundice, your baby may be placed under a set of lights — known as bilirubin lights — for a period of time. The lights help your baby’s system break down excess bilirubin, which builds up because the liver can’t process it all. While under the bilirubin lights, your baby will wear a protective eye mask to rest more comfortably.

▪️Receiving a blood transfusion. Your preterm baby may need a blood transfusion to raise blood volume — especially if your baby has had several blood samples drawn for various tests.

Reference:

premature birth/https://www.mayoclinic.org/diseases-conditions/premature-birth/symptoms-causes/syc-20376730

premature birth/https://www.mayoclinic.org/diseases-conditions/premature-birth/diagnosis-treatment/drc-20376736

Premature Birth/https://www.cdc.gov/reproductivehealth/features/premature-birth/index.html

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