Babies born before the 37th week of pregnancy are considered premature or “preterm” babies in medical language. Babies who are born at the normal time are called “full-term”. When a baby is born prematurely, the mother is often scared and nervous, as premature newborns are at greater risk of complications.

Why do premature babies need special care?

Premature babies are not ready to cope with life in our world. Their little bodies still have parts that are not fully developed, such as their lungs, digestive system, immune system, and skin. Fortunately, medical technology has made it possible for premature babies to survive during their first days, weeks, or months of life until they are strong enough to do so on their own.

What health problems can premature babies have after birth?

The health problems that can affect premature babies include:

  • Apnea – This is a pause in breathing for 20 seconds or more. Premature babies sometimes have apnea. It may occur together with a slow heart rate.
  • Respiratory distress syndrome (RDS) – Also called Hyaline Membrane Disease, it is a common respiratory problem in babies born before 34 weeks of pregnancy. Babies with RDS lack a protein called surfactant that keeps the tiny air sacs in the lungs open and helps prevent respiratory collapse.
  • Intraventricular hemorrhage (IVH) – This is bleeding in the brain. It usually happens near the ventricles in the center of the brain. A ventricle is a space in the brain that is filled with fluid.
  • Patent ductus arteriosus (PDA) – This is a heart problem that happens in the connection (called the ductus arteriosus) between two main blood vessels near the heart. If the duct does not close properly after birth, a premature baby may have breathing problems or heart failure. Heart failure is when the heart cannot pump enough blood.
  • Necrotizing enterocolitis (NEC) – This is a problem with the baby’s intestine. It can cause feeding problems, a swollen belly, and diarrhea. Sometimes it happens 2 to 3 weeks after a premature birth.
  • Retinopathy of prematurity (ROP) – This is an abnormal growth of blood vessels in the eye. ROP can lead to vision loss.
  • Jaundice – This is when a baby’s eyes and skin appear yellow. A baby has jaundice when the liver is not fully developed or is not working well.
  • Bronchopulmonary dysplasia (BPD) – This is a lung condition that can develop in premature babies as well as babies who have been treated with a respirator. Babies with BPD sometimes develop fluid in the lungs, scarring, and lung damage.
  • Infections – Premature babies often have trouble fighting germs because their immune systems are not fully developed. Infections that can affect a premature baby include pneumonia (a lung infection), sepsis (a blood infection), and meningitis (an infection of the fluid around the brain and spinal cord).

They can also have long-term health problems that may affect their entire lives.

Getting to Know the Neonatal ICU

The earlier the baby is born, the higher the chance that they will need more intense medical care. Some premature babies have to stay longer in the neonatal intensive care unit of a hospital (also called NICU). This is the part of a hospital that cares for sick newborns or those who need special care. Thanks to advances in medical care, better treatment and greater chances of survival are now possible for premature babies—unlike in the past. The neonatal ICU is the environment that welcomes the premature baby and will be their refuge for a limited time. Therefore, it is good for parents to get to know each part of it and make it familiar. In the neonatal ICU is the full team of doctors and nurses who provide all the necessary support to the baby during their “stay”. It also features monitoring systems and alarms, respiratory equipment and resuscitation devices, access to doctors in all pediatric specialties, and 24-hour laboratory services. The quantity of equipment in the neonatal ICU can be intimidating, but understanding how the various machines and devices work can help parents feel more relaxed.

Feeding Premature Babies

Premature babies start feeding while still in the hospital. This feeding can be given through a vein, via a tube, or directly from the mother’s breast, but it very much depends on the baby’s health status. Premature babies, as mentioned earlier, do not have a mature intestine and many cannot nurse because they have not yet learned to suck and swallow. That’s why it is necessary to start feeding through a vein or tube. The premature baby can be fed with breast milk or with special premature infant formula developed just for them.

How is the feeding done in the hospital?

In the hospital, feeding for the premature baby is sometimes started as follows:

  • Through a vein – This method delivers nutrition directly into the baby’s bloodstream by means of a serum. It is used for premature babies with immature digestive systems who cannot suck, swallow, and breathe normally. This method is sometimes used while treatment for other health complications is being prepared. This approach uses a needle that can be inserted into the scalp, arm, or leg.
  • Umbilical catheter – This painless method involves a tube that is surgically placed in a blood vessel of the umbilical cord. However, there are risks associated with this method, such as infection and blood clots. Therefore, this method is usually only used in the most critical cases and when the baby may need this type of feeding for several weeks. For these babies, it is the safest and most effective way to receive nutrients.
  • Oral and nasal feeding – This method uses a narrow, flexible tube that is inserted into the baby’s nose or mouth and goes to the stomach. Through the tube, special infant formulas for premature babies or breast milk can be given. It is a solution for babies who are ready to digest breast milk or formula but have not yet developed the ability to suck, swallow, and breathe in a coordinated way.

When can premature babies breastfeed?

Premature babies can breastfeed when their general health improves and they can suck and swallow breast milk. In this transition phase, a technique called supplemental nursing or relactation may be used, in which the baby is placed at the breast still with the tube, to learn to latch and suckle at the breast. Breastfeeding, just as with full-term babies, should be done every 2 to 3 hours, according to the baby’s needs. Premature babies generally do not breastfeed right after birth. Even so, the mother should stimulate her breasts so that her milk will come in. By making circular motions around the edge of the areola every 3 hours, then pressing the areola to extract the milk. At first, only a few drops or a minimal amount of milk may come out—this is normal. It’s just the amount the baby can take in because their stomach is still very small. As the baby grows, breast milk production will also increase, so the mother does not need to worry or feel she has little milk.

The ideal type of milk for premature babies

Breast milk is the only food that contains all the vitamins and proteins the baby needs, whether born at term or prematurely. However, due to prematurity, many babies cannot be breastfed by their mothers, so their feeding is done with specially formulated infant formulas for their condition, which contain all the nutrients needed for their nutrition. There are several brands of premature baby formula, but each has its own indication, so it is important to consult a pediatrician to determine which one best meets the baby’s needs.

Kangaroo Method?

The kangaroo method is a technique widely used in neonatal ICUs and involves placing the premature baby in an upright position on the mother’s bare chest, allowing for skin-to-skin contact. The baby is positioned between the mother’s breasts and their head is turned so that their ear is above her heart. Many studies have shown that the kangaroo method offers significant benefits such as:

  • Body temperature – Studies have shown that a mother can synchronize her body temperature with the baby, and if the baby is cold, her body temperature rises to warm the baby, and vice versa.
  • Breastfeeding – The kangaroo method gives easy access to breastfeeding, and skin-to-skin contact increases milk production.
  • Increase in weight gain – the kangaroo method helps babies fall into a deeper sleep, allowing them to direct more energy to other bodily functions. Greater weight gain also means a shorter hospital stay.
  • Greater bonding and intimacy.

Development of Premature Babies

Most premature babies develop normally. Extremely premature, low birth weight, and sick babies are at greater risk of developmental problems. But even in these cases, many babies still develop normally.

Development concerns – What is corrected age?

It is always important to keep a close eye on the development of a premature child. But it is also worth remembering that there is a wide range of “normals” when it comes to development. Also, corrected age can be very helpful if parents are concerned about the baby’s development. For example, if a premature baby is one year old but was born three months early, their corrected age is only nine months. This means that they should be compared to babies of nine months of age, in terms of development, and not one-year-olds.

Language development in premature babies

Children learn to speak at different times from each other. Most premature babies develop normal language, but language development is often, but not always, uncertain or delayed. The smallest and most premature babies are at greater risk than late-preterm babies. Compared to full-term babies, prematures have more trouble saying things and understanding what is said to them. But this does not mean all early-born children will have language problems. Some will, but others will have excellent language development. Language problems can also be early signs of hearing or cognitive problems.

Physical development in premature babies

Most premature babies have normal physical and motor development. Premature babies tend to be smaller and lighter than full-term babies. If these babies were very ill, sometimes this can affect their growth up to at least 12 years old. But others catch up during preschool and school years.

Motor problems

Physical and motor problems are more likely in very premature or low birth weight babies. The medical team will check for early signs of physical movements and problems with body control, for example, differences in muscle tone on different sides of the baby’s body while still in the neonatal intensive care unit. Referrals for early intervention are often based on these exams. After the premature baby is discharged, parents can check physical development with a pediatrician and compare it to the corrected age. About 40% of very premature children have mild motor impairment. These include problems with:

  • Fine motor skills – for example, doing a puzzle or holding a pencil
  • Motor planning – for example, understanding, planning, and doing something like walking around fallen blocks
  • Visuomotor coordination – for example, writing or drawing
  • Sensorimotor skills – for example, feeling the weight of a full glass and picking it up without spilling.

About 10 to 15% of premature babies have more serious motor impairment, often known as cerebral palsy. The risk of cerebral palsy is higher among very premature babies whose brains did not develop fully (up to 45% of cases of cerebral palsy happen this way). Babies who are very ill in the NICU are also at greater risk for cerebral palsy. Getting a clear cerebral palsy diagnosis before 12 months is not always easy, as a diagnosis considers developmental milestones like sitting, crawling, and walking.

Teeth

Premature babies are more likely to have dental problems than full-term babies. This may happen because while hospitalized they had a breathing tube pressing against the roof of their mouth, or due to lack of calcium and phosphorus that they did not receive adequately since they left the womb early. Dental problems can include:

  • Abnormal dental enamel (the white outer covering of a tooth) – the tooth may look gray or brown, or have an irregular surface. Cavities form more easily in teeth with poor enamel.
  • Late teeth – premature babies’ teeth usually come in a few months later than full-term babies’ teeth, but they emerge in the correct order.
  • Very arched palate – this can affect speech and bite alignment. Most children adapt to the shape of the palate, but some may need braces later.

Sensory development in premature babies

Most premature babies have normal sensory development. But premature babies are more likely to have hearing or vision impairments. Some parents say their premature babies have sensory sensitivities, such as being more sensitive to certain stimuli, like loud noises or certain types of fabrics. Some premature babies do not like things placed in their mouths and may have major trouble feeding. Also, their pain sensitivity is lower compared to full-term babies.

Hearing

Children born prematurely are more likely to have hearing loss. But this is just about 2 to 6% of premature babies, and it is more common in babies born before the 30th week of pregnancy. Some of them have severe hearing loss in both ears and need hearing aids or cochlear implants. Most babies have their first hearing screening test while still in the hospital. This test detects most hearing problems, but some are diagnosed later. It is important to diagnose and address hearing loss because children need to hear well to develop language, social, and communication skills.

Vision

Premature babies are more likely than full-term babies to have mild visual problems such as nearsightedness or farsightedness. Only 1 to 12% of premature babies develop serious vision problems, and this is more common in very premature babies. The most serious vision problems will be detected very early. Very premature babies undergo regular eye exams while still in the hospital, which allows for early treatment.

Reasoning development in premature babies

From the beginning, babies are learning about the world all the time, building thinking skills and testing how things work. Most premature babies have normal reasoning and learning (cognitive) development. Very premature or extremely low birth weight babies, or those who have had many medical complications, have a higher risk of problems with reasoning. A very small proportion of children born prematurely will have severe problems and learning difficulties. Health professionals often use IQ tests to check children’s reasoning skills. Average scores for very premature or very low birth weight children are within the normal range, but also slightly lower than the average for full-term children of the same age. This means that the majority of premature children can do well at school. Parents may not notice any problems until their premature child goes to school. That is when children have to bring together their reasoning skills for problem-solving activities. For example, reading involves visual memory, auditory memory, and letter recognition. If a child has a problem in any of these areas, it can interfere with their ability to learn to read. So they will need extra support at school.

Social and emotional development in premature babies

Social and emotional development is learning to recognize and manage feelings, understand how others are feeling, express feelings, and interact positively with others. Being able to manage feelings is crucial to all areas of development. It helps to pay attention, work towards goals, develop friendships, gain independence, and express what is going on to others. Most premature babies have normal social and emotional development, but they may behave differently from full-term babies. For example, crying is a baby’s way of communicating that they need something. Premature babies in the neonatal intensive care unit tend not to cry much, except perhaps during painful procedures. In their first year, premature babies are more likely to sleep than to engage. They may also look away or get irritable. They are less likely to engage socially than full-term babies. As the baby matures, this becomes less of an issue. When a premature baby’s needs are met, they will gradually learn to reach out into the social world and communicate more.

Social and emotional problems

If a child has “social and emotional problems,” it means the child is having trouble adjusting to their environment, following rules, and socializing with other children and adults. It is normal for all children to misbehave sometimes or get upset when their needs are not met. However, children born prematurely are more likely to struggle to cope and manage their feelings. They may find it difficult to keep calm, eat well, or sleep well. Some may experience low self-esteem or have trouble making friends. Premature children are more prone than full-term children to conditions such as attention deficit hyperactivity disorder, autism, anxiety, and depression. However, these problems still affect only a small number of children born prematurely. Premature babies are fragile, but also extremely persistent in their daily fight. It’s up to parents to help them in the best way possible and love them unconditionally. See Also: Premature Birth – Why Does It Happen? Photos: SeppH, Polihale