Premature Birth Complications

A typical pregnancy lasts about 40 weeks, yet some babies arrive sooner. A premature birth is a birth that takes place before the 37th week of pregnancy.

• family integrated care programs
• nutrition management
• skin-to-skin contact with premature babies
• efforts to reduce the number of infections in premature babies

While outcomes have improved for premature babies, complications can still occur. The following complications can affect preterm babies in the first weeks after birth.

The most common type of jaundice among premature babies is exaggerated, physiologic jaundice. In this condition, the liver can’t rid the body of bilirubin. This substance is produced during the normal breakdown of red blood cells. As a result, bilirubin accumulates in the baby’s blood and spreads into the tissues. Because bilirubin is a yellowish color, the baby’s skin takes on a yellowish tint.

Jaundice is usually not a serious problem. However, if the bilirubin level gets too high, it can cause bilirubin toxicity. The substance can then build up in the brain and cause brain damage.

Ask your doctor or nurse for your baby’s bilirubin level. Normal levels of bilirubin in a newborn should be under 5 mg/dL. Many preterm babies, however, have bilirubin levels above that number. Bilirubin levels are not dangerous until they reach levels above 15-20 mg/dL, but phototherapy is generally started before levels get that high.

Treatment: The standard treatment for jaundice is phototherapy. This involves placing a baby under bright lights. The lights help break down the bilirubin into a substance that the body can get rid of more easily. Usually phototherapy is needed for less than a week. After that, the liver is mature enough to get rid of bilirubin on its own.

A baby’s kidneys usually mature quickly after birth, but problems balancing the body’s fluids, salts, and wastes can occur during the first four to five days of life. This is especially true in babies less than 28 weeks into development. During this time, a baby’s kidneys may have difficulty:

• filtering wastesfrom the blood
• getting rid of wastes without excreting excess fluids
• producing urine

Because of the potential for kidney problems, neonatal intensive care unit (NICU) staff carefully record the amount of urine a baby produces. They may also test the blood for levels of potassium, urea, and creatinine.

Staff must also be watchful when giving medications, especially antibiotics. They need to make sure that the medicines are excreted from the body. If problems arise with kidney function, staff may need to restrict the baby’s fluid intake or give more fluids so that substances in the blood are not overly concentrated.

Treatment: The most common basic treatments are fluid restriction and salt restriction. Immature kidneys usually improve and have normal function within a few days.

A premature baby can develop infections in almost any part of the body. A baby may acquire an infection at any stage, ranging from in utero (while in the uterus), birthing through the genital tract, to after birth including the days or weeks in the NICU.

Regardless of when an infection is acquired, infections in premature infants are more difficult to treat for two reasons:

• A premature baby has a less developed immune system and fewer antibodies from the mother than a full-term baby. The immune system and antibodies are the body’s main defenses against infection.
• A premature baby often requires a number of medical procedures, including insertion of intravenous (IV) lines, catheters, and endotracheal tubes and possibly assistance from a ventilator. Each time a procedure is performed, there’s a chance of introducing bacteria, viruses, or fungi into the baby’s system.

If your baby has an infection, you may notice some or all of the following signs:

• lack of alertness or activity
• difficulty tolerating feedings
• poor muscle tone
• inability to maintain body temperature
• pale or spotted skin color, or a yellowish tint to the skin (jaundice)
• slow heart rate
• apnea (periods when the baby stops breathing)

These signs may be mild or dramatic, depending on the severity of the infection. As soon as there’s any suspicion that your baby has an infection, the NICU staff obtains samples of blood and often urine and spinal fluid to send to the laboratory for analysis.

Treatment: If there is evidence of infection, your baby may be treated with antibiotics, IV fluids, oxygen, or mechanical ventilation (help from a breathing machine). Although some infections can be serious, most babies respond well to treatments, including antibiotics if the infection is bacterial. The earlier your baby is treated, the better the chances of successfully fighting the infection.

Breathing problems in premature babies are caused by an immature respiratory system. Immature lungs in premature babies often lack surfactant. This substance is a liquid that coats the inside of the lungs and helps keep them open. Without surfactant, a premature baby’s lungs can’t expand and contract normally. This increases their risk for respiratory distress syndrome.

Some premature babies also develop apnea and experience pauses in their breathing lasting for at least 20 seconds.

Some premature babies who lack surfactant may need to be put on a ventilator (breathing machine). Babies who are on a ventilator for a long time are at risk of developing a chronic lung condition called bronchopulmonary dysplasia. This condition causes fluid to build up in the lungs and increases the likelihood of lung damage.

Treatment: While being on a ventilator for an extended period of time may injure a baby’s lungs, it still may be necessary for the baby to receive continued oxygen therapy and ventilator support. Doctors may also use diuretic and inhaled medications.

The most common heart condition affecting premature babies is called apatent ductus arteriosus (PDA). The ductus arteriosus is the opening between two major blood vessels of the heart. In premature babies, the ductus arteriosus may remain open (patent) instead of closing as it should soon after birth. If this occurs, it can cause extra blood to be pumped through the lungs in the first days of life. Fluid can build up in the lungs, and heart failure can develop.

Treatment: Babies can be treated with the medication indomethacin, which causes the ductus arteriosus to close. If the ductus arteriosus remains open and symptomatic, an operation to close the duct may be required.

Brain problems can also occur in premature babies. Some premature babies have intraventricular hemorrhage, which is bleeding in the brain. Mild bleeding doesn’t usually cause permanent brain injury. However, heavy bleeding may result in permanent brain injury and cause fluid to accumulate in the brain. Severe bleeding can affect a baby’s cognitive and motor function.

Treatment: Treatment for brain problems can range from medication and therapy to surgery, depending on the severity of the problem.

Some premature birth complications are short-term and resolve within time. Others are long-term or permanent. Long-term complications include the following:

Cerebral palsy

Cerebral palsy is a movement disorder that affects muscle tone, muscle coordination, movement, and balance. It’s caused by an infection, poor blood flow, or a brain injury during pregnancy or after birth. Often, a specific cause can’t be determined.

Treatment: There is no cure for cerebral palsy, but treatments can help improve any limitations. Treatments include:

• assistive aids like eyeglasses, hearing aids, and walking aids
• medications to help with prevent muscle spasms, like diazepam and dantrolene
• surgery to improve mobility

Vision problems

Premature babies are at risk for retinopathy of prematurity. In this condition, blood vessels in the back of the eye become swollen. This can cause gradual retina scarring and retinal detachment, increasing the risks of vision loss or blindness.

Treatment: If retinopathy is severe, some of the following treatments may be used:

• cryosurgery, which involves freezing and destroying abnormal blood vessels in the retina
• laser therapy, which uses powerful light beams to burn and eliminate abnormal vessels
• vitrectomy, which is a surgery to remove scar tissue from the eye
• scleral buckling surgery, which consists of placing a flexible band around the eye to prevent retinal detachment

Hearing problems

Some premature babies experience some hearing loss. Hearing loss can sometimes be total, causing deafness. Many times, the exact cause hearing loss in premature babies is unknown.

Your baby will have their hearing tested in the hospital or shortly after discharge. Some of the later signs that your baby may have hearing loss are:

• not being startled by loud sounds
• not imitating sounds by six months of age
• not babbling by one year of age
• not turning at the sound of your voice

Treatment: Depending on the cause of hearing loss in your baby, treatments will vary. Treatments can include:

• surgery
• ear tubes
• hearing aid
• cochlear implant

Dental problems

Dental issues can affect a premature baby later in life. These include tooth discoloration, delayed tooth growth, or improper alignment.

Treatment: A pediatric dentist can help correct these problems.

Behavioral problems

Children born prematurely are more likely to have behavioral or psychological problems. These include attention-deficit disorder (ADD) and attention-deficit/hyperactivity disorder (ADHD).

Treatment: Creating a structured and consistent schedule plus medication, like Ritalin or Adderall, can help kids with ADHD.

Impaired cognitive function

Premature babies are also at greater risk for long-term disabilities, which can be intellectual, developmental, or both. These children may develop at a slower rate than babies born full-term.

Chronic health problems

In addition, premature babies have a greater risk for chronic health problems. They are more susceptible to infections, and may suffer from other problems such as asthma or difficulty feeding. There’s also an increased risk of sudden infant death syndrome (SIDS) among premature infants.

Over the last 25 years, the global mortality rate due to preterm birth complications has gone down significantly. In 1990, the mortality rate due to preterm birth complications was 21.4 per 100,000 people. By 2015, that rate dropped to 10.0 per 100,000 people.

The earlier a baby is born, the greater the risk for short-term and long-term complications. This table shows the survival rate by the length of pregnancy:

The outlook for premature babies has improved tremendously over the years. Throughout both the developed and developing world, mortality rates for preterm babies have gone down considerably within the last 25 years.

Depending on how early your baby is delivered and any complications that occur, your baby may not be able to come home with you immediately. Hospital stays can vary widely in length depending on the medical needs of your baby.

It’s important to note that your preterm baby might not meet growth or development milestones at the same rate as full term babies. This is normal. Preterm babies usually catch up to full-term babies developmentally by the age of two years.

Some premature birth complications can’t be prevented. However, neonatal intensive care units have saved a lot of lives and they will continue to do so. You can be confident that your hospital’s NICU will do everything in their powers to care for your baby and offer the support you need.