Survival Rate
The great news is that more than 95% of very premature babies survive. Although these babies are very immature and may face serious health problems, most of them recover from their premature birth with few long-term consequences.
What Does a Very Premature Baby Look Like?
If you are visiting a very premature baby in a neonatal intensive care unit (aka NICU), you may be surprised by how small the baby is. Very premature babies have thin skin with visible veins, and there is a lot of medical equipment present, often including:
IV lines: Due to their immature digestive systems, very premature babies are fed by intravenous (IV) lines at first and are introduced slowly to breast milk or formula. IV lines may come from the umbilical cord stump (umbilical catheters), or peripheral IVs or PICC lines may be placed in a premature baby’s extremities or scalp. Monitoring equipment: Very premature babies will have stickers on their chests and wrists or feet to monitor their heart rate, breathing rate, and oxygen saturation. NG/OG tubes: Before about 33 weeks gestation, babies cannot suck, swallow, and breathe at the same time. Very premature babies are fed through a tube that goes from the nose or mouth down into the stomach. Respiratory support: Most very premature babies need respiratory support after birth. A very sick or immature baby may need mechanical ventilation. Other very premature babies may need continuous positive airway pressure (aka CPAP) or a nasal cannula.
Health Problems in the NICU
A very premature baby may have a smooth NICU course or a complicated one. The most common health problems of very premature babies include:
Apnea of prematurity: Because their nervous systems are immature, premature babies may have periods of apnea or bradycardia. They usually outgrow this condition, which can be treated with medication, by the time they leave the NICU. Anemia: Anemia (a lack of red blood cells) is common in premature babies. Anemia of prematurity is most often seen in babies who are born before 32 weeks, and it may be treated with iron supplements, blood transfusions, or medications. Intraventricular hemorrhage (IVH): Very premature babies have fragile blood vessels, especially in the brain. If these vessels break, blood may spill into the brain’s ventricles. About 15% to 20% of very premature babies develop IVH. Necrotizing enterocolitis (NEC): This disorder is characterized by necrosis of the intestinal mucosa. This is a serious condition that is treated with medication or surgery. Thankfully, only a small number of premature babies suffer from NEC. It may affect up to 3% of preterm infants born weighing 1251 to 1500 grams (2 pounds 12.13 ounces to 3 pounds 4.91 ounces) and up to 11% of preterm babies weighing less than 750 grams (1 pounds 10.46 ounces). Patent ductus arteriosus (PDA): The ductus arteriosus is a blood vessel, and it lets blood circulate around a fetus’s lungs. Although a PDA is normal in fetuses, this blood vessel should close at birth. Whether or not a baby is born with a PDA depends significantly on birth weight. It can occur in full-term infants, but preterm babies are at higher risk. In a hospital study, 25% of babies born before 28 weeks and 12% of babies born between 28 and 32 weeks had a PDA. Medication or surgery can be used to close a PDA. Respiratory distress syndrome (RDS): About 70% to 85% of very premature babies need treatment for RDS. Respiratory distress is treated with respiratory support or medication. Sepsis: Because premature babies have immature immune systems, they are more susceptible to infection than term babies. In the United States, about 36% of preterm babies suffer from at least one infection while in the hospital after birth.
Potential Long-Term Health Problems
Most very premature babies recover from premature birth with few lasting effects. They may have special needs for the first few years, but they usually outgrow their medical conditions over time. The most common long-term health problems for very premature babies are:
Apnea of prematurity: Most very premature babies outgrow this before they leave the NICU, but others still have spells after they go home. These babies may go home with an apnea monitor to make sure they maintain their heart and breathing rates.Chronic lung disease: Respiratory support can scar the lungs, causing chronic lung disease. Some very premature babies need oxygen after NICU discharge, and many suffer from asthma or other respiratory illnesses as young children.Developmental delays: Although severe cognitive disabilities are uncommon in very premature babies, developmental delays and trouble in school are more common. Studies show that very premature babies score lower on arithmetic, reading, and spelling assessments in elementary school. These children may catch up with intervention, though.
Ways to Improve Outcomes
There are many things that you can do as a parent to help give your baby the best possible start.
Get early prenatal care: Early and regular prenatal care can help moms minimize their risks for premature birth and prevent or stop premature labor. Pump breast milk: Even if moms don’t plan to breastfeed, pumping breast milk—even for a short time—can help give very premature babies the best start. Seek early intervention: Many very premature babies will qualify for early intervention services. These state-run programs help very premature babies catch up to their peers and meet milestones on time. Try kangaroo care: Bonding through kangaroo care can help premature babies grow and mature, and has many benefits for both parents and premature babies. This involves holding the baby (who is wearing only a diaper) skin-to-skin against your chest to keep them warm and feeling secure.
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