Premature babies

A baby is considered premature when born before the 37th week of pregnancy. Preterm births have increased considerably over the past 25 years. They now account for 8 percent of births in Quebec—more than 6,000 children each year. About 1,200 of these babies will be born before the 32nd week of pregnancy.

What are the causes of preterm birth?

Several factors can increase the likelihood of a preterm delivery:

• The mother’s age
• A previous preterm labour or birth
• Maternal infections (e.g., urinary tract infection, intrauterine infection)
• High blood pressure and gestational diabetes
• Certain problems related to the fetus (delayed fetal growth, birth defects)
• How many babies the mother is carrying
• A pregnancy that is the result of assisted reproduction
• Premature dilation of the cervix
• Premature rupture of membranes
• Spontaneous preterm labour
• Certain aspects of the mother’s lifestyle (e.g., smoking, drinking alcohol, using drugs)

Types of preterm births

A typical pregnancy is around 40 weeks long. Most premature babies are born between weeks 32 and 37 of pregnancy, but some are born as early as week 22.

Whether your baby develops health problems, and how severe they are, depends on a number of factors, including the gestational age of the baby at birth, complications in the baby or the mother, the use of steroids, and the baby’s birth weight. Premature babies may also develop physical, behavioural, and intellectual problems.

Certain clinical conditions may be more severe in some babies. Some issues can be identified as early as hospitalization, while others may be diagnosed during medical follow-ups after discharge from the hospital, or even in early childhood.

Moderately to late premature babies (born between 33 and 36 weeks)

• These babies have an underdeveloped respiratory system and difficulty regulating their body temperature.
• They need little or no help with feeding. However, they have difficulty coordinating breathing, suckling, and swallowing, so they tire quickly.

Very premature babies (born between 29 and 32 weeks)

• These babies do not have full control of their breathing and may experience periods of stopped breathing. They often need additional oxygen and must be placed in an incubator because they can’t properly regulate their body temperature.
• They are initially fed via a feeding tube that goes through their nose or mouth and into their stomach. This helps them conserve the energy they would otherwise use to suckle and swallow. An intravenous solution may also be administered to ensure that the baby receives the calories and essential nutrients they need to grow (link in French).

Extremely premature baby (born before 28 weeks)

• Extremely premature babies cannot breathe or feed on their own. They must be placed on a ventilator and given an intravenous drip. They are also given medications.
• They may have many health problems and are more likely to experience complications in the hospital (e.g., infections, brain hemorrhage, retinopathy).
• If a baby is born between 22 and 25 weeks, they are at the outer edge of viability and may suffer severe after-effects.

What kinds of health problems can premature babies have?

Premature babies are at risk of developing a number of complications because they are still weak and their bodies are underdeveloped.

• Respiratory distress syndrome: This is the most common condition in premature babies due to the immaturity of their lungs. It’s why some premature babies need to be put on a ventilator.
• Bronchopulmonary dysplasia: Bronchopulmonary dysplasia is an abnormality in the development of the lungs. This complication occurs in premature babies born before 32 weeks of pregnancy who have been given oxygen on a ventilator for a prolonged period.
• Apnea and bradycardia: Apnea is a temporary interruption of breathing, and bradycardia is an irregular heartbeat. Because premature babies’ brains are underdeveloped, it’s harder for them to regulate their breathing and heart rate. This leads to respiratory and cardiac irregularities, so premature babies will often be connected to a cardiorespiratory monitor so their vital signs can be monitored.
• Jaundice: This condition is more common in premature babies because their livers are immature and feeding is often delayed. Premature babies need phototherapy treatment for jaundice.
• Anemia: Premature babies are more likely to suffer from anemia because about 80 percent of their iron reserves are accumulated during the last trimester of pregnancy. Their rapid growth following birth also contributes to this risk.
• Infections: Premature babies are more likely to get infections because of their fragile and permeable skin, underdeveloped immune system, and low weight, as well as the many medical procedures they undergo. Infections can develop during pregnancy, childbirth, or hospitalization. These infections are usually treated with antibiotics.
• Brain damage: Brain hemorrhages affect 30 percent of babies born before 30 weeks or weighing less than 1,500 g. This is due to the fragility of certain areas of the brain in premature babies. Blood vessels can start to bleed if pressure in the brain increases. The after-effects vary depending on the severity of the bleeding. Luckily, there are simple steps that can be taken to prevent hemorrhages.
• Necrotizing enterocolitis: This complication is an inflammation of the intestine that can be fatal. It occurs mainly in the first two weeks after birth and affects 5 to 10 percent of babies weighing less than 1,500 g.
• Heart defects: Some premature babies may have a heart murmur because their arterial duct hasn’t had time to close.
• Deafness: Premature babies often have an underdeveloped sense of hearing. It is estimated that 2 to 10 percent of babies born at 32 weeks of pregnancy or earlier will have hearing problems.
• Retinopathy: This anomaly affects the eyes of premature babies. It is an abnormal growth of blood vessels in the eye, which causes the retina, the membrane covering the back of the eye, to detach. The main cause is the administration of oxygen. It mainly affects babies born before 28 weeks and can sometimes cause vision loss.

How long do premature babies stay in the hospital?

Because of the many possible complications, a premature baby may be hospitalized for several weeks, or even months, in the neonatal unit after birth. For example, a baby born before 28 weeks of pregnancy is likely to remain in the hospital until their expected due date. Babies born between 35 and 36 weeks may be discharged from the hospital within the normal time frame, depending on their clinical condition.

Caring for a premature baby

There are many ways you can help care for your baby in the hospital. Here are examples of what you can do.

Comfort them

Premature babies are exposed to a highly stimulating environment in the neonatal unit (noise, light, handling, smells). They can also experience stress if their environment is not made to resemble their mother’s womb as closely as possible.

However, as parents, you can help soothe your baby. If their condition allows it, you can carry them with you skin to skin (kangaroo-style) and talk to them quietly. This regulates their breathing and heart rate, keeps them warm, makes them feel safe, and promotes improved sleep quality and motor development. The kangaroo method also allows your baby to feel their mother’s breasts. They might even start licking and suckling. For parents, this method helps improve confidence, boost milk production, and reduce anxiety.

When a medical procedure is needed, make sure your baby is woken up gently. To reduce their pain, you can give them breast milk using a pacifier or directly from the breast, if their condition allows it.

Keep your baby stimulated without overwhelming them

The hospital is a source of all kinds of unpleasant sensations for your baby: shots, being moved around by medical staff, the smell of disinfectant, the sound of medical devices, etc. It’s important for them to experience pleasant sensations, too.

Start slowly, because your baby can easily become overstimulated. Just looking at you, hearing you sing, and feeling your touch could be too much for their underdeveloped nervous system.

Try going step by step. For example, you could start with skin-to-skin contact (kangaroo method) with your baby. Once they’ve gotten comfortable, sing them a lullaby. Then, you can gently rub their back. Last, when you think they can handle it, you can try rocking them.

Feed your baby

When a baby is born before 34 weeks of pregnancy, they will likely need to receive part of their nourishment intravenously. They will also be given small doses of milk through a feeding tube that runs through their nose or mouth and into their stomach.

This means that mothers who wish to express their milk can give it to their babies. Breast milk is very beneficial for premature babies. Breastfeeding, however, can be a challenge, so it’s important for mothers to have a strong support network.

When babies reach the equivalent of 30 to 34 weeks in gestational age, they usually begin to learn how to breastfeed or bottle feed. They may continue to be fed through their feeding tube occasionally so they can take breaks.

Bringing baby home

The medical team will assess several factors to determine whether your baby can go home. Here are some examples:

• Does your baby weigh between 2,000 and 3,000 g, depending on their health?
• Is your baby’s respiratory system adequately developed?
• Can your baby breastfeed or bottle feed, and are they gaining 15 to 30 g per day?

After being hospitalized, premature babies often need specific medical and paramedical follow-up care to screen for potential developmental issues and begin the appropriate treatments. Some children will not require any treatment. Only a minority of children will need additional care for anywhere from a few months to several years.

For the first few weeks after you return home, you may feel anxious despite the joy of finally being home. You should expect to go through an adjustment period. If you have any concerns, reach out to your CLSC.

Remember to make time to rest. Don’t stress about the housework, and ask for help. Grandparents, family members, and friends can be a huge help. They can help get baby’s nursery ready, help out around the house, drive you to the hospital centre, or just offer a sympathetic ear. However, if you feel like you just need some peace and quiet, feel free to keep visits to a minimum.

Things to keep in mind

• The majority of premature babies are born between weeks 32 and 37 of pregnancy.
• Due to the possible complications, premature babies need to stay in the hospital for a few weeks to a few months after birth.
• Even if your baby is in the hospital, you can still take care of them by comforting, feeding, and stimulating them.

Scientific review: Audrey Larone Juneau, Nursing Executive, CHU Sainte-Justine Research and copywriting:The Naître et grandir team Updated: February 2021

Photos: iStock.com/Adventure_Photo and GettyImages/metinkiyak and manonallard