This topic is for people
who want to know what to expect when a baby is born early. For information
about early labor, its causes, and its treatment, see the topic
Pregnancy normally lasts
about 40 weeks. A baby born 3 or more weeks early is premature. Babies who are born closer to
their due dates tend to have fewer problems than babies born earlier. But even those who are born late preterm (closer to 37 weeks) are at risk for problems.
Doctors and nurses often
call premature babies "preemies."
premature baby may be stressful and scary. To get through it, you and your
partner must take good care of yourselves and each other. It may help to talk
to a spiritual advisor, counselor, or
social worker. You may be able to find a support group
of other parents who are going through the same thing.
When a baby is born too early, his or her
major organs are not fully formed. This can cause health problems.
Premature birth can
be caused by a problem with the
fetus, the mother, or both. Often the cause is never
known. The most common causes include:
Premature babies who are moved to the neonatal intensive care unit (NICU)
are watched closely for infections and changes in breathing and heart rate.
Until they can maintain their body heat, they are kept warm in special beds
They are usually
tube-fed or fed through a vein (intravenously),
depending on their condition. Tube-feeding lasts until a baby is able
to breathe, suck, and swallow and can take all feedings by breast or
Sick and very premature infants need special treatment,
depending on what medical problems they have. Those who need help breathing are
aided by an oxygen tube or a machine, called a ventilator, that moves air in
and out of the lungs. Some babies need medicine. A few need surgery.
Breast milk gives your
baby extra protection from infection. You can pump breast milk and bring it to the hospital for your baby.
NICU (say "NIK-yoo") nurses can teach you things you'll need to do at home to help your baby.
Before the birth, it is hard to predict how healthy a premature baby will
be. Most premature babies don't develop serious disabilities.
But the earlier a baby is born, the higher the chances of problems. Work together with your doctor and other health providers to closely watch your baby's development and try to catch any problems early on.
When you're at home, don't be surprised if your baby sleeps for shorter
periods of time than you expect. Premature babies are not often awake for more
than brief periods. But they wake up more often than other babies. Because your
baby is awake for only short periods, it may seem like a long time before he or
she responds to you.
Premature babies get sick more easily than
full-term infants. So it's important to keep your baby away from sick family
members and friends. Make sure your baby gets regular checkups and shots to
protect against serious illness.
Sudden infant death syndrome (SIDS)
is more common among premature babies. So make sure your
baby goes to sleep on his or her back. This lowers the chance of SIDS.
Health Tools help you make wise health decisions or take action to improve your health.
Learning about prematurity:
delivery may happen suddenly or after days or weeks of waiting and worrying. If
you know you may deliver early, you, your partner, and your doctor can prepare
for a premature birth.
You and your
premature infant (preemie) are considered high-risk
during preterm labor. This means that you will have less freedom, both to make
birth-related decisions and to move about freely. You can expect the
As soon as
umbilical cord is cut, the neonatal staff will
watch over and stabilize your infant. If your infant is less than 36 weeks'
gestation at birth, they may move him or her to the neonatal
intensive care unit (NICU) for observation and specialized care. If you deliver in a hospital that has no NICU, your infant may need to be taken to another hospital.
During the first hours and
days, your infant will adjust to living outside of the maternal "life-support
system." This is a time when birth defects and complications of prematurity
often become apparent.
If your infant is
born between 22 and 25 completed weeks of pregnancy (extreme prematurity), you
likely will be faced with some
difficult decisions during the first month
after the birth. These
personal stories may help you make your decision.
neonatal staff attends to your infant, the obstetric staff will care for you.
Depending on your condition, this will take
at least a few hours. Meanwhile, your birth partner may want to go with your
infant to the NICU.
Before your breast milk comes in (3 or 4 days
after childbirth), you will be asked to decide whether you plan
to breast-feed or bottle-feed your premature infant. Formula does not give your infant added
protection from early infection, so strongly consider pumping
milk for your infant for at least the first weeks of life. If
you decide to breast-feed, expect at first to pump milk for feedings until your
infant is mature enough to feed orally.
lactation consultant can be very helpful with pumping
and breast-feeding questions and problems, both before and after the birth.
For more information, see:
premature infant is moved to the neonatal intensive
care unit (NICU), you may become overwhelmed with new emotions and information.
You and your loved ones may handle issues and feelings differently, and it may
create a strain on your relationships.
Thinking of yourself and your relationships may
not be easy when you are under a lot of stress. But your child or children
depend on you to be physically and emotionally able to care for them.
Take a quiet moment and focus on yourself. Ask yourself, "How am I doing?
What do I need right now?" Try to take time to get enough rest, food,
exercise, and fresh air and sunlight. Do you have someone you can talk to: a
partner, friend, parent, spiritual advisor, or counselor? If any of these basic
needs aren't being met, make them a top priority.
A premature infant's health at
birth is influenced by many things, including:
Most infants born at 36 and 37 weeks' gestation are mature
enough to be discharged from the hospital with the mother. But many premature
infants need care in the neonatal
intensive care unit (NICU). Hospital care will be needed for:
While in the NICU or at home, many premature
infants also need treatment for
jaundice, infection, and anemia.
premature infants are resilient and surprise everyone
by overcoming great odds. Expect that
your infant can progress for several days but may then have a medical setback.
Premature infants are more likely than others to get an infection. And organs that have not had time to mature can cause a number of problems.
The more premature a newborn is, the greater is the baby's risk of having medical problems. Infants who have reached their 32nd week of
development before birth are less at risk than
those who are born earlier.
Infants born at 23 to 26 weeks' gestation are extremely
underdeveloped and have a much higher risk of death or disability.
Parents of these infants are likely to be faced with difficult
premature infant (preemie) is admitted to the neonatal
intensive care unit (NICU) after birth, you will find out about new
technologies, new medical words, and new rules and procedures.
depend on the NICU staff members, including
nurses, to know how to care for your infant and to be
your teachers. With their help, you can quickly learn about your infant's needs and what you can do for your infant. Throughout your
infant's stay in the NICU, you will want to
keep open communication with the staff.
First you'll learn to scrub up
before visiting your infant's bedside. When you're there, you may be surprised by the number of
machines and instruments surrounding your child. Remember that because of these machines your premature infant has a much greater chance of doing
well than ever before.
At a minimum, your infant will be warmed and watched over with equipment that includes:
If your infant has additional medical needs, other tests
and equipment also may be used, including:
At first sight,
you may question whether and even how to touch your tiny infant. Unless your
newborn is very sick or immature, you will be allowed to touch and possibly
hold him or her. But your infant's nurse or doctor will first need to show you
how to work around the technology and to alert you to your infant's special
needs. When visiting with your premature newborn, remember that:
If you're not able to hold or
help your infant, you can give him or her an immunity boost by providing breast
milk. Regardless of whether you plan to
breast-feed or bottle-feed later on, pumped breast
milk for tube-feeding reduces your infant's risk of infection.
As your infant grows stronger, you will be able to take on
more caregiving tasks. These range from holding and feeding to changing diapers and
bathing. You can count on the NICU nurses to teach you and answer your
questions. If you are breast-feeding, you may be asked to spend the night with
your infant to find out if he or she is strong enough to nurse around the
premature infant is considered ready to go home when
he or she is able to:
Some infants are ready to go home as early as 5 weeks
due date. Other infants, usually those who have had
medical problems, may be sent home later.
As your infant's discharge from the hospital approaches,
you may feel excitement, impatience, and a new kind of anxiety. Responsibility
for your infant's care, which has so recently required lots of technology and
medical training, is now being transferred to you. You can best prepare
yourself by learning:
You will also want to:
If home-based health care and support are
available to you, take advantage of them. Home-based services spare you and
your infant the physical and emotional stress of traveling to numerous
As you and your premature infant
adjust to being at home, you will gradually establish a routine together. During the first weeks at home, consider these
Age is both a measure of time
and a marker of development. Unlike with a full-term infant, a premature
infant's age and development can be defined in different ways. This can be
confusing. When following your premature infant's growth and
development, it can be helpful to know the difference between the following
child's first 2 years of life, he or she will appear to be developmentally
behind full-term children of the same age. But you can expect your infant and
young child to achieve the same sequence of developmental milestones as any
For more information about infant and child developmental
Expect that your premature infant's "lag" in development will catch up at
about age 2. As your child grows into the preschool
years, a 2- to 4-month difference in age or development blends right in among a
group of preschoolers. For more information about preschoolers, see
Growth and Development, Ages 2 to 5 Years.
As your child begins formal schooling, be alert for signs of learning
problems. Learning, reading, and math disabilities due to prematurity may first
become apparent during the early school years.
The website FamilyDoctor.org is sponsored by the American Academy of Family Physicians. It offers information on adult and child health conditions and healthy living. There are topics on medicines, doctor visits, physical and mental health issues, parenting, and more.
The American Academy of Pediatrics (AAP) offers a
variety of educational materials about parenting,
general growth and development, immunizations, safety, disease prevention, and more. AAP guidelines for various conditions and links to other
organizations are also available.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
The March of Dimes tries to improve the health of babies
by preventing birth defects, premature birth, and early death. March of Dimes
supports research, community services, education, and advocacy to save babies'
lives. The organization's website has information on premature birth, birth
defects, birth defects testing, pregnancy, and prenatal care.
The National Institute of Child Health and Human
Development (NICHD) is part of the U.S. National Institutes of Health. The
NICHD conducts and supports research related to the health of children, adults,
and families. NICHD has information on its Web site about many health topics.
And you can send specific requests to information specialists.
American Academy of Pediatrics Section on Ophthalmology, et al. (2006). Screening examination of premature infants for retinopathy of prematurity. Pediatrics, 117(2): 572–576. [Errata in Pediatrics, 117(4): 1468 and Pediatrics, 118(3): 1324.]
Other Works Consulted
American College of Obstetricians and Gynecologists (2008, reaffirmed 2010). Late-preterm infants. ACOG Committee Opinion No. 404. Obstetrics and Gynecology, 111(4): 1029–1032.
Brazelton TB (2006). Prematurity. In Touchpoints, Birth to Three: Your Child's Emotional and Behavioral Development, 2nd ed., pp. 351–356. Cambridge, MA: Da Capo Press.
Chandra S, Baumgart S (2005). Temperature regulation of the premature infant. In HW Taeusch et al., eds., Avery's Diseases of the Newborn, 8th ed., pp. 364–371. Philadelphia: Elsevier Saunders.
Committee on Fetus and Newborn, American Academy of Pediatrics (2007, reaffirmed 2010). Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics, 119(2): 401–403. Also available online:
Cunningham FG, et al., eds. (2010). Diseases common in the preterm fetus and newborn section of Diseases and injuries of the fetus and newborn. In Williams Obstetrics, 23rd ed., pp. 605–628. New York: McGraw-Hill.
Engle WA, Committee on Fetus and Newborn (2008). Surfactant-replacement therapy for respiratory distress in the preterm and term neonate. Pediatrics, 121(2): 419–432.
Engle WA, et al. (2007, reaffirmed 2010). "Late-preterm" infants: A population at risk. Pediatrics, 120(6): 1390–1401.
Pignotti MS, Donzelli G (2008). Perinatal care at the threshold of viability: An international comparison of practical guidelines for the treatment of extremely preterm births. Pediatrics, 121(1): e193–e198.
Soll R, Özek E (2010). Prophylactic protein free synthetic surfactant for preventing morbidity and mortality in preterm infants. Cochrane Database of Systematic Reviews (1).
April 14, 2011
Sarah Marshall, MD - Family Medicine
& John Pope, MD - Pediatrics
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