Premature Birth; Possible Causes and Care.
Most pregnancies last 40-42 weeks. A baby born before the 37th week is known as a premature or pre-term baby. Medical advances have meant that more than 9 out of 10 premature babies survive, and most go on to develop normally.
Most premature babies who are born between 32 and 36 weeks and don’t have any serious long-term problems. However, very premature babies are at a higher risk of developmental problems. It is possible for babies born at 23-24 weeks to survive, but it is risky.
Most babies born before 32 weeks, and those weighing 2.5 kg or less, may need help breathing and may be cared for in a neonatal intensive care unit (NICU) until they have developed enough to survive on their own. Babies born between 32 and 37 weeks may need care in a special care nursery (SCN).
Why are babies born prematurely?
The cause of premature birth is unknown in about half of all cases. However, some of the reasons babies are born prematurely include:
- multiple pregnancies (Twins or more)
- the mother has a problem with her uterus or cervix
- sepsis -the mother gets an infection
- the mother has a medical condition that means the baby must be delivered early, such as pre-eclampsia
- the mother has a health condition like diabetes.
- a history of premature birth.
If you are less than 37 weeks pregnant and you experience any of the signs of premature labor, such as contractions, your waters breaking, bleeding, a ‘show’ of mucus from your vagina or a sudden decrease in your fetus movements, contact your doctor or nearest delivery suite immediately. It may be possible to slow down or stop the labor. But each day the baby stays inside your womb, the greater their chance of survival.
What happens at the birth?
It is best for very premature babies to be born at a hospital that has an NICU. If the hospital where the baby is born does not have an NICU, you and your baby may be transferred to another hospital.
When you are in labour, you may be given medicines to stop the contractions for a while. This allows you to be transferred to another hospital if necessary. You may also receive injections of corticosteroids 12 to 24 hours before the birth to help your baby’s lungs function more efficiently.
Premature babies can be born very quickly. They will usually be born through the vagina. However, in some cases the doctor may decide it is safest to deliver the baby via a caesarean section. Your doctor will discuss this decision with you.
A medical team from the neonatal (newborn) unit will be there for the birth. As soon as your baby is born, they will care for the baby in your room, possibly using a neonatal (baby) resuscitation bed. The team will keep your baby warm and help them to breathe with an oxygen mask or breathing tube, and possibly medicine. Some babies need help to keep their heart beating with cardio-pulmonary resuscitation (CPR) or an injection of adrenalin.
Once your baby is stable, they may be transferred to the NICU or SCN.
How will my premature baby look like?
Babies born at 36 to 37 weeks usually look like small full-term babies. Very premature babies will be small (perhaps fitting in your hand) and look very fragile.
- Skin: it might not be fully developed, and may appear shiny, translucent, dry or flaky. The baby may not have any fat under the skin to keep them warm.
- Eyes: the eyelids of very premature babies may be fused shut at first. By 30 weeks they should be able to respond to different sights.
- Immature development: your baby might not be able to regulate its body temperature, breathing or heart rate. They may twitch, become stiff or limp or be unable to stay alert.
- Hair: your baby may have little hair on its head, but lots of soft body hair (called ‘lanugo’).
- Genitals: the baby’s genitals may be small and underdeveloped.
Your premature baby’s development
Some common issues for premature babies include:
- breathing problems
- heart problems
- problems in their digestive tract
- sepsis (infection)
- sometimes, some developmental problems especially for preterms delivered between 23 – 26 weeks.
Most premature babies will develop normally, but they are at higher risk of developmental problems so will need regular health and development checks at the hospital or with a paediatrician. If you are worried about your child’s development, talk to your doctor.
Problems that may occur later in children who were born prematurely include:
- language delays
- growth and movement problems
- problems with teeth
- problems with vision or hearing
- thinking and learning difficulties
- social and emotional problems.
How to calculate your preterm baby’s age.
When you’re judging whether your premature baby is developing normally, it is important to understand their ‘corrected age’.
The corrected age is your baby’s chronological age minus the number of weeks or months they were born early. For example, a 6-month-old baby who was born 2 months early would have a corrected age of 4 months. That means they may only be doing the things that other 4-month-olds do. Most paediatricians recommend correcting age when assessing growth and development until your child is 2 years old.
When it’s time to go home
The hospital will not send your baby home until they are confident both the baby and you are ready. Staff will make sure you understand how to care for your baby at home. They will also show you how to use any equipment you may need.
You will need appointments to see a neonatologist (newborn baby doctor) or paediatrician. Your local child and family health nurse will also see you regularly.
It is normal to feel a little worried when you are looking after your baby yourself after so long in hospital. Take it slowly in a calm and quiet environment until you both get used to being at home.