Q: What is my baby at risk for if he or she is born prematurely?
A: A preterm infant is any infant born before 37 weeks duration of pregnancy. The more premature the infant is the more complications he/she may face including death. Below is a list of some of the more frequent and serious risks a preterm infant may experience:
1. Respiratory Distress Syndrome (RDS) – this is due to immature lungs. We can give surfactants to help replace the substances missing in the lung that may help the infants to breath more effectively and hopefully decrease the length of time they will need to be on the ventilator or receiving oxygen.
2. Patent Ductus Arteriosus (PDA) – this is the persistence of a vascular structure in the circulatory system that is designed to function in the fetus while he/she is still in the uterus. When it remains open after the infant is born it can cause blood overload to the infant’s heart. This can be seen frequently in premature infants because the structure was meant to still be open and may not close spontaneously as it would in a full term infant. Treatment of the PDA can be done with medicine, but if that fails may require surgery.
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3. Intraventricular Hemorrhage (IVH) – occurs when there is bleeding into the ventricles and/or the tissues of the brain. This bleeding can be very mild (Grade I) or very severe and extensive (Grade IV). IVH can be associated with motor and mental retardation as well as with Hydrocephalus as a possible outcome. Infants born less than 32 weeks or weighing less than 1500 grams (3# 5oz) are more prone to this complication.
4. Retinopathy of Prematurity (ROP) – occurs because the retina in an infant’s eye is among the last areas of the infant to mature. Many factors including exposure to oxygen place the infant at risk to develop abnormal vessels that can cause the retina to be damaged. This can affect an infant’s vision and may require treatment with laser therapy. This disease can also lead to blindness.
5. Necrotizing Enterocolitis (NEC) – occurs because the intestine of the premature infant is immature and often may not receive adequate circulation when the infant is stressed with preterm delivery. The intestine may have erosions that prevent the infant from absorbing milk and can lead to perforation of the intestine or complete erosion of the gut and death. The infant’s gut must be used to feed the baby because complete intravenous infusions alone cannot adequately provide nutrition. It is a delicate balance. These feedings are best done with breastmilk. However, in the most immature of infants, those less than 27 weeks we may still see NEC in spite of breastmilk feeds and every precaution we can make.
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6. Developmental delay, cerebral palsy, learning disorders – the central nervous system is still being developed in infants and is therefore one of the more vulnerable systems for preterm infants. Nutrition, adequate oxygen and circulation as well as factors that are still unclear can impact neurological development in many ways. Infants that did not have IVH may still have some of these outcomes due to other complex processes that may not immediately be apparent. That is why it is recommended that preterm infants have close neuro-developmental follow-up in the first 2 years after birth.
As you can see from the above list, the complications of prematurity are significant. It is better to prevent premature delivery when we can. When women recognize the signs of preterm labor and present themselves promptly to the hospital we may be able to stop the labor and/or give medicines like steroids that can help mature the fetus’s lungs and stabilize brain tissues and membranes which may reduce the risks for RDS and IVH if the labor progresses and results in a preterm delivery.
