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Preterm Primer

Basic information for parents of premature infants

February 2014

One of every eight babies is born premature in the United States, according to the Centers for Disease Control and Prevention. That means 12.5 percent of births occur at less than 37 weeks gestation.

Preemies are at higher risk for medical complications in both the short and long term. Local Indianapolis area physicians were asked to weigh in on the health implications for premature babies and discuss what parents should be aware of during their growth.

Causes of preterm births

Dr. William Engle, medical director of the neonatal intensive care unit at Riley Hospital for Children at Indiana University Health, says about 70 percent of preterm births occur between 34 and 36 weeks gestation. Preemies born at 33 weeks or earlier occur less often but consume the most medical resources.

The most common scenario of premature birth is preterm labor, but what causes this condition is largely unknown. Dr. Ina Whitman, neonatologist at St. Vincent Women's Hospital, says many believe infection of the uterine environment or chorioamnionitis is the root cause.

Other known risk factors include having a previous preterm birth or having a pregnancy through assisted reproduction or multiple gestation, according to Dr. Sheryl King, director of inpatient pediatrics at Community Hospital South. Maternal age and race can also make a difference, as can absence of prenatal care, smoking and drug use. Also, the CDC notes that chronic health problems in the mother such as high blood pressure, diabetes and clotting disorders can cause preterm labor.

Health concerns

Preemies can range in age, with some born at 36 weeks and others at just 25 weeks. Because of this, the types and degrees of problems they face vary. Yet some medical issues can be expected.

Feeding problems are common. The more premature the baby, the more significant the feeding issues. Whitman says the earliest a baby can nipple feed – be it breast or bottle – is 33 to 34 weeks. Before this time they don't have the strength and coordination required to safely nipple feed. These babies will likely receive their nutrients through a combination of IV and feeding tubes.

Jaundice, difficulty breathing, and apnea of prematurity are also more likely. The younger the preemie, the more risks for eye issues, infection and more serious complications like brain bleeds.

Going home

The late preterm infant may stay in a special care nursery or neonatal intensive care unit (NICU) for several days to weeks growing and learning to feed. An extremely preterm infant may stay in the NICU for several months, according to King.

Once home, she says nutrition and growth are the biggest concern. "There may need to be multiple visits to the pediatrician's office to monitor feedings and weight gain. These babies can be developmentally behind so a referral to First Steps may be in order. It is very important to keep preterm infants free of infection. They may become very ill and require hospitalization. We often tell parents to stay home with these little ones," King advised.

Long-term health issues

Most late-term preemies can compete well with peers in learning, growth and development, but Engle says risks are a little higher in these babies so parents and pediatricians should be on higher alert for learning differences or behavior problems as these children grow.

Why do these ongoing risks occur? Consider the brain of a preemie born at 35 weeks, for instance. It is about two-thirds that of a term baby. In other words, the size and development of the brain is still quite immature in preemies, which sets them up for learning and behavior difficulties in the future. Of course, many grow up without these additional challenges, but parents should be aware these babies are at higher risk.

Preventing preterm births

While many preterm births may not be prevented, receiving prenatal care can reduce the risk.

"The hope is that by getting routine comprehensive prenatal care, risk factors can be identified and treated early to help prevent the onset of premature labor," said Engle.

Tags: In This Issue, Special Needs

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