When Your Baby’s Born Premature

What Is Prematurity?

When a baby is born more than three weeks earlier than the predicted due date, that baby is called "premature." Premature babies (preemies) have not grown and developed as much as they should have before birth.

Why Was My Baby Born Early?

Most of the time, doctors don't know why babies are born early. When they do know, it's often because a mother has a health problem during pregnancy, such as:

• diabetes (high blood sugar)
• hypertension (high blood pressure)
• heart or kidney problems
• an infection of the amniotic membranes or vaginal or urinary tracts

Other reasons why a baby may be born early include:

• bleeding, often due to a low-lying placenta (placenta previa) or a placenta that separates from the womb (placental abruption)
• having a womb that isn't shaped normally
• carrying more than one baby (twins, triplets, or more)
• being underweight before pregnancy or not gaining enough weight during pregnancy
• mothers who smoke, use drugs, or drink alcohol while pregnant

Does My Baby Need Special Care?

Yes, preemies may have many special needs. Younger and smaller babies tend to have more health problems than babies born closer to their due dates. So they often need to be cared for in a neonatal intensive care unit (NICU).

Why Must My Baby Stay Warm?

Preemies don't have enough body fat to hold their body temperature. Incubators or radiant warmers keep them warm in the NICU:

• Infant warmers: These are small beds with heaters over them to help babies stay warm while being monitored. Because they are open, they allow easy access to babies.
• Incubators: These are small beds enclosed by clear, hard plastic. Temperature in the incubator is controlled to keep your baby's body temperature where it should be. Doctors, nurses, and others can give care to the baby through holes in the sides of the incubator.

What Are My Baby's Nutritional Needs?

Breast milk is the best nutrition for all babies, especially preemies. Breast milk has proteins that help fight infection. Most preemies can't feed straight from the breast or bottle at first. Mothers pump their breast milk and it's given to babies through a tube that goes through the nose or mouth and into the stomach.

For women who can't give breast milk, doctors may suggest giving the baby pasteurized human breast milk from a milk bank, which is a safe option.

If you don't breast feed or pump breast milk, your baby will get formula. Extra nutrients called fortifiers may be added to breast milk or formula. This is because preemies need more calories, proteins, and other nutrients than full-term babies do.

Preemies are fed slowly because they can get necrotizing enterocolitis (NEC), a serious intestinal problem that affects preemies.

Some babies who are very small or very sick get their nutrition through intravenous (or IV – meaning "in the vein") feedings called total parenteral nutrition (TPN). TPN has a special mix of nutrients like proteins, carbohydrates, fats, vitamins, and minerals.

Doctors and dietitians watch the diets of preemies very carefully and make changes when needed to make sure babies get the nutrients needed to grow.

What Health Problems Can Happen?

Because their organs aren't fully ready to work on their own, preemies are at risk for health problems. In general, the more premature a baby is, the greater the chance of health problems.

These problems include:

• anemia, when babies don't have enough red blood cells
• apnea, when a baby stops breathing for a short time; the heart rate may lower; and the skin may turn pale or blue
• bronchopulmonary dysplasia and respiratory distress syndrome, problems with breathing
• hyperbilirubinemia, when babies have high levels of bilirubin, which is produced by the normal breakdown of red blood cells. This leads to jaundice, a yellowing of the skin and whites of the eyes.
• necrotizing enterocolitis, a serious disease of the intestines
• patent ductus arteriosus, a problem with the heart
• retinopathy of prematurity, a problem with the eye's retina
• infections that babies can get from the mother before, during, or after birth

What Else Should I Know?

Preemies often need special care after leaving the NICU, sometimes in a high-risk newborn clinic or early intervention program. Depending on their health, they may need care from specialists, such as doctors who treat problems with the brain and nervous system (neurologists), eyes (ophthalmologists), and lungs (pulmonologists).

Preemies will also need to go to all doctor visits, including well-child checkups, get vaccines that all babies need to stay healthy, and have routine hearing and eye exams. As your baby grows, doctors will check:

• your baby's growth
• development, including speech and language, learning, and motor skills
• muscle tone, strength, and reflexes

How Can I Cope?

Caring for a preemie can be more demanding than caring for a full-term baby.

Take care of yourself by eating well, resting when you can, and getting exercise. Spend one-on-one time with your other children when you can, and get help from others. Look for support from friends, family, and support groups. You also can get support online from groups such as:

• March of Dimes
• Graham's Foundation
• Life's Little Treasures Foundation
• Hand to Hold