Because premature babies are born before they are physically ready to leave the womb, they often face some health problems. That's why preemies are given extra medical attention and help immediately after delivery.
Depending on how premature your baby is, your pediatrician or obstetrician may call in a
neonatologist. This is a pediatrician who specializes in the care of premature or very ill babies. The neonatologist can help determine what, if any, special treatment your newborn needs.
Here are some of the most common health conditions in premature babies and possible treatments to help them thrive.
Respiratory distress syndrome
Respiratory distress syndrome (RDS) is a breathing disorder related to the baby's immature lungs. It happens because the lungs of preterm babies often lack a liquid called surfactant. Usually, in full-term babies, this liquid lines tiny air sacs in the lungs. It's helps them stay expanded at the end of each breath, letting oxygen into the blood and carbon dioxide out.
Treatment for RDS
Doctors can treat some premature babies with artificial surfactants. In addition a high-flow nasal canula, continuous positive airway pressure (CPAP) machine, or breathing machine (ventilator) can help them breathe better and keep blood oxygen levels up. See
When Baby Needs Oxygen At Home for more information.
Bronchopulmonary dysplasia
Bronchopulmonary dysplasia (BPD), also called chronic lung disease of prematurity, is when newborns need oxygen therapy for several weeks or months.
Treatment for BPD
Babies tend to outgrow this condition as their lungs grow and mature. Those with moderate to severe BPD, however, may have longer-term health problems with lung growth and development. Your baby's medical team will discuss care for these conditions before you take your baby home.
Apnea
Apnea of prematurity (AOP) is a temporary pause (of more than 20 seconds) in breathing. It is common in preterm infants. With apnea, there is often also a drop in heart rate, called bradycardia and a decline in the amount of oxygen in the blood (called desaturation).
Apnea, bradycardia, and desaturations are monitored using cardiorespiratory monitors, which track heart rate and breathing, along with pulse oximetry to measure blood oxygen.
How is apnea treated in premature babies?
To treat apnea, your baby may get caffeine, extra oxygen through a small tube in the nose (called a nasal cannula), or breathing support with CPAP. In more serious cases, a breathing machine may be needed.
Rarely, apnea can result from infection or other causes, such as anemia, low blood sugar, or
necrotizing enterocolitis (NEC). Your baby’s care team will talk with you about what’s causing the apnea, how they plan to treat it, and what it means for your baby. The good news is that most infants outgrow the condition by the time they leave the hospital.
Retinopathy of prematurity
Retinopathy of prematurity (ROP) is when the retina, the light-sensitive lining at the back of the eye, hasn't fully developed yet. This can sometimes cause abnormal blood vessels to grow bleed.
Treatment for ROP
In most babies, ROP gets better on its own without any treatment. But in more serious cases, doctors might need to treat it using laser surgery or special eye injections. If not treated, ROP can sometimes lead to vision problems like myopia (nearsightedness) or even blindness.
A pediatric eye doctor (called a pediatric ophthalmologist or retina specialist) will check your baby’s eyes to see if they have ROP or any other vision issues and will guide you on what to do next if treatment is needed.
Intraventricular hemorrhage
Intraventricular hemorrhage (IVH) is bleeding inside or around the ventricles, spaces in the brain that contain cerebrospinal fluid. IVH is most common in premature babies, especially very-low-birth-weight babies (less than 3 pounds, 5 ounces, or 1,500 grams). Bleeding can happen, since blood vessels in a premature baby's brain are very fragile and immature. They can rupture easily. Most babies affected by IVH develop the condition within the first week after birth.
How is IVH diagnosed?
IVH is diagnosed by doing an ultrasound examination of the head. Mild hemorrhages (grades 1 and 2) are most common, and often occur with no further complications. Severe hemorrhages (grades 3 and 4) are the most serious and may result in long-term brain injury to the baby.
When IVH leads to hydrocephalus
Hydrocephalus (too much cerebrospinal fluid in the brain) may develop after severe IVH. It results from the block in the flow of the cerebrospinal fluid within the brain and/or the spinal cord. If the ventricle size increases, causing pressure on the developing brain, a small reservoir is surgically placed to all spinal fluid to flow away from the brain and into the belly.
Often, hydrocephalus resolves on its own. However, if the head size increases and the baby weighs more than 4 pounds 6.6 ounces (2 kg), a ventriculoperitoneal shunt may have to be placed. Your neonatologist and neurosurgeon will explain its pros and cons to you prior to surgery. There is no specific treatment for IVH, except to treat any other health problems that may worsen the condition. Although care of sick and premature infants has advanced greatly, it is not possible to prevent IVH from occurring in some babies.
Cerebral palsy
Babies born prematurely, particularly those who have IVH or hydrocephalus, are at risk for cerebral palsy (CP). Cerebral palsy is a disorder of the brain's control of movement, strength or posture.
Screening for cerebral palsy
Babies can be screened for cerebral palsy using specialized examinations. You should discuss this with your baby's doctors. Identifying babies at risk for CP is important, as earlier physical therapy can lead to improved outcomes.
Infections
Preterm babies are at risk for infection, since their immune systems are not fully developed yet. The tricky part is that the signs of infection can look a lot like the usual challenges that come with being born early. These include apnea, slow heart rate, low blood oxygen, the need for breathing and oxygen support, a swollen belly, trouble feeding and low blood pressure.
Testing for neonatal sepsis
Because these symptoms can be caused by either prematurity or an infection, extra caution is needed. If your baby shows these symptoms, they may have a sepsis workup. This includes blood, urine and sometimes spinal fluid tests.
The baby may also receive antibiotics. If cultures are negative after 48 hours, suggesting that there is no infection, the antibiotics will be stopped. Otherwise, if any of the cultures are positive, antibiotics will be given for 7 to 21 days, depending on the type of infection.
Necrotizing enterocolitis (NEC)
NEC is the most common and serious intestinal disease among premature babies. It happens when tissue in the gut, usually the small intestine is injured or inflamed. This can lead to death of intestinal tissue. In rare cases, a hole (perforation) can form in the intestinal wall.
Most cases of NEC occur in babies born before 32 weeks gestation. NEC usually develops within the first 2 to 6 weeks after birth. Signs include trouble feeding and a swollen belly. Diagnosis is confirmed with an ultrasound of x-ray exam of the baby's abdomen.
Treatment for NEC
Treatment for NEC involves stopping feedings for 5 to 10 days and giving antibiotics. If it is severe, surgery may be needed. A pediatric surgeon is usually consulted if air is detected in the infant's bowel wall, so that they can follow the baby's condition with the neonatologist and be ready to intervene if necrotic (dead) bowel or intestinal perforation is suspected. They will discuss with you when surgery may be needed. Breast milk is the single most effect way to prevent NEC in preterm infants.
Research is currently under way on the role infant-specific probiotics play in decreasing the risk of NEC.
Jaundice
Jaundice happens when a chemical called bilirubin builds up in the baby's blood. As a result, the skin may develop a yellowish color.
Treatment for newborn jaundice
Treating jaundice involves placing the undressed baby under special lights (while their eyes are covered to protect them).
Developmental delays & disabilities
Developmental delays and disabilities are common, affecting 1 in 6 of all children, but can be more common in those born prematurely.
"Developmental delay" is a term used to describe a delay in how a child plays, learns, speaks, acts and moves. Because premature babies were not yet done developing before they were born, it is not expected that they would show the same developmental skills at the same age as a full-term newborn. So, pediatricians often use a premature baby's corrected age (the age they would be if they were born on or after their due date) to determine if the child is showing any developmental delays.
Early intervention services for preterm babies
When a premature baby is in the NICU, the team may refer a child at risk for developmental delays for services such as feeding therapy, speech or physical therapy.
These early intervention services may start while the baby is still in the NICU. Or, they may be provided later by your state's early intervention system to help support learning skills that typically developing children experience in the first 3 years.
You can expect your pediatrician to ask about your child's development at each well- child visit, as they do with all children. In addition, your child will have several developmental screenings done in the first few years. You should always share any concerns you have about their child's development with your pediatrician.
What other health problems can premature babies have?
Other conditions sometimes seen in preterm babies include
anemia of prematurity (a low red blood cell count) and
heart murmurs.
Remember
Talk with your child's doctor if you have any concerns about the health of your premature baby.
More information