Infants born prematurely literally start life a little bit behind. Their lungs may not be well enough developed to absorb oxygen and discharge carbon dioxide. Their intestinal tracts may not absorb food well and their central nervous systems may not allow them to maintain temperature stability.
Occasionally they may need extra oxygen by tube, nasal prongs or even need a respirator. Intravenous calories can nourish and sustain the most vulnerable preemies and a gradual transition from tube feeding to breast or bottle will let the stomach and intestines mature without risking harm.
Even babies born a week or two early can have “respiratory distress syndrome of prematurity”–or RDS as it’s called–but this is much more likely under 34-35 weeks gestation (5-6 weeks early.) If premature delivery is anticipated and can’t be stopped, an obstetrician will give the mother-to-be an injection of steroids to speed up lung maturation. This relatively simple and apparently harmless medication has saved countless babies’ lives and kept others from prolonged hospitalizations. Your doctor may not have a lot of time to explain this fully to you when it’s needed on an emergency basis but please know that it works and is safe.
Below I answer frequently-asked questions about the impact of prematurity on infant survival, development, vaccination decisions, and family dynamics.
Q: My sister-in-law delivered 5 weeks early. She smokes, and I’ve heard that smoking can trigger early labor. Is that true? What are my chances of having a premature baby?
A: Yes, smoking and poor (or absent) prenatal care increase the risk of prematurity. Low maternal weight, poor nutrition, drug abuse, maternal age under eighteen years or over forty may lead to prematurity. An attentive doctor in partnership with a healthy aware mom-to-be should recognize many of the risk factors and then the signs of pre-term labor. Premature labor can often be stopped with decreased activity, bed rest and medication. Please make sure you discuss these signs and symptoms with your doctor in early pregnancy visits.
Anatomical problems such as an incompetent cervix, fibroid tumors and unusual uterine shape may predispose a woman to early labor and delivery, too.
Q. “My friend’s baby has been diagnosed with cerebral palsy. He was born 8 weeks early, was in the hospital for over six weeks and had quite a few complications during that hospitalization. Is cerebral palsy associated with prematurity?”
A. Babies with neurological abnormalities or physical anomalies may be born early. We’re not quite sure why.
We’re also not sure if “cerebral palsy” (a broad diagnosis which encompasses motor and intellectual problems of infancy, childhood and beyond) is the cause of the premature birth. The other possibility is that babies who go through hard deliveries and then require extra oxygen, develop infections and have rocky hospital course suffer some injury to the nervous system and develop the neurological problems which we call cerebral palsy.
This is a medical and a medicolegal issue and an extremely difficult discussion with your doctor. The prognosis for recovery is tremendously varied and I have seen many babies who looked pretty bad at the beginning make great recoveries as the months and years go by. I have become certain that optimism is almost always warranted.
Here’s the hardest part: Very few people have spent much time in a Newborn Intensive Care Unit. Here is what you will see: The premature infant will have at least one and sometimes as many as three IV lines. One or two may originate from the belly button where the umbilical blood vessels provide the best access for fluids and medicine. Extra oxygen may be delivered with a hood, mask, nasal prongs or through an endotracheal tube from a respirator. A preemie can look much more fragile and much sicker than he actually is and the first reaction may be panic and fear. Make certain that everything, absolutely everything, is explained to you during those first hours and that re-explanations and updates are given frequently.