Babies born before the 37th week of gestation are considered premature or “preterm” babies in medical language. Babies who are born in the time considered normal are called “full term”.
When a baby is born prematurely, the mother is often frightened and nervous, as premature newborns are at increased risk of complications.
Why do premature babies need special care?
Premature babies are not prepared to deal with life in our world. Their small bodies still have parts that are not fully developed like their lungs, digestive system, immune system and skin .
Fortunately, medical technology has made it possible for premature babies to survive in their first days, weeks or months of life until they are strong enough to do it on their own.
Health problems that premature babies may have after birth?
Health problems that can affect premature babies include:
- Apnea – This is a pause in breathing for 20 seconds or more. Premature babies sometimes have apnea. It can happen along with a slow heart rate.
- Respiratory distress syndrome (RDS) – Also called Hyaline Membrane Disease, it is a common respiratory problem in babies born before 34 weeks of pregnancy. Babies with SRD do not have a protein called surfactin that maintains small air sacs in the lungs to prevent a respiratory collapse.
- Intraventricular hemorrhage (IVH) – It is a bleeding in the brain. It usually happens near the ventricles in the center of the brain. A ventricle is a space in the brain that is filled with fluid.
- Persistence of the ductus arteriosus (PDA) – This is a heart problem that happens in the connection (called arterious ducts) between two main blood vessels near the heart. If the duct does not close properly after birth, a premature baby may have breathing problems or heart failure. Heart failure is when the heart cannot pump enough blood.
- Necrotizing enterocolitis (NEC) – This is a problem with the baby’s intestines. It can cause feeding problems, a bloated belly and diarrhea. Sometimes it happens 2 to 3 weeks after a premature birth.
- Retinopathy of prematurity (ROP) – This is an abnormal growth of blood vessels in the eye. ROP can lead to loss of vision.
- Jaundice – It is when a baby’s eyes and skin appear yellow. A baby has jaundice when the liver is not fully developed or is not functioning well.
- Bronchopulmonary dysplasia (BPD) – This is a lung condition that can develop in premature babies, as well as babies who are treated with a respiratory machine. Babies with BPD sometimes develop fluid in the lungs, scarring and lung damage.
- Infections – Premature babies often have trouble fighting germs because their immune systems are not fully formed. Infections that can affect a premature baby include pneumonia, a lung infection; sepsis which is an infection of the blood, and meningitis, which is an infection in the fluid around the brain and spinal cord.
They may also have long-term health problems, which can affect their entire lives.
Knowing the Neonatal ICU
The sooner the baby is born, the more likely it is that he will need more medical care. And some premature babies have to stay longer in the neonatal intensive care unit of a hospital (also called the NICU).
This is the part of a hospital that takes care of newborn babies who are sick or in need of more special care. That thanks to advances in medical care they are able to provide better care and greater chances of life for the premature baby, unlike in the past.
The neonatal ICU is the environment that welcomes the premature baby and will be your refuge for a limited period. Therefore, it is good for the parents to know every part of it making it familiar.
In the neonatal ICU is the entire team of doctors and nurses who will provide all the necessary support to the baby during this “stay”. It also has monitoring and alarm systems, respiratory and resuscitation equipment , access to doctors in all pediatric specialties, 24-hour laboratory service.
The amount of equipment in the neonatal ICU can be daunting, however, understanding how the various machines and equipment work can help parents relax.
Feeding Premature Babies
Premature babies start to feed while still in the hospital. This food can be given through the vein, through a tube or directly from the mother’s breast, but it depends a lot on her state of health.
Premature babies, as mentioned before, do not yet have a mature intestine and many are unable to breastfeed because they do not yet know how to suck and swallow. That is why it is necessary to start feeding through the vein or the probe. The premature baby can be fed with breast milk or with milk formulas for premature babies that are developed especially for them.
How is the food in the hospital?
In the hospital, feeding the premature baby is sometimes initiated:
- In the vein – This method takes, through serum, nutrition directly into the baby’s bloodstream. It is used for premature babies who have immature digestive systems and are unable to suck, swallow and breathe normally.
This method is sometimes used when treatment for other health complications is being prepared. This approach uses a needle that can be placed on the scalp, arm or leg.
- Umbilical catheter – This painless method involves a tube that is surgically placed in an umbilical cord vessel. However, there are risks associated with this method that include infection and blood clots.
Therefore, the method is normally used only in the most critical cases and only when the baby may need this type of feeding for several weeks. For these babies, it is the safest and most effective way to receive nutrients.
- Oral and nasal feeding – This method uses a narrow flexible tube that is placed in the baby’s nose or mouth and goes to the stomach. Special milk formulas for preterm infants or breast milk itself can be given through the tube.
It is a solution for babies who are ready to digest breast milk or formula, but are still unable to suck, swallow and breathe in a coordinated manner.
When can premature babies breastfeed?
Premature babies will be able to breastfeed when their general health improves and they can suck and swallow breast milk . In this transition phase, it may be necessary to use a technique called translocation or relactation , from which the baby is placed to breastfeed with the tube, to learn how to take the breast and suck the breast milk.
Breastfeeding, as for term babies, should be done every 2 or 3 hours, according to the baby’s needs. Premature babies do not usually breastfeed after delivery . Even so, the mother must stimulate the breast for the milk to flow.
Making circular movements at the edges of the areola every 3 hours, and then pressing the areola to express the milk. In the beginning, it is normal for only a few drops or a minimal amount of milk to come out, but this is the amount the baby can drink, as his stomach is still very small. As the baby grows, the production of breast milk also increases, so the mother does not have to worry or think she has little milk.
Ideal type of milk for premature babies
The breast milk is the only food that contains all the vitamins and proteins that the baby needs, both born at term as premature. However, due to prematurity, many babies are unable to be breastfed by their mothers, so feeding is done using milk formulas developed especially for their condition at the moment, and they contain all the nutrients that are important for their feeding.
There are several brands of formula for premature baby milk , but each has its indication, so it is important that the pediatrician is consulted so that he can indicate the one that will best meet the baby’s needs.
The kangaroo method is a technique widely used in neonatal ICUs and consists of placing the premature baby in an upright position on the mother’s bare chest, allowing him to have skin-to-skin contact with her.
The baby is positioned between the mother’s breasts and her head is rotated so that her ear is positioned above her heart. Many studies have shown that the kangaroo method offers significant benefits such as:
- Body temperature – Studies have shown that a mother has thermal synchrony with the baby and that, if the baby is cold, her body temperature rises to warm the baby and vice versa.
- Breastfeeding – The kangaroo method allows easy access to the breast, and skin-to-skin contact increasing milk production.
- Increase weight gain – the kangaroo method allows the baby to fall into a deeper sleep allowing him to direct more energy to other bodily functions. Greater weight gain also means a shorter hospital stay.
- Greater intimacy and bonding.
Premature Baby Development
Most premature babies develop normally. Extremely premature, low birth weight and sick babies are at increased risk of developmental problems . But even in these cases, many babies develop normally.
Development concerns – What is age corrected?
It is always important to keep an eye on the development of the premature child. But it is also worth remembering that there is a wide variety of “normals” when it comes to development.
In addition, the corrected age can be very useful if the parents are concerned about the baby’s development. For example, if a premature baby is one year old but was born three months earlier, the corrected age is only nine months. This means that it will be compared to babies of nine months of age, in a matter of development and not to babies of one year .
Language development in premature babies
Children learn to speak at different times from each other. Most premature babies develop normal language , but language development is often unsafe, but not always, delayed.
Smaller and more premature babies are at greater risk than late premature babies. Compared to full-term children, preterm infants have more problems saying things and understanding what is said to them.
But that does not mean that all children who are born prematurely will have a language problem. Some will, but others will have excellent language development . Language problems can also be an early sign of hearing or cognitive problems.
Physical development in premature babies
Most premature babies have normal physical and motor development. Babies born prematurely tend to be smaller and lighter than those born at term.
If these babies were very sick, they can sometimes affect their growth until they are at least 12 years old . But others recover during preschool and school years.
Physical and motor problems are more likely in very premature and low birth weight babies. The medical team will check for the first signs of physical movement and body control problems, for example, differences in muscle tone on different sides of the baby’s body while still in the neonatal intensive care unit.
References for early intervention are often based on these tests. After the premature baby is discharged, parents can check their physical development with a pediatrician and compare it with the development of the corrected age. About 40% of very premature children have mild motor impairment.
These include problems with:
- Fine motor skills – for example, putting together a puzzle or holding a pencil
- Motor planning – for example, understanding, planning and doing something like walking around fallen blocks
- Visual-motor coordination – for example, writing or drawing
- Sensory-motor skills – for example, feeling the weight of a full glass and picking it up without spilling the contents.
About 10 to 15% of premature babies have greater motor impairment, often known as cerebral palsy. The risk of cerebral palsy is greater with very premature babies whose brains have not fully developed (up to 45% of cases of cerebral palsy happen this way).
Babies who are very sick in the NICU are also at increased risk for cerebral palsy. Obtaining a clear diagnosis of cerebral palsy before 12 months is not always easy. This is because a diagnosis considers developmental skills such as sitting, crawling and walking.
Premature babies are more likely to have dental problems than a term baby. This can happen because while they were hospitalized they had a breathing tube pressed against the roof of their mouth, or due to a lack of calcium and phosphorus that they did not receive properly because they left before the uterus.
Teeth problems can include:
- Abnormal tooth enamel (white outer covering of a tooth) – the tooth may appear gray or brownish, or have an uneven surface. Caries are more easily formed in teeth with poor enamel.
- Late teeth – Premature babies ‘teeth usually come a few months later than term babies’ teeth, but they will be born in the right order.
- Very curved roof of the mouth – this can affect speech and bite. Most children adapt to the shape of the roof of their mouth, but others may need braces later.
Sensory development in premature babies
Most premature babies have normal sensory development . But premature babies are more likely to have hearing or visual impairments. Some parents say that their premature babies have sensory sensitivities, greater sensitivity to some sensory stimuli, such as loud noise or certain types of tissues.
Some premature babies don’t like to be put in their mouths and can have big problems feeding. And yet, sensitivity to pain is lower compared to babies born at term.
Children who are born prematurely are more likely to have hearing loss. But this is only about 2 to 6% of premature babies , and it is more common in babies who were born before the 30th week of pregnancy.
Some of them have severe hearing problems in both ears that need hearing aids or cochlear implants. Most babies have their first hearing screening test while they are still in the hospital.
This test detects most hearing problems , but some are diagnosed later. It is important to diagnose and deal with hearing loss, because children need to hear correctly to develop language, social and communication skills.
Premature babies are more likely than term babies to develop mild visual problems , such as nearsightedness or farsightedness. Only 1 to 12% of premature babies develop severe visual problems and this is more common in very premature babies.
The most serious visual problems will be resolved very early. Very premature babies have regular eye exams while they are in the hospital, which can lead to early treatment.
Development of reasoning in premature babies
From the beginning, the baby is learning about the world all the time, building thinking skills and experiencing how things work. Most premature babies have normal reasoning and development of (cognitive) learning.
Very premature or extremely low weight babies, or those who have had many medical complications are at increased risk of problems with thinking. A very small proportion of children who are born prematurely will have severe problems and learning difficulties.
Health professionals often use IQ tests to check children’s reasoning skills. The average scores for very premature or very low birth weight children are in the normal range, but are also slightly lower than the average for term children of the same age.
This means that most premature children can do well at school . Parents may not notice any problems until the premature child goes to school. That is, when children need to combine their reasoning skills in problem solving activities.
For example, reading involves visual memory, auditory memory and letter recognition. If your child has a problem in one of these areas, it can interfere with their ability to learn to read . Then, she will need extra support at school.
Social and emotional development in premature babies
Social and emotional development is learning to recognize and manage feelings, understand how others are feeling, express feelings and interact positively with others.
Being able to manage feelings is important for all areas of development. This helps to pay attention, work towards goals, develop friendships, gain autonomy and express what is happening to other people.
Most premature babies have normal social and emotional development , but they can behave differently than full-term babies. For example, crying is a baby’s way of communicating so that he shows that he needs something. Premature babies in the neonatal intensive care unit tend not to cry much, except perhaps during painful procedures.
In the first year, premature babies are more likely to sleep rather than interact. They can also look away or be irritated. They are less likely to engage in social interactions than term babies.
As the baby matures, this will be less of a concern. When the premature baby’s needs are answered, he will gradually learn to step out into the social world and communicate more.
Social and emotional problems
If a child has “social and emotional problems”, it means that the child is having trouble adapting to his environment, following the rules and being sociable with other children and adults.
It is normal for all children to behave badly at times, to get bored when they are not attended to. But, children born prematurely are more likely to have difficulty coping and managing their feelings.
They may find it difficult to stay calm, eat well or sleep well. Some may experience low self-esteem or not find friends easily. Premature children are more likely than term children to have conditions such as attention deficit hyperactivity disorder , autistic disorder , anxiety and depression . But these problems still affect very few children born prematurely.
Premature babies are fragile, but they are also extremely persistent in their daily struggle . It is up to the parents to help them in the best possible way and to love them unconditionally.
My name is Dr. Alexis Hart I am 38 years old, I am the mother of 3 beautiful children! Different ages, different phases 16 years, 12 years and 7 years. In love with motherhood since always, I found it difficult to make my dreams come true, and also some more after I was already a mother.
Since I imagined myself as a mother, in my thoughts everything seemed to be much easier and simpler than it really was, I expected to get pregnant as soon as I wished, but it wasn’t that simple. The first pregnancy was smooth, but my daughter’s birth was very troubled. Joana was born in 2002 with a weight of 2930kg and 45cm, from a very peaceful cesarean delivery but she had already been born with congenital pneumonia due to a broken bag not treated with antibiotics even before delivery.