The Premature Baby

While it can be a common worry, few women anticipate having a premature baby. Although modern science has made it possible for a baby born as early as 24 weeks gestation to live, those weeks, and sometimes even months, that a premature baby needs to spend in the neonatal intensive care unit can be overwhelming for a parent. Not knowing what to expect during this time can make it even harder. If you have recently delivered a premature baby, or are at risk of delivering one, here is the information you need to know.

Premature Babies: The Stats
In the United States today, more than 1300 babies will be born prematurely. The rate of premature births has increased 31% from 1981 to 2003. A baby born more than three weeks before its due date is considered a premature baby.

Most women give birth to their babies after about 40 weeks. However, about one in 10 women will be subject to preterm labor. Premature babies are often at risk of developmental and medical problems because they have not had enough time to develop in the womb. In particular, vital organs may not be fully formed. Due to this factor, a doctor may try to delay a baby�s birth before 34 weeks in order to allow the baby to develop its vital organs, such as the lungs.

Signs of Pre-term Labor
Mothers at risk of pre-term labor may notice signs as early as four months before the due date of their infant. Typical signs of pre-term labor include regular contractions of the uterus, light vaginal bleeding, menstrual or abdominal cramps, lower back pain, a watery vaginal discharge and a feeling of pressure in the pelvis.

Causes of Pre-term Labor
The causes of pre-term labor are varied. For nearly half of premature births, the reason for a premature birth is unknown while for others there are specific medical conditions. Some of these medical conditions include:

 

  • A rupture of the amniotic sac. Normally a rupture of the amniotic sac does not occur until labor or just before labor. A rupture of the amniotic sac puts the baby and the mother at a high risk of infection.
  • Infections of the uterus, cervix, or urinary tract. Premature labor may be caused by the body�s natural immune response to bacterial infections.
  • Weak cervix. In a normal pregnancy, the cervix dilates in response to uterine contractions. A weak cervix may be caused by a number of reasons: pressure on the uterus from the on-going pregnancy; a previous pregnancy; surgery; carrying more than one fetus; or having too much amniotic fluid (hydramnios).
  • Chronic diseases. A woman may be at higher risk of having pre-term labor is she suffers from high blood pressure, diabetes, kidney disease or hypo-thyroidism.
  • Uterine abnormalities. A woman may be at higher risk of having pre-term labor if she has an abnormally shaped uterus or a benign tumor of the uterus.
  • Previous premature delivery
  • Substance abuse.
  • Malnutrition . An undernourished or anemic woman is more liable to go into pre-term labor.
  • Other conditions, such as a fetus with congenital defects or an overabundance of amniotic fluid.
  • Other factors that may lead to pre-term labor are women who are pregnant with twins, triplets or multiple babies, exposed to domestic violence, have had a short time period between pregnancies and who are pregnant with a single fetus from IVF.

 

Treatment
If you have started pre-term labor, your health care provider may choose to prescribe medication. While these medications will not help postpone labor until you are full term, they will put labor off long enough to allow you to be transferred to the appropriate facility. In some cases, they may also be used in combination with medications designed to help facilitate growth in your baby. Common medications that can be prescribed for pre-term labor include:

 

  • Terbutaline (Brethine)- relaxes the uterine muscles.
  • Magnesium Sulfate- relaxes muscles by intravenous.
  • Ibuprofen(Advil, Motrin)- blocks the production of substances that stimulate uterine contractions
  • Corticosteroids (betamethasone,dexamethasone)-medications that can help the baby�s lungs develop in 24 to 48 hours.

 

In some instances, a mother may be prescribed bed rest to put off labor.

Neonatal Intensive Care Unit (NICU)
After birth, premature babies are placed in the neonatal intensive care unit (NICU). Depending on the gestation stage and medical conditions, a premature baby may be required to stay in the NICU anywhere from several weeks to several months. In the NICU a premature baby will receive intensive care from trained medical professionals, respiratory therapists and staff.

A preemie will be placed in an incubator where he is kept warm to help regulate his body temperature. Your baby will be hooked up to a number of machines that will help him receive fluids and nutrients, as well as monitor his blood pressure, heart rate, breathing and temperature.

For parents, this type of equipment can seem intimidating. However, don�t be shy to ask the hospital staff just what each piece of equipment is and how it is helping your child. Understanding more about the machines and just what is going on in the care for your child can often put a parents mind at ease.

When a premature baby is healthy enough to go home, the staff can give further advice on how parents can take proper care of their premature baby. Due to the fact that premature babies have more illnesses and their illnesses can progress faster than healthier babies, it is vitally important to have regular check-ups with a doctor.

Physical Complications in Premature Babies
Babies born at 23 to 26 weeks of gestation are at the greatest risk of developing serious medical conditions. Some of these conditions are cerebral palsy, the accumulation of fluid in the brain (hydrocephalus), neurological problems, developmental delays and seizures.

Premature babies that suffer from severe bleeding in the brain in the first 10 days of life are more likely to have developmental delays, seizures, learning disabilities and fluid accumulation in the brain. A premature baby may suffer from retinal problems or retinopathy of prematurity (ROP), an irregular growth of blood vessels in the retina, due to the fact she did not have proper eye development in the womb. Additionally, premature babies can develop intestinal problems as well as a condition known as necrotizing enterocolitis (NEC). Babies with this condition will need to be fed intravenously and take antibiotics for a few weeks. Premature babies are also at an elevated risk of SIDS.

However, not all babies born prematurely will experience such severe complications. Babies born after 28 weeks have a much lower risk of complications while those born after 32 weeks often have minor problems that are commonly resolved by the time they go home.

Psychological Complications in Premature Babies
In addition to the physical problems that can arise in a premature baby, a number of psychological issues can also occur. According to the University of Wisconsin Medical School, there are five areas of development to consider for a premature baby: physiological (body functions), motor (movement and muscle tone), states of consciousness (the sleep-wake cycle), attention (ability to respond) and self-regulation (ability to keep these functions in balance).

A premature baby that has not fully developed its nervous system in utero may be substantially immature in many brain functions. Signs of immature brain function include:

 

  • Physiological: Gagging easily, changing color often, and having uneven breathing or heart rate.
  • Motor: Twitching, being stiff, limp or unable to remain curled up
  • State of Consciousness: Unable to stay alert or is constantly fussy
  • Attention: Troubles focusing on a person; quickly tires when interacting with someone
  • Self Regulation: Difficulty calming down after being disturbed

 

Understanding and recognizing any particular areas in psychological functioning that your child may be a bit behind will help you to better respond to her needs and adjust her environment to facilitate her development.

Giving birth to and caring for a premature baby can be a complex and trying experience. Parents of premature infants should utilize all the resources at their disposal including family, friends, support groups, educational books and medical staff.

 

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