Common Health Problems Associated with Prematurity
Babies that are born prematurely are at high risk for a number of complications. These are the most common complications seen immediately after the birth. Even though many of these complications can be diagnosed and treated, they can often lead to long-lasting difficulties as the baby grows.
- Hypothermia: Babies who are born too small and too soon often have trouble controlling their body temperature because they don’t have enough body fat to prevent the loss of heat. This is known as low body temperature or hypothermia. Babies in the NICU are placed in an incubator or warmer right after birth to help control their temperature. Maintaining a normal body temperature will allow for optimal function of the bodies physiological processes.
- Respiratory distress syndrome (RDS): A serious breathing problem that affects mainly babies born before 34 weeks of pregnancy. RDS can result from several situations. The first is that the baby’s lungs aren’t fully developed. Sometimes a type of medication known as corticosteroids is given to these infants to help the lungs mature more quickly. If a woman is at risk of delivering her baby before 34 weeks, corticosteroids may be given to her to try to prevent the baby from developing RDS. RDS may also occur if the lungs are too immature to produce an important material called surfactant. Surfactant is a slick coating covering the lining of the lungs. Babies don’t make enough surfactant to be able to breathe outside the womb until a certain point in their development. Most babies born prematurely have only about 5% of the surfactant that they need. Fortunately, they can receive replacement surfactant to coat the lungs and allow for easier breathing. Sometimes this can prevent RDS from occurring at all and in other cases; the replacement surfactant can save the baby’s lungs from long-term damage. A doctor may suspect a baby has RDS if she is struggling to breathe. A lung X-ray and blood tests often confirm the diagnosis. Along with surfactant treatment, babies with RDS may need additional oxygen and mechanical breathing assistance to keep their lungs expanded. They may receive a treatment called continuous positive airway pressure (CPAP), which delivers pressurized air to the baby’s lungs. The air may be delivered through small tubes in the baby’s nostrils, or through a tube that has been inserted into his windpipe. CPAP helps a baby breathe, but it does not breathe for him. The sickest babies may temporarily need the help of a respirator to breathe for them while their lungs mature.
- Apnea: Premature babies sometimes stop breathing for 20 seconds or more. This interruption in breathing is called apnea, and it may be accompanied by a slow heart rate. Premature babies are constantly monitored for apnea. If the baby stops breathing, a nurse will stimulate the baby to start breathing by patting him or touching the soles of his feet. Some babies are treated with medication, caffeine, to stimulate their breathing. Eventually, premature babies stop having apnea as they mature.
- Bleeding in the brain (IVH): Intraventricular hemorrhages are more common in babies born before 32 weeks of pregnancy. Bleeding in the brain is called intraventricular hemorrhage (IVH). It can cause pressure in the brain and brain damage. The bleeds usually occur in the first three days of life and generally are diagnosed with an ultrasound examination. Most brain bleeds are mild and resolve themselves with no or few lasting problems. More severe bleeds can cause the fluid-filled structures (ventricles) in the brain to expand rapidly, causing pressure on the brain that can lead to brain damage (such as cerebral palsy, learning, and behavioral problems). In such cases, surgeons may insert a tube into the brain to drain the fluid and reduce the risk of brain damage. In milder cases, drugs sometimes can reduce fluid buildup. IVH also is associated with a risk for developing cerebral palsy.
- Patent ductus arteriosus (PDA): A heart problem that is common in premature babies. Untreated, it can lead to heart failure. Before birth, a large artery called the ductus arteriosus lets the blood bypass the lungs because the fetus gets its oxygen through the placenta. The ductus normally closes soon after birth so that blood can travel to the lungs and pick up oxygen. When the ductus does not close properly, it can lead to heart failure. PDA can be diagnosed with a specialized form of ultrasound (echocardiography) or other imaging tests. Babies with PDA are treated with a drug that helps close the ductus, although surgery may be necessary if the drug does not work.
- Necrotizing enterocolitis (NEC): Some premature babies develop this potentially dangerous intestinal problem usually two to three weeks after birth. It can lead to feeding difficulties, abdominal swelling and other complications. NEC can be diagnosed with imaging tests, such as X-rays and blood tests. Affected babies are treated with antibiotics and fed intravenously (through a vein) while the bowel heals. In some cases, surgery is necessary to remove damaged sections of the intestine.
- Retinopathy of prematurity (ROP): An eye problem that occurs mainly in babies born before 31 weeks of pregnancy. In severe cases, treatment is needed to help prevent vision loss. The smaller a baby is at birth, the more likely that baby is to develop ROP. This disorder – which usually develops in both eyes – is one of the most common causes of visual loss in childhood and can lead to lifelong vision impairment and blindness. About 14,000-16,000 of premature infants are affected by some degree of ROP. The disease improves and leaves no permanent damage in milder cases of ROP. About 90 percent of all infants with ROP are in the milder category and do not need treatment. However, infants with more severe diseases can develop impaired vision or even blindness. Infants that are considered high risk for ROP will have screening eye examinations by an ROP an ophthalmologist (eye doctor) while in the NICU. Most cases are mild and heal themselves with little or no vision loss. In more severe cases, the ophthalmologist may treat the abnormal vessels with a laser or with cryotherapy (freezing) to protect the retina and preserve vision.
- Jaundice: Premature babies are more likely than full-term babies to develop jaundice because their livers are too immature to remove a waste product called bilirubin from the blood. In addition, premature infants may be more sensitive to the ill effects of excess bilirubin. Babies with jaundice have a yellowish color to their skin and eyes. Jaundice often is mild and usually is not harmful; however, if the bilirubin level gets too high, it can cause brain damage. If blood tests show an infant’s bilirubin level is too high, the baby will be treated with special lights (phototherapy) that help the body eliminate bilirubin. Occasionally, a baby may need a blood transfusion.
- Anemia: Premature infants often are anemic, which means they do not have enough red blood cells. Normally, the baby will store iron during the later months of pregnancy and uses it late in pregnancy and after birth to make red blood cells. Infants born too soon may not have had enough time to store iron. Babies with anemia tend to develop feeding problems and grow more slowly; anemia also can worsen any heart or breathing problems. Anemic infants may be treated with dietary iron supplements, drugs that increase red blood cell production or, in severe cases, blood transfusion.
- Chronic lung disease (also called bronchopulmonary dysplasia or BPD): Chronic lung disease most commonly affects premature infants who require ongoing treatment with supplemental oxygen. The risk of BPD is increased in babies who still need oxygen when they reach 36 weeks after conception (weeks of pregnancy plus weeks after birth adding up to 36 or more weeks). These babies develop fluid in the lungs, scarring and lung damage, which can be seen on an X-ray. Affected babies are treated with medications that make breathing easier and are slowly weaned from the ventilator. Their lungs usually improve over the first two years of life. However, some children develop chronic lung disease resembling asthma.
- Infections: Premature babies have immature immune systems that are inefficient at fighting off bacteria, viruses and other organisms that can cause infection. Serious infections that are commonly seen in premature babies include pneumonia (lung infection), sepsis (blood infection), and meningitis (infection of the membranes surrounding the brain and spinal cord). Babies can contract these infections at birth from their mother or they may become infected after birth. Infections are treated with antibiotics or antiviral drugs.
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Centers for Disease Control
American Academy of Pediatrics
Premie Milestones Brochure
A Primer on Premies
March of Dimes
National Institute of Child Health and Human Development (NICHD)
Preterm Labor and Birth