Premature birth – every day medical information

A premature birth is a birth that occurs more than three weeks before the due date, or a birth that occurs before the start of the 37th week of pregnancy (the ninth month). Babies born long before their due date usually have complex medical problems. The complications associated with this condition vary, but the earlier the date of delivery, the greater the risk of developing these complications.

Symptoms of premature birth

Your baby may have very few symptoms of preterm birth, or he may have no symptoms at all. Some of the symptoms that may appear include:

• Small size, with a large asymmetric head.
• Severe appearance, where the round features are reduced compared to the child born at the time, due to the lack of fat stores.
• Thin hair (vellus) that covers most parts of the body.
• Decreased body temperature, especially immediately after birth in the delivery room, as a result of a lack of stored fat.
• Difficulty breathing, feeling short of breath.
• Inability to suck or swallow, which leads to difficulties in feeding.

special care

If you delivered a baby prematurely, he or she will likely need to stay in the hospital longer in a special care unit. According to the amount of care that the child needs, he can be admitted to the intensive care unit, and the doctors and medical team specialized and trained in dealing with such cases, will provide assistance to the child, and do not hesitate to ask any questions you think of.

Your baby may need extra help with feeding and adjusting soon after birth. The medical team can help you understand what you and your baby need, and what plan to sell.

Preterm birth risk factors

The exact cause of preterm birth is often unknown, but there are known risk factors for preterm birth, including:

• Previous exposure to preterm birth.
• Pregnancy with twins, triplets or more.
• A period of less than six months between each pregnancy.
• Pregnancy by artificial insemination.
• Having problems with the uterus, cervix or placenta.
• Smoking cigarettes or using illegal drugs.
• Some infections, especially those affecting the amniotic fluid (the fluid that surrounds the fetus), and the lower reproductive system.
• Certain chronic conditions such as high blood pressure or diabetes.
• Weight gain or loss before pregnancy.
• Stressful life events such as the death of a loved one or domestic violence.
• Repeated miscarriage.
• Physical injury or exposure to trauma.

Preterm birth can happen to any woman, and many women who have this condition don’t have any known risk factors.

Complications of premature birth

Although not all premature babies have complications, premature birth can cause both long-term and short-term problems. The earlier a baby is born, the higher the risk of complications. The weight of the child at birth also plays an important role. Some problems may be apparent at birth, while others may not appear until later.

short term complications

Complications of preterm labor in the first weeks can include:

Breathing problems

A prematurely born baby may face breathing problems due to the immaturity of the respiratory system. If the child’s lungs are deficient in surface activity factor (a substance that allows the lungs to expand), the child may have respiratory distress syndrome, because the lungs have difficulty expanding and contracting normally.

Babies can also have a syndrome known as bronchopulmonary dysplasia, and some premature babies may have long pauses in breathing, known as apnea.

heart problems

The condition of the open ductus arteriosus is one of the most common heart diseases that affect premature babies, along with low blood pressure. An open ductus arteriosus is a permanent opening between the aorta and the pulmonary artery.

This opening often closes on its own, but if left untreated, it can lead to heart sounds and heart failure, among other complications. Low blood pressure may require intravenous fluids, medications, and blood transfusions in some cases.

brain problems

If a baby is born prematurely, the risk of a brain haemorrhage known as intraventricular hemorrhage increases. Most of these types of bleeding are minor and go away without serious effects, but some infants are prone to bleeding in the brain that causes permanent brain injury.

Temperature control problems

Babies born prematurely can lose their body heat quickly, because their bodies do not have the amount of stored fat that healthy babies have, and they cannot generate enough heat to replace the lost heat.

If the body temperature drops too low, babies can develop a condition known as hypothermia, and a premature baby with this condition can cause breathing problems and low blood sugar levels.

The baby may also use up all the energy gained from feeding to get warm, so premature babies need extra heat from a warmer until they are able to maintain body heat without any help.

Digestive problems

Babies born prematurely are more likely to have problems with the digestive system, causing complications after initiation of feeding such as enteritis, which results in infection of the cells that line the wall of the intestine. Babies who get only breast milk are less likely to get IBD.

blood problems

Premature babies have blood problems such as anemia and jaundice (jaundice). Anemia is a common condition in which the body suffers from a lack of red blood cells. Although newborns suffer from a decrease in the number of red blood cells during the first months, this decrease can be greater than that of children born before their due date.

Jaundice is the yellow color of the baby’s skin and eyes, because the baby’s blood contains an excess amount of bilirubin , a yellow substance found in the liver or red blood cells. Although there are many causes of jaundice, it is more common in preterm babies.

Metabolic problems

Premature babies usually have problems with their metabolism. Some premature babies may have low blood sugar. This can happen because premature babies have smaller glucose stores than healthy babies. Premature doctors also have difficulty converting stored glucose into stable, active glucose.

Immune system problems

An underdeveloped immune system, which is typical for premature babies, can increase the risk of infection. In premature infants, infection can spread rapidly into the bloodstream, causing sepsis.

Long-term complications

A premature birth can cause long-term complications, including:

Cerebral Palsy

Cerebral palsy is a disorder that affects movement abilities, muscle strength, and posture. It can occur as a result of infection, poor blood flow, or injury to a newborn’s brain, either early in pregnancy or when the baby is young or immature.

deterioration of learning abilities

Premature babies are likely to lag behind other babies at important developmental milestones. These children may have learning difficulties, upon reaching school entry age.

vision problems

Premature babies may have retinopathy of prematurity, a disease that occurs when blood vessels swell and overgrow in the layer of light-sensitive nerves at the back of the eye (retina).

Sometimes the damaged blood vessels of the retina cause scarring of the retina itself, and it does not move from its normal position. When the retina is pulled from its position at the back of the eye, this condition is called retinal detachment, a condition that, if undetected, can cause damage to vision and can even lead to blindness.

Hearing problems

Babies born prematurely are at some risk of developing some hearing loss. Children’s hearing abilities are checked in the hospital before they go home.

Dental problems

Babies resulting from premature birth, who were in a critical condition, are at high risk of dental problems such as delayed tooth growth, tooth discoloration and improper alignment of the teeth.

Behavioral and psychological problems

Babies who have been born prematurely may suffer from behavioral and psychological problems, and they may suffer from developmental delays.

chronic health problems

Premature babies can suffer from chronic health problems, some of which require hospitalization. They may suffer from infections, asthma and problems with feeding, on an ongoing basis. They are also at high risk of Sudden Infant Death Syndrome.

Prevention of premature birth

Although the main cause of preterm birth is not known, there are some things that can be done to help women at risk of preterm labor to reduce this risk, including the following:

progesterone supplement

Women who have a history of preterm labor or a small cervix, or who have all of these factors, may be able to reduce their risk of preterm birth with progesterone supplementation.

cervical cerclage

This surgical procedure is performed during pregnancy in women who have a short cervix, or have previously shortened the cervix, resulting in premature labor.

During this procedure, the doctor encircles the cervix with strong stitches, which can provide support to the uterus. The stitches are then removed near the time of delivery. Ask your doctor if you need to avoid any strenuous activity for the remainder of your pregnancy.

Diagnosis of premature birth

After the baby is transferred to the incubator, he may undergo several tests, and some other tests are done if the medical team suspects certain complications. Possible examinations for the child may include:

Monitor breathing and heart rate

The child’s breathing and heart rate are continuously monitored, and blood pressure is continuously measured.

fluid control

The medical team carefully monitors the amount of fluid your child gets during feeding and through intravenous fluids, and the amount of fluid the child loses through diapers.

blood tests

Blood samples are collected with a stick known as a heel stick or with a needle inserted into a vein to monitor a number of important elements such as sodium, glucose and bilirubin levels in the baby’s blood. A blood sample may be analyzed to measure the number of red blood cells, check for anemia, or evaluate this sample to look for any infections.

If the doctor anticipates that the condition requires obtaining several blood samples, the medical team may place an intravenous line, to avoid prick the child with a needle each time the doctor needs a blood sample.

echocardiography

An echocardiogram is an ultrasound of the heart, to look for problems with heart function, and is somewhat similar to a fetal ultrasound. An echocardiogram uses sound waves to create images of the heart, which are displayed on a monitor.

Ultrasound examination

An ultrasound can be done to look for any cerebral hemorrhage or fluid buildup, or to examine the abdominal organs to see if there are any problems in the digestive system, liver or kidneys.

eye check

The eye doctor checks the baby’s eyes and vision to look for any problems with the retina (retinopathy of prematurity). If your child has any complications, some other specialized tests may be required.

premature birth treatment

The Infant Special Care Unit provides round-the-clock care for a premature baby. Supportive care for your child may include:

• Put the child in an incubator, to maintain a normal body temperature.
• Monitor baby’s vital signs such as blood pressure, heart rate, breathing and temperature.
• Use a feeding tube, to get the necessary fluids and nutrients.
• Monitor how much fluid your child needs each day, such as sodium and potassium levels, and if any extra fluids are required, get them intravenously.
• Put the child under bilirubin lights for a period of time, to treat jaundice, and the child will put on a protective eye mask, so that he can feel comfortable.
• Obtaining a blood transfusion, to raise the level of blood, especially if the child has had blood samples drawn several times for various tests.

pharmaceutical

Your child may be given medications to help him grow and to stimulate the normal functions of his lungs, heart and blood circulation. Depending on your child’s condition, medications may include:

• Pulmonary surfactant, a drug used to treat respiratory distress syndrome.
• Fine mist or IV medication, to improve breathing and heart rate.
• Antibiotics, if an infection is present, or there is a potential risk of infection.
• Medicines that increase the amount of urine leaving the body (diuretics), to control excess fluid.
• Injecting a drug into the eye, to stop the growth of new blood vessels that cause retinopathy in premature infants.
• Medicines that help close the heart’s play called ductus arteriosus.

surgery

Surgery can sometimes be necessary to treat a number of conditions associated with preterm birth, so talk to your doctor and medical team to understand the complications that may require surgical intervention, and learn about the surgery that can be used to treat these complications.

Bringing the child home

The child is ready to go home in the following cases:

• He can breathe without any help.
• It can maintain a constant body temperature.
• He can breastfeed from the mother or by bottle.
• Constantly gaining weight.
• If he does not have any infection.

In some cases, the child may go home before they meet some of the above requirements, as long as the doctor and medical team develop an agreed plan, to care for the child at home and monitor his condition.

The doctor and his team will help you learn how to care for your baby at home. Before leaving the hospital, the hospital staff will ask you about the following:

• Living arrangements.
• The presence of any other children in the manhole.
• Having relatives or friends who can help care for the baby.
• Primary care for children.

Lifestyle and some home remedies

You may feel relaxed, happy and stressed at the same time, when it’s time for the baby to come home, so you should take some time to think of ways to prepare for your baby’s presence at home, and you can do the following:

Knowing how to take care of your child

Before leaving the hospital, you can read the information available on how to resuscitate a baby’s heart, and you can ask the doctor and medical team any questions you want to know. Make sure you can take care of the baby, especially if you need to use medications, use special monitors, give the baby oxygen or other treatments. Discuss symptoms, such as the baby’s breathing or feeding problems, which may require a call to the doctor.

Discuss breastfeeding methods

Ask the doctor about the supplements that the child needs, whether through breast milk or alternative formulas for breast milk. And remember that premature babies usually need less food and more feedings, compared to healthy babies. You should ask the doctor to find out how often and how much food your child needs.

Protect your child’s health

Premature babies are more susceptible to serious infections than other infants, and try to reduce your baby’s exposure to crowded places, and first ensure good hand hygiene for anyone who wants to pet your baby.

And ask people who are sick to postpone their visit to your baby, until they recover, because babies from premature birth are at high risk of infection in the lungs and respiratory tract. Your pediatrician might suggest a preventative treatment called palivizumab, which can help your child prevent any serious infections.

An organized schedule of follow-up visits

Discuss your child’s need for future follow-up appointments with the doctor. The child may need to see the doctor initially every week or every two weeks, to monitor his growth and medical needs.

Follow up on vaccinations

Although it is suggested that vaccinations or vaccinations be given according to the age of the child to stabilize the medical condition of premature babies, there is a possibility of delays in the vaccination schedule. And communicate with the pediatrician to follow up on vaccinations as scheduled.

You can also protect your child by making sure everyone else gets their vaccinations, including the flu shot. Pregnant women, family members, and all adults should also check that they have the pertussis vaccine.

Monitor for any developmental delays

The doctor may watch for any delays in the child’s development or disabilities in the coming months. Children who are classified as at risk receive more accurate assessment and care.

Adaptation to the situation and support

Caring for a prematurely born baby can cause physical and psychological stress, as you may be concerned about your baby’s health and the long-term effects of a postpartum pregnancy. You may feel angry, guilty, or tired, so the following suggestions can help you get through these tough times:

• Learn everything you can about your child’s condition, through books or trusted sources.
• Take care of yourself, you should get enough rest and eat healthy foods.
• Use a breast pump until the baby is able to breastfeed normally.
• Accept help from others. They can take care of your other babies, help prepare food and meet household needs, so you can save your energy for your premature baby.
• Record all the details of your baby’s progress, along with your own thoughts and feelings. And you can put pictures of your child to note the changes that he is exposed to over the days.
• Talk to your partner, friends and family about your feelings. You can talk to the medical team or you can find support groups in your area. Many parents feel that talking to other parents with the same condition can be helpful.

Taking care of a child is a huge challenge, so take it step by step, and despite the worries and setbacks, you should celebrate your child’s sudden strength to survive and resist, and value the time you spend with him.

Getting ready for the doctor’s appointment

Uncertainty about your child’s condition, and seeing the monitors in the ICU, can be frightening. You can ask the doctor and the medical team all the questions that you want to know the answers to. Among the questions that you can ask the doctor are:

• What is the condition of my child? Has anything changed?
• How does this device help my child?
• Why do you give my child these medicines?
• What types of tests does my child need?
• When can I carry my baby? Can you show me how I can carry it?
• How long will my baby continue to get food by tube?
• When can I breastfeed my baby or by bottle?
• When will my child be able to focus his eyes?
• How should I contact if I have any questions related to my child’s health?
• Can I bring a blanket or family photos and put them in the care room?
• What can I do to take care of my child while he is in the incubator?
• When will my child be able to go home?
• What do I need to know so that I can take care of my child when he comes home?
• How often should we come back for follow-up after we leave the hospital?

And don’t hesitate to ask any questions while your child is in the incubator, and don’t hesitate to ask for your participation in your child’s treatment as well, as this participation can give you confidence in yourself as a new mother, and it can also help when the child returns home.