5 Preemie Myths and Misconceptions

Debunking some of the more common misunderstandings about premature babies

Preemie receiving human milk. GettyImages

1. "A late premature baby is just a smaller version of a full-term baby."

Don't let the name "late" fool you! There is nothing late about these babies. In fact, a late preterm infant is a baby born three to six weeks early, or between 34 and 36 completed weeks of gestation. In the last six weeks of pregnancy, the baby usually gains about one half pound per week, so babies born a few weeks early are somewhat smaller than full-term newborns, but they are not just smaller infants.

Late preterm babies have their own, unique health considerations that can be pretty serious including respiratory problems, low blood sugar levels, feeding difficulties, and trouble maintaining their body temperature. Babies born even just a few weeks preterm often have low calcium and phosphorus stores because they miss out on the important last weeks of pregnancy when two-thirds of bone mineralization takes place.

Late preterm babies also have an increased risk of infection due to an immature immune system. Antibodies from the mother are passed to her unborn baby through the placenta during the final stage of pregnancy. When a baby is born early, they miss out on receiving these antibodies making them more susceptible to infections.

Late preterm babies also have an immature neurological system. The brain of a baby born at 35 weeks gestation weighs only two-thirds of that of a full-term baby.

An infant’s nervous system is still developing during those final months and weeks in the womb. It is during this time that a fatty substance called myelin develops; this speeds up the transmission of nervous impulses and forms a sheath around the nerve fibers. Because of their immature neurological system, premature babies often find it hard to calm and comfort themselves and may need extra time and careful attention as they grow and learn in their new environment outside the womb.

2. "When a premature baby has the hiccups, it means that they are growing."

"Your baby has hiccups; he must be growing!" This is a common assumption based on an old wives tale, but it is far from the truth when it comes to premature babies. 

Inside the womb- you may have noticed that your baby had the hiccups quite a bit, but this typically doesn't start until  the third trimester of pregnancy. Hiccuping in the womb is in response to the baby swallowing amniotic fluid while “practice breathing” in preparation for life after birth. During the last trimester of pregnancy, a baby swallows approximately 750ml of amniotic fluid every day. Amniotic fluid has an array of growth factors, anti-inflammatory, and anti-infective components that help to mature the gut, building immunity and preparing it for the introduction of milk after birth.

After birth- a term newborn may continue to hiccup quite frequently, and it may be tied to feeding. Hiccups are caused by sudden contractions of the diaphragm triggered by irritation of the muscle and stimulation of the vagus nerve- the nerve that connects your brain to your abdomen.

Hiccups are fairly common in newborn babies and their occurrence typically fades within the first few weeks after birth.

For a premature baby, the hiccup is more of the physiologic response rather than a physical cause. The premature baby’s neurological system is immature and will respond to stress differently because of it. The brain regulates body functions such as heart rate, breathing rate, blood pressure, and temperature. A premature baby has premature organs regulated by an immature nervous system, which can cause physiological stress responses to occur if the baby becomes overstimulated or disorganized in their behavior. Some of these behavioral stress cues are sneezing, spitting up, gagging and hiccuping. It’s important to learn your baby’s  stress and stable cues so that you can respond to and comfort your baby in the very best way possible as they grow and develop in the foreign NICU world.

3. "It really doesn't matter what type of milk a premature baby gets or where it comes from; it's all food, and a calorie is a calorie, right?"

With research, medical, and scientific advancements we have come a long way in the world of preemie care. However, no matter how advanced it gets, the NICU can only try to replicate what nature does the very best within the womb, the growth and development of the baby. This is also true when it comes to the nutritional needs of the newborn. Formula companies have been able to create milk that is specific for premature babies nutritional and growing needs. However, they will never be able to do what nature does best, especially when it comes to the very special needs of a premature infant's immature immune and gastrointestinal systems.

Human milk has over 130 oligosaccharides, prebiotics, and probiotics that are specific to human milk. These good bacteria help colonize the premature baby’s gut with friendly, healthy live cells and antibodies. These antibodies help to grow good pathogens and help to protect against severe intestinal inflammation and an infection called Necrotizing Enterocolitis (NEC) that can be very devastating to a premature baby.

Colostrum has a profile of anti-inflammatory and anti-infective components that is very similar to that of amniotic fluid. Human milk feedings and specifically colostrum feedings in the early days stimulate rapid growth of the intestinal tract and mucosal lining helping to mature and protect it just like amniotic fluid does while the baby is in utero. Human milk builds immunity and protects the premature baby from infection and disease.

Human Milk is more than just a meal! It has so many powerful benefits that help the preterm baby not only grow and survive but thrive in the NICU. Human milk helps reduce many other serious preterm complications and should be considered an essential part of neonatal care. Human milk is the gold standard in neonatal care and should always be viewed as a life-saving medication for fragile infants.

4. "A premature baby is ready to be discharged from the NICU when they reach 5 pounds."

When your premature baby hits 5 pounds, it is a major milestone worth celebrating, but it may not mean that your baby can now be discharged from the NICU and is ready to head home.

Discharge from the Neonatal Intensive Care is based on milestones, and a premature baby must typically meet the following criteria before they are ready to go home:

  • Be able to hold their temperature (within normal range) all on their own in an open crib without the aid of a hat or additional blankets.
  • Be able to eat all of their food by mouth with ease while taking in an adequate number of calories.
  • Gaining adequate weight.
  • Breathing on their own. Most babies are off oxygen when discharged from the NICU, but some infants may need supplemental oxygen for a longer period of time and may be sent home with this therapy.
  •  Not have any “episodes” of apnea, (pauses in breathing) and bradycardia, (slow heart rate) or change in color. You may be able to take your baby home on a monitor if they have short self-resolving episodes that do not require any intervention.

Before discharge your baby may also need a car seat study or test, a hearing screen, important specialty appointments made, and you may also need some education on CPR, safe sleep, and infant care. Start planning early so that when your baby is ready to go home, you are too!

Since every baby is different, and their journeys vary from just a few days to many months, it is difficult to say when your baby will hit all these milestones and be ready for discharge. Keep track of your baby’s progress by starting a journal or checklist, and celebrating these milestones as they happen. 

5. "A baby born prematurely will hit milestones at the same age and stage as a full-term baby."

Don’t compare your baby to your friend’s baby who was born the same week or your neighbor’s nephew who was walking at nine months of age. It’s easy to get caught up in these comparisons, because let’s face it, people like to talk…and brag.  But, it’s important to keep in mind that your baby is still a “preemie” when discharged from the hospital and just because you have left the NICU does not mean your baby is now considered a full-term baby. Your baby is a premature baby who has now hit full term gestation. There is a big difference, especially if your baby has had a rough and fighting start. Your premature baby is now healthy and stable enough to continue to grow outside of the hospital. That is a pretty amazing feat, but please remember to refer to your actual due date, rather than your baby’s birth date when following a developmental milestone guideline.

For example, a baby that was born at full term will begin to show signs of early communication at two months of age when they discover their voice and begin to make cooing sounds. This is an exciting milestones achievement! However, a premature baby born 2 months early, at two months of age may have just mastered the suck-swallow-breathe milestone and is now able to take all milk by mouth. This is exciting too, but is more on track, developmentally, with that of a full-term newborn. 

Sources:

Retrieved from http://www2.aap.org/sections/perinatal/PDF/preemie.pdf

A hiccup cure that really works › Dr Karl's Great Moments In Science (ABC Science). (n.d.). Retrieved from http://www.abc.net.au/science/articles/2012/09/04/3582324.htm

Central nervous system maturation in the stressed premature - Holmes - 2004 - Annals of Neurology - Wiley Online Library. (n.d.). Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/ana.410060610/abstract

(n.d.). Retrieved from http://www.healthychildren.org/English/ages-stages/baby/preemie/Pages/Preemie-Milestones.aspx

The Immune System in Pregnancy: A Unique Complexity. (n.d.). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025805/

Late Preterm Birth. (n.d.). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876317/

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