Prematurity

What is prematurity?

A baby born before 37 weeks of pregnancy is considered premature or born too early. The number of premature births in the U.S. is rising. Twins and other multiples are more likely to be premature than single birth babies. 

Other terms often used for prematurity are preterm and preemie. Many premature babies weigh less than 5 pounds, 8 ounces. They may be referred to as low birth weight. Babies born before 34 weeks of pregnancy are often called early preterm.

Babies born between 34 and 37 weeks of pregnancy are often called late preterm or near-term infants. 

What causes prematurity?

Premature birth may have a number of causes. Some things directly cause early labor and birth. Others can make the mother or baby sick and need early delivery. Sometimes the exact cause for a premature birth is unknown. This can be true even though the mother may have done everything right during the pregnancy.

Who is at risk for prematurity?

Many women have no known risk factors for premature birth. But several things can make premature birth more likely.

Risks for the mother include:

• Having had a previous preterm labor or birth
• Carrying twins, triplets, or more babies at one time
• Having an abnormal cervix or uterus
• Being younger than 20 or older than 35
• Being African American
• Having long-term health problems such as heart disease or kidney disease
• Smoking
• Using illegal drugs such as cocaine

Pregnancy risks include having any of the following:

• Infections
• High blood pressure
• Diabetes
• Blood clotting problems
• Problems with the placenta
• Vaginal bleeding
• Short time between pregnancies

Certain developmental problems can put unborn babies at higher risk for prematurity.

What are the symptoms of prematurity?

The following are the most common symptoms of a premature baby. But each baby may show slightly different symptoms. Symptoms may include:

• Small size. Premature babies often weighing less than 5 pounds, 8 ounces.
• Thin, shiny, pink or red skin. You are able to see veins through the skin.
• Little body fat
• Little scalp hair. But the baby may have lots of soft body hair (lanugo)
• Weak cry
• Poor muscle tone
• Male and female genitals are small and underdeveloped

The symptoms of prematurity may look like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is prematurity diagnosed?

A baby born before 37 weeks of pregnancy is considered premature or born too early. Babies born before 34 weeks of pregnancy are often called early preterm. Babies born between 34 and 37 weeks of pregnancy are often called late preterm or near-term infants.

How is prematurity treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment may include:

• Corticosteroid medicine for the mother to help the baby’s lungs grow and mature before birth
• Monitoring the baby’s temperature, blood pressure, heart and breathing rates, and oxygen levels
• Temperature-controlled bed
• Oxygen given by mask or with a breathing machine called a ventilator
• IV fluids, feedings, or medicines
• Special feedings with a tube in the stomach if a baby cannot suck
• X-rays or other imaging tests
• Skin-to-skin contact with the parents (kangaroo care)

What are the complications of prematurity?

Premature babies are cared for by a neonatologist. This is a doctor with special training to care for newborns. Other specialists may also care for babies, depending on their health problems.

Premature babies are born before their bodies and organ systems have completely matured. These babies may be small. They may weigh less than 5 pounds, 8 ounces. They may need help breathing, eating, fighting infection, and staying warm. Very premature babies, those born before 28 weeks, are at the greatest risk for problems. Their organs and body systems may not be ready for life outside the mother’s womb. And they may be too immature to function well.

Some of the problems premature babies may have include:

• Keeping their body temperature steady or staying warm
• Breathing problems, including serious short- and long-term problems
• Blood problems. These include low red blood cell counts (anemia), yellow-color to the skin from breaking down old red blood cells (jaundice), or low blood sugar levels (hypoglycemia).
• Kidney problems
• Digestive problems, including difficulty feeding and poor digestion
• Nervous system problems, including bleeding in the brain or seizures
• Infections

Premature babies can have long-term health problems as well. Generally, the more premature the baby, the more serious and long-lasting are the health problems.

Can prematurity be prevented?

More babies are surviving even though they are born early and are very small. It is best to prevent preterm labor if possible.

It's important to get good prenatal care while you are pregnant. Your healthcare provider can help find problems and suggest lifestyle changes to lower the risk for preterm labor and birth. Some ways to help prevent prematurity include:

• Stopping smoking if you smoke. You should stop smoking before you are pregnant.
• Finding out if you are at risk for preterm labor
• Learning the symptoms of preterm labor
• Getting treated for preterm labor

Your healthcare provider may give you the hormone progesterone if you are at high risk for preterm birth. Progesterone can help if you have had a previous preterm birth. 

How is prematurity managed?

Premature babies often need time to "catch up" in both development and growth. In the hospital, this catch-up time may involve learning to eat and sleep, as well as steadily gaining weight. Babies may stay in the hospital until they reach the pregnancy due date. They may be cared for in a neonatal intensive care unit (NICU) and an intermediate NICU.

Talk with your baby's healthcare provider about when your baby will be able to go home. In general, babies can go home when they:

• Have no serious health conditions
• Can stay warm in an open crib
• Take all feedings by breast or bottle
• Have no recent periods of not breathing (apnea) or low heart rate

Before discharge, premature babies need an eye exam and hearing test to check for problems related to prematurity. You must be able to give care, including medicines and feedings, before your baby can go home. You will  also need information about follow-up visits with the baby's healthcare provider and vaccines. Many hospitals have special follow-up healthcare programs for premature and low-birth-weight babies.

Even though they are otherwise ready to go home, some babies still have special needs. This includes things such as extra oxygen or tube feedings. You will learn how to take care of your baby if he or she needs these things. Hospital staff can help set up special home care.

Ask your baby’s healthcare provider about a "trial run" overnight stay in a parenting room at the hospital before your baby is discharged. This can help you adjust to caring for your baby while healthcare providers are nearby for help and reassurance. You may also feel more confident taking your baby home when you know infant CPR and safety.

Premature babies are at increased risk for sudden infant death syndrome (SIDS). You should always put your baby down to sleep on his or her back.

Key points about prematurity

• Babies born before 37 weeks of pregnancy are considered premature or born too early.
• Many premature babies also weigh less than 5 pounds, 8 ounces. They may be referred to as low birth weight.
• Premature babies can have long-term health problems. In general, the more premature the baby, the more serious and long-lasting are the health problems.
• Prenatal care is a key factor in preventing preterm births and low-birth-weight babies.
• Premature babies are at increased risk for sudden infant death syndrome (SIDS).
• Even though they are otherwise ready for discharge, some premature babies still need special care when they go home.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.