Preemie Issues - a quick look

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Preterm infants are at greater risk for both short and long term difficulties. The tinier and earlier a preemie is born the greater the risk for complications.


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Preemie Babies are not just tiny...

Premature babies are not just tiny; they are at risk for a number of health concerns, including breathing difficulties, brain injury, eye disorders, infection, bowel problems and heart dysfunction.
The issues surrounding preterm birth can be complex but we have tried to cover everything you may want to know. If you have any questions please ask them in our forums.


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Health Outcomes: 23 to 25 weeks GA

Breathing

Almost all preterm babies born this early will require help to breathe from a ventilator. It is likely they will have respiratory distress syndrome, which means that their lungs are too immature to breathe without help. It is not unusual when babies are this premature that they need extra oxygen up to, or more than 36 weeks post conception, but they may come off the ventilator and instead receive oxygen through nasal prongs. If your prem needs help beyond 36 weeks then there is a high chance they have chronic lung disease (also called bronchopulmonary dysplasia - BPD).

Approximately 65% of preemies born this early develop chronic lung disease. It usually resolves by the age of two.

A ventilator may also be used for preemie babies born this early because they are at higher risk for apnea of prematurity. 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. Apnoea usually resolves by the time the infant is 36 weeks postmenstrual age.

Heart Function

Patent Ductus Arteriosus

Approximately 40% to 50% of micro preemies will have patent ductus arteriosus (PDA). PDA will sometimes close by itself and in mild cases doesn’t require treatment. If the PDA is affecting your baby’s breathing or heart function doctors may try medication or surgery. Approximately 10% of micro preemies need surgery to close their PDA.

Brain

Intraventricular hemorrhage (IVH) and Periventricular leukomalacia (PVL)

Approximately 15% to 20% preemies born 23 to 25 weeks’ gestation have large brain bleeds (grade 3 or 4). It is very difficult to predict what the long-term consequences are to severe brain bleeds; some of these babies recover without many major difficulties, while others develop cerebral palsy, or suffer from severe intellectual, visual, or hearing impairment. Most IVHs occur in the first 3 days of life, so babies will get an ultrasound to check for damage.

Eyes

Retinopathy of Prematurity (ROP)

Most micro babies develop ROP, abnormal blood vessels, but most of these will resolve on their own. Around 15% require surgery or other forms of treatment to prevent serious injury (retinal detachment, which causes blindness). NICU medical staff will test your baby’s eyes between 4 to 6 weeks.

Infection

Approximately 50% of micro preemies develop one or more infections during their stay in the hospital. Approximately 75% of these prems survive with the help of antibiotics and increased respiratory and nutritional support.

Stomach & Intestines

Necrotising Enterocolitis (NEC)

Approximately 5% to 10% of micro preemies develop inflammation of the intestinal tract, called necrotising enterocolitis. It is more common during the 2nd or 3rd week of life, after feedings have started. . Mild cases of NEC can cause feeding intolerance and recovery is usually quick. In more serious cases of NEC preemies may require antibiotics, intravenous nutrition, or sometimes bowel surgery. About 50% of prem’s with severe NEC need surgery.

(Dani, Poggi, Romagnoli, & Bertini, 2009; Johnson et al., 2009; Saigal, Rosenbaum, Hattersley, & Milner, 1989)(Anderson & Doyle, 2006; Bradford, 2003; Doyle & Anderson, 2005; Hack et al., 2005; Taylor, Espy, & Anderson, 2009)

 


Technical Reference List

Anderson, P. J., & Doyle, L. W. (2006). Neurodevelopmental outcome of bronchopulmonary dysplasia. Seminars in Perinatology, 30(4), 227-232. Bradford, N. (2003). Your premature baby the first five years. Toronto: Firefly Books. Dani, C., Poggi, C., Romagnoli, C., & Bertini, G. (2009). Survival and major disability rate in infant born at 22-25 weeks of gestation. Journal of Perinatal Medicine, 37(6), 599-608. Doyle, L. W., & Anderson, P. J. (2005). Improved neurosensory outcome at 8 years of age of extremely low birthweight children born in Victoria over three distinct eras. Arch Dis Child Fetal Neonatal Ed, 90(6), 121-128. Hack, M., Taylor, H. G., Drotar, D., Schluchter, M., Cartar, L., Andreias, L., et al. (2005). Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s. Jama, 294(3), 318-325. Johnson, S., Fawke, J., Hennessy, E., Rowell, V., Thomas, S., Wolke, D., et al. (2009). Neurodevelopmental disability through 11 years of age in children born before 26 weeks of gestation. Pediatrics, 124(2), e249-257. Saigal, S., Rosenbaum, P., Hattersley, B., & Milner, R. (1989). Decreased disability rate among 3-year-old survivors weighing 501 to 1000 grams at birth and born to residents of a geographically defined region from 1981 to 1984 compared with 1977 to 1980. Journal of Pediatrics, 114(5), 839-846. Taylor, H. G., Espy, K. A., & Anderson, P. J. (2009). Mathematics deficiencies in children with very low birth weight or very preterm birth. Dev Disabil Res Rev, 15(1), 52-59.

 

 



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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