It’s something that most pregnant moms dread – preterm labour leading to a baby born long before its due date. It’s easy to imagine the worst because there’s a higher risk of complications. But the good news is that recent medical developments promise better healthcare for prem babies.
When is a baby premature?
Although a ‘textbook’ pregnancy lasts 40 weeks, a baby is regarded as full-term if she’s born after 37 weeks. At this point, development is complete and your baby won’t be deemed premature. But if born earlier, she’ll be treated as premature.
The World Health Organisation (WHO) categorises premature babies as follows:
- Those born before 28 weeks are extremely preterm
- Those born between 28 and 32 weeks are very preterm
- Those born between 33 and 37 weeks are moderate to late preterm.
Why does it happen?
Premature birth can be caused by a number of factors in both the mom and her baby. But some of the more common reasons are:
- Multiple pregnancies
- Maternal infections
- High blood pressure (preeclampsia)
- A history of drugs
- Short interim between pregnancies
- A multiple pregnancy (twins or triplets).
Moms often feel that they’re the reason for their babies being born premature but more often than not, the cause is unknown.
What you can expect
A premature baby can face a host of possible health complications. Usually, the earlier she’s born, the more likely she’ll develop complications. A delivery closer to full term often means fewer complications.
You might have read miraculous stories of babies born at 25 weeks and surviving:
“From about 26-27 weeks gestation, we can start to pull babies through – if they’re in a good hospital with the right equipment and an NICU (neonatal intensive care unit),” says paediatrician Dr Dewald Buitendag.
“A baby born at 25 weeks or less in South Africa is usually not expected to survive. Babies born at 26 or 27 weeks will most likely survive but will experience complications after birth. At 27-28 weeks, you would expect them to pull through.
“In my experience, these extremely premature babies are rare,” says Dr Buitendag. “I see far more babies born at 32-35 weeks and that’s often to do with blood pressure complications in the mother, HELLP Syndrome (life-threatening liver disorder), maternal infections, placenta praevia, abruptio placentae, or other common causes.
“If the placenta isn’t functioning well and the baby has stopped growing, that would also be a reason for premature delivery,” Buitendag adds.
We look at the complications that could arise …
Breathing is one of the biggest complications premature babies face. The earlier a baby is born, the less developed the lungs are. “Babies born at 26, 27, or 28 weeks will go onto a ventilator to breathe for them.
“We give the baby medication, a surfactant to ripen the lungs. That shortens the time that the baby spends on the ventilator.” The ventilator can also cause damage to the lungs so the goal is to keep the baby on it for as short a time as possible.
Paediatricians now use gentle ventilation, with low pressure and as slow a rate as possible, to protect the lungs.
Extremely premature babies who don’t respond to the ventilator may be put on an oscillator – a new type of ventilator – which vibrates to keep the lungs open rather than pumping air into them.
Doctors could also use a tube that delivers surfactant to the lungs. When the tube is removed, the paediatrician puts a mask called a nasal CPAP (continuous positive airway pressure) over the baby’s nose:
“It gives pressure, but it doesn’t pump air into the lungs,” says Buitendag.
With older preemies, from 33-34 weeks and where the baby has received cortisone via the mother, ventilation might not be necessary at all.
In utero, a heart valve called the ductus arteriosus is open, bypassing blood so that it doesn’t go through the fluid-filled lungs. It’s supposed to close after birth but in premature babies it often doesn’t. Doctors use certain types of medication to force it to close, but if that fails and the baby can’t be weaned off the ventilator because of it, surgery would be required to fix the problem.
Brain bleeds are another complication in preemies. “The slightest rise or drop in their blood pressure can make them pop a vessel in their brain resulting in a brain bleed,” says Buitendag. Babies born at 26, 27, or 28 weeks often experience brain bleeds but it’s not usual in babies born around 33-34 weeks and onwards. These bleeds can cause damage, and depending on the severity of the bleed (mild to severe), it can cause long-term neurological problems: “Some bleeds are quite mild and resolve on their own without causing problems.
A skilled paediatrician will try to prevent circumstances that cause a vessel to burst,” adds Buitendag.
“We check carefully for infection, especially with all the procedures we do. Doctors can introduce infections, or perhaps the baby’s immune system might not be strong enough and germs in the air make her sick,” explains Buitendag. Sometimes the baby is born prematurely because of a maternal infection, which can be transmitted to the baby.
Retinopathy of Prematurity (ROP) can cause blindness or long-term vision problems – and the smaller the baby, the higher the risk. Oxygen given to them to assist with breathing can cause problems with their eyes. Any baby born earlier than 32 weeks, or weighing less than 1.5kg at birth, will be assessed by an eye specialist for this condition and it’ll be managed carefully.
NEC (necrotising enterocolitis)
It sounds pretty terrifying and it’s something premature babies can develop when there’s a lack of oxygen to, or infection in, the intestines. When this happens, the intestines can bleed. In severe cases, it could burst open and this would require a portion of the intestine to be removed. If a long piece is removed, the baby may have problems with absorbing nutrients in the future. However, this is a rare complication.
Premature babies often don’t have a developed sucking reflex, which usually develops at 35-36 weeks. Buitendag says that it’s crucial to get the baby onto food. The process starts slowly – just 5ml a day at first via a tube through the nose or mouth and into the stomach, slowly increasing dosage. Very premature babies are fed through a vein.
“Babies may only go home when they can feed by themselves,” says Buitendag.
What the future holds for premature babies
Because of medical advances in the past 20 years, the odds of a baby surviving premature birth have increased dramatically. But very preterm or extremely preterm babies often face medical, developmental, or behavioural problems that continue into childhood.
The earlier a baby is born and the lower their birthweight, the greater the risk of complications. And there’s also a higher probability that some complications will continue past infancy.
Parents of premature babies can also expect long hospital stays. A baby born at 28 weeks is likely to spend between 2-3 months in hospital before being discharged.
Quick glance at possible prem problems:
Extremely preterm, 25 – 28 weeks:
- Breathing problems requiring ventilation
- High risk of infection
- Brain haemorrhage.
Very preterm, 28 – 32 weeks:
- Breathing problems
- Infection risks
- Brain haemorrhage.
Moderate to late preterm, 33 – 37 weeks:
- Reduced chance of breathing problems, bleeding, or infection.
- The South African Neonates, Infant and Toddler Support Group; www.sanitsa.org.za
- Little Steps – website for premature babies, their parents and professionals; www.littlesteps.co.za
- Premature Baby & Premature child; www.prematurity.org
Xanet is an award-winning journalist and Living and Loving’s digital editor. She has won numerous awards for her health and wellness articles and was a finalist for the Discovery Journalist of the Year in 2009 and again in 2011 for the Discovery Best Health Consumer Reporting and Feature Writing category. She is responsible for our online presence across social media channels and makes sure our moms have fresh and interesting articles to read every day. Learn more about Xanet Scheepers.