Breathing

Babies born this early are also referred to as extremely preterm infants. Approximately 50% of these preterm babies develop respiratory distress syndrome (RDS) because their lungs are so immature. Most need help to breathe from a ventilator and most will also come off the ventilator after a few weeks. If extra oxygen is needed they will receive this through nasal prongs until they reach term.

If your prem needs help beyond 36 weeks then there is a high chance they have chronic lung disease (also called bronchopulmonary dysplasia - BPD). Around 50% of these preemies develop CLD. 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 extremely preterm infants 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 extremely preterm infants need surgery to close their PDA.

Brain

Intraventricular hemorrhage (IVH) and Periventricular leukomalacia (PVL)

Approximately 5% to 10% preemies born extremely preterm 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)

Approximately 75% of extremely preterm infants develop ROP, abnormal blood vessels, but most of these will resolve on their own. Around 5% 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 30% of extremely preterm infants 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 extremely preterm infants 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)