Premature Babies
What medical complications are common in premature babies?
There are a number of complications that are more likely in premature than full-term babies. While babies born near term may have few or none of these problems, babies born before 32 to 34 weeks gestation may have a number of complications. In some cases, these complications may be fairly mild while, in other cases, they are severe and may lead to long-term medical problems or even death.
- Respiratory distress syndrome (RDS). About 24,000 babies a year – most of whom were born before the 34th week of pregnancy – suffer from this breathing problem. Babies with RDS lack a protein called surfactant that keeps small air sacs in the lungs from collapsing. Treatment with surfactant helps affected babies breathe more easily. Since treatment with surfactant was introduced in 1990, deaths from RDS have been reduced by about two-thirds.
A doctor may suspect a baby has RDS if she is struggling to breathe; a lung X-ray and blood tests often confirm the diagnosis. Babies with RDS may need additional oxygen and mechanical breathing assistance to keep their lungs expanded. They may receive a treatment called continuous positive airway pressure (CPAP), which delivers pressurized air to the baby’s lungs. The air may be delivered through small tubes in the baby’s nose, or through a tube that has been inserted into his windpipe. CPAP helps a baby breathe, but does not breathe for him. The sickest babies may temporarily need the help of a respirator to breathe for them while their lungs mature. They also may be treated with a gas called nitric oxide, which can improve breathing by helping blood vessels in the lungs relax.
Apnea. Premature babies sometimes stop breathing for 20 seconds or more. This interruption in breathing is called apnea, and it may be accompanied by a slow heart rate. Premature babies are constantly monitored for apnea. If the baby stops breathing, a nurse will stimulate the baby to start breathing by patting him or touching the soles of his feet
- Intraventricular hemorrhage (IVH). Bleeding in the brain occurs in some very low birthweight babies, with the most premature babies at highest risk. The bleeds usually occur in the first three days of life and generally are diagnosed with an ultrasound examination. Most brain bleeds are mild and resolve themselves with no or few lasting problems. More severe bleeds can cause the fluid-filled structures (ventricles) in the brain to expand rapidly, causing pressure on the brain that can lead to brain damage (such as cerebral palsy, learning and behavioral problems). In such cases, surgeons may insert a tube into the brain to drain the fluid and reduce the risk of brain damage. In milder cases, drugs sometimes can reduce fluid buildup.
- Patent ductus arteriosus (PDA). PDA is a heart problem that is commonly seen in premature babies. Before birth, a large artery called the ductus arteriosus lets the blood bypass the lungs because the fetus gets its oxygen through the placenta. The ductus normally closes soon after birth so that blood can travel to the lungs and pick up oxygen. In premature babies, the ductus may not close properly, which can lead to heart failure and lack of oxygen to the organs. PDA can be diagnosed with a specialized form of ultrasound (echocardiography) or other imaging tests. Babies with PDA are treated with a drug that helps close the ductus, although surgery may be necessary if the drug does not work.
- Necrotizing enterocolitis (NEC). Some premature babies develop this potentially dangerous intestinal problem (usually 2 to 3 weeks after birth), which leads to feeding difficulties, abdominal swelling and other complications. It is believed that the bowel may become damaged when its blood supply is decreased, and bacteria that are normally present in the bowel invade the damaged area, causing more damage. When tests (including X-rays and blood tests) show that a baby has NEC, she will be given antibiotics and fed intravenously while her bowel heals. In some cases, surgery is necessary to remove damaged sections of the intestine.
- Retinopathy of prematurity (ROP). ROP, an abnormal growth of blood vessels in the eye, occurs mainly in babies born before 32 weeks of pregnancy. It can lead to bleeding and formation of scars that can damage the retina of the eye, sometimes resulting in vision loss and blindness. Babies with mild ROP – which is diagnosed during an examination by an ophthalmologist (eye doctor) – usually require no treatment because, in most cases, the eyes heal by themselves with little or no vision loss. In more severe cases, the ophthalmologist may treat the abnormal vessels with a laser or with cryotherapy (freezing) to protect the retina and preserve vision.
- Jaundice. Premature babies are more likely than full-term babies to develop jaundice because their livers are too immature to remove a waste product called bilirubin from the blood. In addition, premature infants may be more sensitive to the ill effects of excess bilirubin. Babies with jaundice have a yellowish color to their skin and eyes. Jaundice often is mild and usually is not harmful; however, if the bilirubin level gets too high, it can cause brain damage. This generally can be prevented because blood tests will show when bilirubin levels are too high, so the baby can be treated with special lights (phototherapy) that help the body eliminate bilirubin. Occasionally, a baby may need a blood transfusion.
- Anemia. Premature infants often are anemic, which means they do not have enough red blood cells. Normally, the fetus stores iron during the later months of pregnancy and uses it late in pregnancy and after birth to make red blood cells. Infants born too soon may not have had enough time to store iron. Babies with anemia tend to develop feeding problems and grow more slowly; anemia also can worsen any heart or breathing problems. Anemic infants may be treated with dietary iron supplements, drugs that increase red blood cell production or, in severe cases, blood transfusion.
- Chronic lung disease (also called bronchopulmonary dysplasia). Chronic lung disease most commonly affects premature infants who require ongoing treatment with supplemental oxygen at 36 weeks postmenstrual age (after conception). These babies develop fluid in the lungs, scarring and lung damage, which can be seen on an X-ray. Affected babies are treated with medications that make breathing easier, and are slowly weaned from the ventilator. Their lungs usually improve over the first two years of life. However, many children develop chronic lung disease resembling asthma.
- Infections. Premature babies have immature immune systems that are inefficient at fighting off bacteria, viruses and other organisms that can cause infection. Serious infections that are commonly seen in premature babies include pneumonia (lung infection), sepsis (blood infection), and meningitis (infection of the membranes surrounding the brain and spinal cord). Babies can contract these infections at birth from their mothers or they may become infected after birth. Infections are treated with antibiotics or antiviral drugs.
- Can medical problems in premature newborns be prevented?
When a doctor suspects that a woman may deliver preterm, he or she may suggest treatment with corticosteroid drugs. Corticosteroids speed maturation of fetal lungs and significantly reduce the risk of RDS, IVH, necrotizing enterocolitis and infant death. These drugs are given by maternal injection and are most effective when administered at least 24 hours before delivery. Her doctor also may suggest treatment with medications (called tocolytics) that may postpone labor (though often not for more than a couple of days). Even this short delay can give the doctor time to treat the pregnant woman with corticosteroids and arrange for delivery in a hospital with a NICU that can give appropriate care to a premature infant, which could make a life-saving difference for her baby.
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