In the Hospital - a quick look

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For some parents of preemie babies, the neonatal intensive care unit (NICU for short) becomes a home away from home while they wait for their preemie baby to get strong enough to leave.


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The NICU is where your preemie baby will get lots of help.

It can be noisy, confronting, and stressful. Learning a little about the equipment, what health professionals are doing, and some of the medical jargon can help parents of preemie babies feel more confident and less overwhelmed.
Preemie help is here to make sense of it all.

 


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Preemie Breathing Difficulties

Premature babies have underdeveloped lungs and often have difficulty breathing by themselves. Respiratory distress syndrome and chronic lung disease are the most common breathing difficulties related to preterm birth.

Premature babies have underdeveloped lungs and often have difficulty breathing by themselves. Respiratory distress syndrome and chronic lung disease are the most common breathing difficulties related to preterm birth.  Respiratory distress syndrome and chronic lung disease

Respiratory Distress Syndrome

Respiratory Distress Syndrome (RDS) in premature infants is caused when there isn’t enough surfactant produced and because the lungs are immature.
Difficulty breathing due to underdeveloped lungs is often a common consequence of preterm birth that needs immediate attention. Respiratory distress syndrome, also called hyaline membrane disease (HMD), is the most common lung disorder in preterm infants. Preterm infants do not produce enough of a slippery, protective substance called surfactant, which helps the lungs inflate with air and keeps them from collapsing when the infant tries to breathe in air, after birth, by themself.

(Doyle et al., 1999) (Rosenberg, Desai, Na, Kan, & Schwartz, 2001)

A lack of oxygen to other parts of the preemie infant’s body can result in other difficulties. For example, lack of oxygen can affect brain and eye development. Respiratory problems are the most common cause of death in preterm infants, although these problems have lessened over time, and they also have a large effect on other health outcomes. That is, they are related to high rates of cognitive (thinking and reasoning), motor skills, educational, and behavioural difficulties.

(Lee et al., 1999)

Why don’t preemies produce enough surfactant?

Surfactant is produced by the fetal lung from approximately 24 weeks’ gestation and increases gradually, showing a rapid rise at 35 weeks’ gestation, therefore if your baby is born too early they have not had a chance to produce enough surfactant to help them breathe.

(Jobe, Mitchell, & Gunkel, 1993)

Incidence of Respiratory Distress Syndrome

The chance of premature babies developing respiratory distress syndrome is closely related to the degree of prematurity. The rate of RDS is higher for babies born earlier (lower gestational age).

Incidence:

  • 50% of preemies born at 26–28 weeks
  • 25% of preemies born at 30–31 weeks

Chronic Lung Disease

Chronic lung disease (CLD), also called bronchopulmonary dysplasia, is a common condition after preterm birth. It is the general term used for long-term respiratory problems in premature babies.
Chronic lung disease is a disorder that results from inflammation, injury, and scarring of the airways and the alveoli (air sacs). Chronic lung disease occurs in at least 20% of infants that require ventilation. The lungs of preemie babies are fragile and are therefore easily damaged by equipment that is helping them survive, such as mechanical ventilation and extra oxygen for breathing. The scarring of preemies immature lungs can result in difficulty breathing and an increased need for oxygen.

(Fenton, Mason, Clarke, & Field, 1996; Marshall et al., 1999; Simon et al., 2007)

Although a small number of babies will develop very serious CLD, the good news is that most babies will improve over time – weeks or months – and will “grow out” of their lung disease. If your baby is ready to go home; feeding and growing well, you may be given equipment so that you can give your baby oxygen at home. Babies with CLD are more likely to be admitted to hospital in the first year of life, largely related to chest infections.

(Zaichkin, 2009)

Why don’t preemies produce enough surfactant?

Surfactant is produced by the fetal lung from approximately 24 weeks’ gestation and increases gradually, showing a rapid rise at 35 weeks’ gestation, therefore if your baby is born too early they have not had a chance to produce enough surfactant to help them breathe.

(Jobe, Mitchell, & Gunkel, 1993)

Incidence of Chronic Lung Disease

The chance of premature babies developing chronic lung disease is closely related to the degree of prematurity. So that CLD increases with decreasing gestational age.

  • 50% of preemies born at 24 and 25 weeks and surviving to 36 weeks will have CLD.
  • 33% of preemies 26 and 27 weeks gestation and surviving to 36 weeks will have CLD.
  • 10% of preemies born at 28 and 29 weeks gestation will develop CLD.
  • Babies born at 30 weeks and above are even less likely to develop CLD.

Apnoea of Prematurity

Apnea of prematurity is when a premature infant stops breathing for more than 15 seconds and/or is accompanied by a slowed heart rate or not enough oxygen is reaching the body’s tissues. It is a major concern for caregivers in neonatal intensive care units. In the womb a fetus uses his mother for oxygen exchange rather than his own lungs. After birth, babies must use their own lungs and develop a regular breathing pattern. The area of a premature baby’s brain, responsible for setting a regular pattern of breathing, is often immature and can result in irregular breathing patterns, shallowness of breath and pauses. A prolonged pause is called an apnoea spell. A spell of apnoea means the baby stops breathing, the heart rate may decrease and his skin may turn pale or blue. Apnoea usually resolves by the time the infant is 36 weeks postmenstrual age. There is no clear evidence that apnoea of prematurity causes long-term learning and development problems but recurring apnoea causes concern because of effects of repeated episodes where the tissues don’t get enough oxygen, especially the gut and brain.

(Martin, Abu-Shaweesh, & Baird, 2004; Poets, 2010; Zaichkin, 2009)

Incidence of Apnoea of Prematurity

Apnoea of prematurity is a very common problem for preterm infants. Apnoea may occur in 25% of all infants born weighing less than 2,500 grams and around 85% of those weighing less than 1,000 grams (or 2 pounds, 3 ounces).

  • Preemies born less than 2,500 g (5 ½ pounds) – 25%
  • Preemies born less than 1,500 g (3 1/3 pounds) - 50%
  • Preemies born less than 1,000 g (3 1/3 pounds) – 84%
  • Preemies born less than 29 weeks gestation – 95%
  • Preemies born less than 34 weeks gestation – 70%
(Moriette, Lescure, El Ayoubi, & Lopez, 2010; Theobald, Botwinski, Albanna, & McWilliam, 2000; Toubas, Westbrook, Maish, & Sagraves, 1994)

 


Technical Reference List

Doyle, L. W., Gultom, E., Chuang, S. L., James, M., Davis, P., & Bowman, E. (1999). Changing mortality and causes of death in infants 23-27 weeks' gestational age. J Paediatr Child Health, 35(3), 255-259.
Fenton, A. C., Mason, E., Clarke, M., & Field, D. J. (1996). Chronic lung disease following neonatal ventilation. II. Changing incidence in a geographically defined population. Pediatr Pulmonol, 21(1), 24-27.
Jobe, A. H., Mitchell, B. R., & Gunkel, J. H. (1993). Beneficial effects of the combined use of prenatal corticosteroids and postnatal surfactant on preterm infants. Am J Obstet Gynecol, 168(2), 508-513.
Lee, K., Khoshnood, B., Wall, S. N., Chang, Y. p., Hsieh, H. L., & Singh, J. K. (1999). Trend in mortality from respiratory distress syndrome in the United States, 1970-1995. J Pediatr, 134(4), 434-440.
Marshall, D. D., Kotelchuck, M., Young, T. E., Bose, C. L., Kruyer, L., & O'Shea, T. M. (1999). Risk factors for chronic lung disease in the surfactant era: a North Carolina population-based study of very low birth weight infants. North Carolina Neonatologists Association. Pediatrics, 104(6), 1345-1350.
Martin, R. J., Abu-Shaweesh, J. M., & Baird, T. M. (2004). Apnoea of prematurity. Paediatr Respir Rev, 5 Suppl A, S377-382.
Moriette, G., Lescure, S., El Ayoubi, M., & Lopez, E. (2010). Apnea of prematurity: What's new? Archives De Pediatrie, 17(2), 186-190. doi: 10.1016/j.arcped.2009.09.016
Poets, C. F. (2010). Interventions for apnoea of prematurity: a personal view. Acta Paediatr, 99(2), 172-177.
Rosenberg, K. D., Desai, R. A., Na, Y., Kan, J., & Schwartz, L. (2001). The effect of surfactant on birthweight-specific neonatal mortality rate, New York City. Ann Epidemiol, 11(5), 337-341.
Simon, A., Ammann, R. A., Wilkesmann, A., Eis-Hubinger, A. M., Schildgen, O., Weimann, E., et al. (2007). Respiratory syncytial virus infection in 406 hospitalized premature infants: results from a prospective German multicentre database. Eur J Pediatr, 166(12), 1273-1283.
Theobald, K., Botwinski, C., Albanna, S., & McWilliam, P. (2000). Apnea of prematurity: diagnosis, implications for care, and pharmacologic management. Neonatal Netw, 19(6), 17-24.
Toubas, P. L., Westbrook, C. K., Maish, W., & Sagraves, R. (1994). Influence of gestational age and sex on the incidence of apnea at birth and 7 days. Pediatric Research, 37(4 PART 2), 354A.
Zaichkin, J. (2009). Newborn Intensive Care: what every parent needs to know (3rd ed.). MI: Sheridan Books.

 

 



AlbertEinstein_iconOne of the greatest minds in history, Albert Einstein was born preterm.

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Preemie, Premmie, or Prem?

Most babies spend between 38 and 42 weeks in their mother’s uterus. So, technically a preterm birth, preemie, premmie, or prem, is an infant who is born less than 37 completed gestational weeks. 


Read More: Defining Preterm birth


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