What you need to know about premature birth

A birth is premature if it happens more than three weeks before the baby’s estimated date of birth. That means any birth that occurs before the start of the 37th week of pregnancy.

These babies are born with many different complications, which are more severe the earlier the baby is born. The baby will then usually be required to stay longer in hospital, either in intermediate care or in an intensive care unit.

Doctors and a specialised team with training in taking care of preterm babies will be available to help care for your baby. Don’t hesitate to ask questions. Your baby may need extra help feeding and adapting immediately after delivery. Your healthcare team can help you understand what is needed and what your baby’s care plan will be.

For unknown reasons, black women are more likely to experience premature birth than are women of other races. But premature birth can happen to anyone. In fact, many women who have a premature birth have no known risk factors.

Risk factors

Factors which are known to place women at risk of premature births include:

• Previous history of premature birth.

• Pregnancy with twins, triplets or other multiples.

• An interval of less than six months between pregnancies.

• Conceiving through in vitro fertilisation.

• Problems with the uterus, cervix or placenta which may be due to infection or inflammation.

• Smoking cigarettes or using illicit drugs.

• Some infections, particularly of the amniotic fluid and lower genital tract.

• Some chronic conditions, such as high blood pressure and diabetes.

• Being underweight or overweight before pregnancy.

• Stressful life events, such as the death of a loved one or domestic violence.

• Multiple miscarriages or abortions.

• Physical injury or trauma.

Picture: iStock

Symptoms

The prematurely born baby will have the following features:

• Small size, with a disproportionately large head.

• Low fat stores making the baby look thin and wasted.

• Fine hair covering much of the body.

• Low body temperature, especially immediately after birth in the delivery room, due to a lack of stored body fat.

• Difficulty breathing or respiratory distress.

• Lack of reflexes for sucking and swallowing, leading to feeding difficulties.

Complications

Being born too early can cause short-term and long-term health problems. Generally, the earlier a baby is born, the higher the risk of complications. Birth weight plays an important role, too, with babies born bigger usually having less complications.

In the first weeks, the complications of premature birth may include:

Breathing problems. A premature baby may have trouble breathing due to an immature respiratory system.

Heart problems. The most common heart problems premature babies experience what is called a “hole in the heart” or patent ductus arteriosus (PDA) and low blood pressure (hypotension).

PDA is a persistent opening between the aorta and pulmonary artery. While this heart defect often closes on its own, left untreated it can lead to a heart murmur, heart failure as well as other complications.

Brain problems. The earlier a baby is born, the greater the risk of bleeding in the brain, known as an intraventricular hemorrhage. Most hemorrhages are mild and resolve with little short-term impact. But some babies may have larger brain bleeding that causes permanent brain injury.

Temperature control problems. Premature babies can lose body heat rapidly. They don’t have the stored body fat of a full-term infant and they can’t generate enough heat to counteract what’s lost through the surface of their bodies.

Gastrointestinal problems. Premature infants are more likely to have immature gastrointestinal systems, resulting in complications such as necrotising enterocolitis (NEC).

This potentially serious condition, in which the cells lining the bowel wall are injured, can occur in premature babies after they start feeding. Premature babies who receive only breast milk have a much lower risk of developing NEC.

Blood problems. Premature babies are at risk of blood problems such as anaemia and newborn jaundice. Anaemia is a common condition in which the body doesn’t have enough red blood cells.

Newborn jaundice is a yellow discolouration in a baby’s skin and eyes that occurs because the baby’s blood contains excess bilirubin, a yellow-coloured substance, from the liver or red blood cells.

Metabolism problems. Premature babies often have problems with their metabolism. Some premature babies may develop an abnormally low level of blood sugar (hypoglycaemia).

This can happen because premature infants typically have smaller stores of stored glucose than do full-term babies. Premature babies also have more difficulty converting their stored glucose into more-usable, active forms of glucose.

Immune system problems. An underdeveloped immune system, common in premature babies, can lead to a higher risk of infection. Infection in a premature baby can quickly spread to the bloodstream, causing sepsis.

In the long term, premature birth may lead to the following complications:

• Cerebral palsy.
• Impaired learning.
• Vision problems.
• Hearing problems.
• Dental problems.
• Behavioural and psychological problems.
• Chronic health issues.

Prevention

Although the exact cause of preterm birth is often unknown, there are some things that can be done to help women – especially those who have an increased risk – to reduce their risk of preterm birth, including:

Progesterone supplements. Women who have a history of preterm birth, a short cervix or both factors may be able to reduce the risk of preterm birth with progesterone supplementation.

Cervical cerclage. This is a surgical procedure performed during pregnancy in women with a short cervix, or a history of cervical shortening that resulted in a preterm birth.

During this procedure, the cervix is stitched closed with strong sutures that may provide extra support to the uterus. The sutures are removed when it’s time to deliver the baby. Ask your doctor if you need to avoid vigorous activity.

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