What are short and long-term health issues for premature babies?

What kinds of short- and long-term health issues do premature babies face? How can they be treated?

Expert:Carmina Erdei, MD, Neonatologist at Brigham and Women’s Hospital

To understand the health issues for premature babies, we must first understand how doctors identify a premature baby. Babies born before 37 weeks are considered premature or preterm. Many women who give birth prematurely have no known risk factors. However, twins and multiples are more likely than single birth babies to be born prematurely. Other risk factors for preterm birth include:

• Mother being younger than 16 or older than 35 years old at the time of delivery
• smoking
• having an abnormal uterus or cervix
• having an infection
• having heart or kidney disease.

Premature babies are smaller than full-term babies, often weighing less than 5 pounds (and sometimes, in extreme cases, weighing less than one pound!). They also may have thin, translucent skin, very little body fat, and underdeveloped organs and muscles from head to toe.

Ideally, most babies should be born between 39 and 41 weeks of pregnancy. Preterm babies are divided into four categories based on gestational age. 

• Babies born between 37 weeks and 38 weeks, 6 days are considered early term.
• Babies born between 34 weeks and 36 weeks, 6 days are considered late preterm.
• Babies born at or below 32 weeks are very preterm.
• Babies born at or below 28 weeks are extremely preterm.

Short-term health issues for premature babies: in the hospital 

The earlier a baby is born, the more help and support the baby will need. Doctors care for premature babies are cared for in a neonatal intensive care unit, where they are very closely monitored.

They can be fed through a stomach tube if they are unable to eat on their own. Since premature babies do not have fully matured bodies or organ systems, they often need help breathing, eating, staying warm, and fighting infection.

Often, premature babies have underdeveloped lungs, such the lungs are one of the last organs to mature during gestation. Doctors can help breathing with a breathing tube and a ventilator. They may prescribe extra tests such as x-rays and blood work. They will treast other condtions with medications including antibiotics.

Premature babies may also have other health concerns:

• immature breathing patterns
• ability to feed correctly
• control of body temperatureregulation of blood sugar
• anemia
• jaundice
• infections
• growth problems 
• heart problems
• kidney issues
• neurological problems
• vision and hearing deficits

The Growth and Development Unit (GDU)

Because of this, in addition to promoting physical health, NICU specialists will work with your baby to support neurodevelopment beginning the day they are born. Stable preemies who ‘graduate’ the critical stage of their early life, but are still not fully ready to go home, transition to the Growth and Development (GDU) unit of the NICU for further specialized multidisciplinary care.

The GDU offers an enriched environment where infants benefit from ongoing expert medical, nursing, and developmental therapies that match their evolving needs. In the Growth and Developement Unit, families are at the center of a child’s care, and they are encouraged to spend as much time as they can with their infants, hold them skin-to-skin, read with them, feed them, and be an active part of their lives and care.

Skin-to-skin contact is especially important for premature babies. Also known as ‘kangaroo care,’ skin-to-skin contact (placing a baby on a family member’s bare chest) is scientifically proven to help babies gain weight, maintain their own body temperature, and better regulate their physiologic and neurologic stability. Skin-to-skin contact is recommended to start as soon as possible after birth, and continue daily throughout a baby’s hospital stay in the NICU and beyond.

Sometimes the practice may need to be modified if the baby is extremely preterm and fragile, but should continue to be implemented as much and as frequently as possible, with support from the baby’s NICU team. The practice is especially beneficial for fragile babies, so as soon as the baby is stabilized, skin-to-skin therapy should begin.

It’s not just the baby who derives benefits from skin-to-skin. Skin-to-skin also helps family members bond with their new baby, better cope with the stress of having an infant in the NICU, and even promotes mothers’ milk production. 

In the longer term, preterm infants face risk for cognitive, motor and language delays in early childhood, as well as learning, emotional and behavioral problems at school age. 

Long-term health issues for premature babies: after the NICU

Support and neurodevelopment don’t end when the baby leaves the hospital – it is merely the beginning of the road. The baby’s medical team will work with the family to provide resources that allow parents and caregivers to continue supporting the baby’s growth and development throughout childhood. In the long term, premature babies are more likely than full-term babies to experience:

• cognitive difficulties
• motor problems (including cerebral palsy)
• language delays
• a wide range of emotional and behavioral problems including anxiety, ADHD, and autism
• dental issues
• poor vision and hearing loss

Neonatal doctors will help families transition to an at-home treatment plan which is tailored to their baby’s specific needs. Some health issues for premature babies will require continued support from medical and educational specialists throughout childhood and school years, to ensure they are able to achieve their best potential.

We now understand that for every baby, there is an incredible amount of growth and development that happens throughout the first few months to years of life. The time babies may need to spend in the NICU represents a window of opportunity in a premature baby’s life when optimal support to promote physical and neurological development is critically important – and very effective. Honoring the vital importance of the baby’s family, and supporting the entire family in the NICU as well as after transition to homeare key to giving premature babies the best start in life.