What Is a Very Premature Baby?

Health Conditions a Very Premature Baby May Have

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A premature baby (also know as a preterm baby) is one who is born before 37 weeks gestation. Since babies grow so quickly during pregnancy, a premature baby who is born three to four months early is very different from one who is born just three to four weeks early. That's why doctors often use the following terminology to distinguish among different kinds of premature babies:

Micro preemierefers to a baby who is born before 26 weeks gestation 
Very premature babyrefers to a baby who is born between 27 and 30 weeks gestation
Moderately preterm babyrefers to a baby was born between 31 and 34 weeks gestation
Late preterm babyrefers to a baby a who is born between 34 and 37 weeks gestation

This article will focus mainly on the very premature baby category, or babies who are born between 27 and 30 weeks gestation.

What Is the Survival Rate for a Very Premature Baby?

The great news is that more than 95 percent of very premature babies survive. Although these babies are very immature and may face serious health problems, most of them recover from their premature birth with few long-term consequences.

What Does a Very Premature Baby Look Like?

If you are visiting a very premature baby in a neonatal intensive care unit (aka NICU), you may be surprised by how small the baby is. A baby born at 27 weeks weighs only around 1,000 grams (2 pounds, 3 ounces); a baby born at 30 weeks weighs around 1,450 grams (3 pounds, 3 ounces). Very premature babies have thin skin with visible veins, and there is a lot of medical equipment present, often including:

  • Respiratory support: Most very premature babies need respiratory support after birth. A very sick or immature baby may need mechanical ventilation. Other very premature babies may need continuous positive airway pressure (aka CPAP) or a nasal cannula.
  • IV lines: Due to their immature digestive systems, very premature babies are fed by intravenous (IV) lines at first and are introduced slowly to breast milk or formula. IV lines may come from the umbilical cord stump (umbilical catheters), or peripheral IVs or PICC lines may be placed in a premature baby's extremities or scalp.
  • NG/OG tubes: Before about 33 weeks gestation, babies cannot suck, swallow, and breathe at the same time. Very premature babies are fed through a tube that goes from the nose or mouth down into the stomach.
  • Monitoring equipment: Very premature babies will have stickers on their chests and wrists or feet to monitor their heart rate, breathing rate, and oxygen saturation.

Are There Health Problems in the NICU for Very Premature Babies?

A very premature baby may have a smooth NICU course or a complicated one. The most common health problems of very premature babies include:

  • Respiratory distress syndrome (RDS): About 70 percent to 85 percent of very premature babies need treatment for RDS. Respiratory distress is treated with respiratory support or medication.
  • Patent ductus arteriosus (PDA): Nearly half of babies born at 27 weeks and 17 percent of babies born between 29 and 30 weeks are born with a PDA. The ductus arteriosus is a blood vessel, and it lets blood circulate around a fetus's lungs. Although a PDA is normal in fetuses, this blood vessel should close at birth. Medication or surgery can be used to close a PDA.
  • Sepsis: Because premature babies have immature immune systems, they are more susceptible to infection than term babies. About 25 percent of very premature babies need medication to treat an infection.
  • Apnea of prematurity: Because their nervous systems are immature, premature babies may have periods of apnea or bradycardia. They usually outgrow this condition, which can be treated with medication, by the time they leave the NICU.
  • Anemia: Anemia (a lack of red blood cells) is common in premature babies. Anemia of prematurity is most often seen in babies who are born before 32 weeks, and it may be treated with iron supplements, blood transfusions, or medications.
  • Intraventricular hemorrhage (IVH): Very premature babies have fragile blood vessels, especially in the brain. If these vessels break, blood may spill into the brain's ventricles. About 10 percent of very premature babies have a severe IVH.
  • Necrotizing enterocolitis (NEC): In NEC, the linings of the intestines become infected and begin to die. This is a serious condition that is treated with medication or surgery. Thankfully, only a small number (about 5 percent) of very premature babies suffer from NEC.

What Are Potential Long-Term Health Problems for a Very Premature Baby?

Most very premature babies recover from premature birth with few lasting effects. They may have special needs for the first few years, but they usually outgrow their medical conditions over time. The most common long-term health problems for very premature babies are:

  • Apnea of prematurity: Most very premature babies outgrow this before they leave the NICU, but others still have spells after they go home. These babies may go home with an apnea monitor to make sure they maintain their heart and breathing rates.
  • Chronic lung disease: Respiratory support can scar the lungs, causing chronic lung disease. About 33 percent of very premature babies need oxygen after NICU discharge, and many suffer from asthma or other respiratory illnesses as young children.
  • Developmental delay: Although severe cognitive disabilities are uncommon in very premature babies, developmental delays and trouble in school are more common. About 33 percent of very premature babies need some help in school as they get older.

How Can I Improve My Very Premature Baby's Outcome?

There are many things that you can do as a parent to help give your baby the best possible start:

  • Get early prenatal care: Early and regular prenatal care can help moms minimize their risks for premature birth and prevent or stop premature labor.
  • Pump breast milk: Even if moms don't plan to breastfeed, pumping breast milk—even for a short time—can help give very premature babies the best start.
  • Try kangaroo care: Bonding through kangaroo care can help premature babies grow and mature, and has many benefits for both parents and premature babies. This involves holding the baby (who is wearing only a diaper) skin-to-skin against your chest, in between your bare breasts, to keep him or her warm and feeling secure. 
  • Seek early intervention: Many very premature babies will qualify for early intervention services. These state-run programs help very premature babies catch up to their peers and meet milestones on time.

Sources:

Marlow, N. "Neurocognitive Outcome After Very Preterm Birth." Archives of Disease in Childhood June 2003; 89, 224-228.

Qiu, X et al. "Comparison of Singleton and Multiple-Birth Outcomes of Infants Born at or Before 32 Weeks of Gestation." Obstetrics & Gynecology Feb 2008; 111, 365-371.

Vohr, B et al. "Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants <32 Weeks' Gestation Between 1993 and 1998." Pediatrics Sept 2005; 116, 635-643.

https://www.nlm.nih.gov/medlineplus/ency/article/001560.htm

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