A premature baby is a baby born before 37 weeks of gestation. Depending on when the birth occurred, the premature newborn has underdeveloped organs that may not be ready to function outside the womb. Previous premature birth, multiple births, malnutrition during pregnancy, delays in prenatal care, infections, assisted reproductive technologies (such as in vitro fertilization), and high blood pressure can all cause the condition. to an increased risk of premature birth.
Because many organs are underdeveloped, premature newborns may have difficulty breathing and feeding, and are at risk of bleeding in the brain, infections and other problems.
Preterm (younger) babies who were born earlier are also more likely to have problems, including developmental problems.
Although some premature babies grow up to have permanent problems, most of the survivors'' condition is normal.
However, prenatal care may reduce the risk of a premature birth.
Preterm labor can sometimes be delayed for a short time by giving the mother drugs to slow or stop contractions.
When the infant is expected to be born very early, the mother may be given injections of corticosteroids to speed the development of the fetus''s lungs and help prevent bleeding in the brain (intraventricular hemorrhage).
(See also Overview of Common Problems in Newborns.)
Gestational age refers to the duration of the embryonic stage. Gestational age is the number of weeks between the first day of a mother''s last menstrual period and the day of delivery. This time frame is often adjusted according to other information that doctors receive, including the results of early ultrasonography, which provide information Additional gestational age: The expected gestational age at which the baby is born is 40 weeks.
Newborns are classified according to their gestational age as premature if they are born before the 37th week of pregnancy. Preterm infants are also classified as follows:
Preterm infants born very early: before the 28th week of pregnancy
Premature babies born prematurely: Delivered from 28 weeks to 32 weeks of gestation.
Premature infants born at medium early stage: delivery from 32 weeks to 34 weeks of gestation.
Premature babies born at late preterm stage: delivery from 34 weeks to 37 weeks of gestation.
Premature birth occurs in 1 in 10 full-term births in the United States. Higher degrees of preterm birth are associated with higher risks of serious and even life-threatening complications.
Severe prematurity is the single most common cause of death among newborn infants. Newborns born very early are also at increased risk of long-term problems, particularly developmental delays, cerebral palsy, and learning disorders. Even so, most premature infants grow up without any suffering. long-term difficulties.
the reasons
In many cases, the causes of preterm birth are not known. However, there are many known risk factors for preterm birth. Adolescents, older women, women of low socioeconomic status, and women with a low educational level face an increased risk of having a preterm birth.
Risk factors from a previous pregnancy
A previous premature birth
Previous multiple pregnancies
Previous multiple induced miscarriages or spontaneous miscarriages
Risk factors before or during pregnancy
Pregnancy by an assisted reproductive technology (such as in vitro fertilization), especially when these pregnancies involve: multiple fetuses (twins, triplets, quadruplets)
Multiple fetuses occur naturally
Little or no prenatal care
smoking cigarettes
Neglecting to treat infections during pregnancy, such as urinary tract infections, sexually transmitted diseases or infections of the uterus (intra-amniotic infection)
Previous surgery involving the cervix or a weak cervix (cervical insufficiency))
heart disease
Hypertension
Kidney disease
diabetic
Preeclampsia (pre-eclampsia) or eclampsia (eclampsia)
Premature abruption of the placenta (placental abruption)
Premature rupture of membranes
But there are no known risk factors for most women who deliver prematurely.
Early prenatal care may reduce the risk of a premature birth.
symptoms
Premature newborns usually weigh less than 2.5 kg, and some may weigh up to 0.5 kg. Symptoms often vary with the immature organs
Very premature newborns tend to stay longer in the hospital''s neonatal intensive care unit until their organs can function well on their own. Newborns born late in pregnancy, on the other hand, may have few, if any, organs. They need time to mature. Newborns born late in pregnancy may stay in the hospital to regulate their body temperature and blood sugar (glucose) levels, eat well, and gain weight.
Also, the immune system of any premature infant is not fully developed, so premature newborns are vulnerable to infection.
Physical features of the premature newborn
Physical features of the premature newborn
Small size
Head large in relation to the rest of the body
Little subcutaneous fat
Delicate, soft and pink skin
Visible veins under the skin
Few wrinkles on the soles of the feet
Little poetry
Soft ears with little cartilage
Underdeveloped breast tissue
Boys: the scrotum is small with some folds The testicles may not be undescended in premature newborns who are born very early.
Girls: the labia majora have not yet covered the labia minora from the genitals
Rapid breathing with short pauses (cyclic breathing), episodes of apnea (pauses longer than 20 seconds), or both
Weakness and poor coordination of the sucking and swallowing reflexes
Decreased physical activity and muscle tone (a premature newborn tends not to retract the arms and legs at rest as a full-term newborn does)
Spending most of the time sleeping
complications
Most complications of prematurity result from incomplete development and maturation of organs and systems in the body. The risk of complications increases the earlier the birth is timing. The risk of complications also depends partly on the presence of certain causes of preterm birth, such as infection, diabetes, or high blood pressure or pre-eclampsia.
The brain is not fully developed
Many problems arise when an infant is born before the brain is fully developed. These problems include:
Inconsistent breathing: The part of the brain that controls regular breathing may be so immature that premature newborns breathe inconsistently, with short pauses in breathing or periods of completely stopped breathing lasting 20 seconds or longer (apnea of preterm infants) .
Difficulty coordinating feeding and breathing: The parts of the brain that control reflexes, including the mouth and throat, are immature, so premature newborns may not be able to suck and swallow normally, resulting in difficulty coordinating feeding and breathing.
Bleeding in the brain: Newborns born very early are at increased risk of bleeding in the brain.
Underdevelopment of the digestive tract and liver
Underdevelopment of the digestive tract and liver can lead to many problems, including
Frequent bouts of ejection: Premature newborns may have difficulty feeding at first. Not only are sucking and swallowing reflexes immature, but their small stomachs empty slowly, which may lead to recurrent bouts of ejection (reflux).
Frequent episodes of feeding intolerance: The intestines of premature babies move very slowly, and premature babies often have difficulty passing stools. Because of the slow movement of the intestinal tract, premature babies do not easily digest breast milk or formula that is offered.
Intestinal damage: In newborns born too early, a serious condition can occur in which part of the intestine becomes severely damaged and can cause infection (a condition called necrotizing enterocolitis).
Hyperbilirubinemia: Premature newborns are at risk of developing hyperbilirubinemia. In hyperbilirubinemia, the newborn''s liver is slow to filter bilirubin (a yellow pigment that results from the normal breakdown of red blood cells) from the blood. This gives the skin and the whites of the eyes a yellow color (jaundice). Premature newborns tend to have jaundice in the first few days after birth. The jaundice is usually mild and resolves when newborns nurse more and have more stools (bilirubin is excreted in the stool, giving it its yellow colour). Light at first. In rare cases, so much bilirubin builds up that a newborn is at risk of kernicterus. (Kernicterus is a form of brain damage caused by deposits of bilirubin in the brain.)
Underdevelopment of the immune system
Infants born very early have low levels of antibodies, proteins in the blood that help prevent infection. The mother''s antibodies cross the placenta late in pregnancy and help protect the newborn from infection at birth. Premature newborns have fewer maternal protective antibodies and are therefore more susceptible to infection, especially infection of the blood (neonatal sepsis) or the tissues around the brain (meningitis). Breathing (endotracheal tubes) increases the risk of serious bacterial infections.
Underdevelopment of the kidneys
Before birth, waste products produced by the fetus are passed through the placenta to be excreted through the mother''s kidneys. After birth, these functions must be carried out by the newborn''s kidneys. Kidney function in very early newborns is poor, but it improves as the kidneys mature. Newborns whose kidneys are underdeveloped have difficulty regulating the amount of salt and other electrolytes in addition to water in the body. Kidney problems can lead to failure to thrive and a buildup of acid in the blood (a condition called metabolic acidosis).
Lung growth deficiency
The lungs of premature newborns may not have enough time to fully develop before birth. Small air sacs called alveoli, which absorb oxygen from the air and remove carbon dioxide from the blood, do not form until about the beginning of the last trimester (third trimester). In addition to this structural development, the tissues of the lungs must synthesize a fatty substance called surfactant. Surfactant lines the interior of the air sacs and allows them to remain open throughout the respiratory cycle, making breathing easier. In the absence of surfactant, the air sacs tend to collapse at the end of each wheezing, which makes breathing very difficult. The lungs do not usually make surfactant until about 32 weeks of gestation, and production is not usually sufficient until about 34 to 36 weeks.
These factors mean that babies born early are at risk of breathing problems, including respiratory distress syndrome (RDS). It helps the entry and exit of air from the lungs).
There is no treatment to make the lung structures mature more quickly, but with adequate nutrition, the lungs continue to mature over time.
There are two ways to increase the amount of surfactant and reduce the chance and severity of respiratory distress:
Before childbirth: Corticosteroids, such as betamethasone, increase the production of surfactant in the fetus, and are given to the mother by injection when preterm labor is expected, usually 24 to 48 hours before delivery.
After birth: Doctors may administer surfactant directly into a newborn''s trachea (trachea).
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