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Premature infant

Preterm infant; Preemie; Premie; Neonatal - premie; NICU - premie

A premature infant is a baby born before 37 completed weeks of gestation (more than 3 weeks before the due date).

Causes

At birth, a baby is classified as one of the following:

  • Premature (less than 37 weeks gestation)
  • Full term (37 to 42 weeks gestation)
  • Post term (born after 42 weeks gestation)

If a woman goes into labor before 37 weeks, it is called preterm labor.

Late preterm babies who are born between 35 and 37 weeks gestation may not look premature. They may not be admitted to a neonatal intensive care unit (NICU), but they are still at risk for more problems than full-term babies.

Health conditions in the mother, such as diabetes, heart disease, and kidney disease, may contribute to preterm labor. Often, the cause of preterm labor is unknown. Some premature births are multiple pregnancies, such as twins or triplets.

Different pregnancy-related problems increase the risk of preterm labor or early delivery:

  • A weakened cervix that begins to open (dilate) early, also called cervical incompetence
  • Birth defects of the uterus
  • History of preterm delivery
  • Infection (a urinary tract infection or infection of the amniotic membrane)
  • Poor nutrition right before or during pregnancy
  • Preeclampsia: high blood pressure and protein in the urine that develop after the 20th week of pregnancy
  • Premature rupture of the membranes (placenta previa)

Other factors that increase the risk for preterm labor and a premature delivery include:

  • Age of the mother (mothers who are younger than 16 or older than 35)
  • Being African American
  • Lack of prenatal care
  • Low socioeconomic status
  • Use of tobacco, cocaine, or amphetamines

Symptoms

The infant may have trouble breathing and keeping a constant body temperature.

Exams and Tests

 

A premature infant may have signs of the following problems:

  • Not enough red blood cells (anemia)
  • Bleeding into the brain or damage to the brain's white matter
  • Infection or neonatal sepsis
  • Low blood sugar (hypoglycemia)
  • Neonatal respiratory distress syndrome, extra air in the tissue of the lungs (pulmonary interstitial emphysema), or bleeding in the lungs (pulmonary hemorrhage)
  • Yellow skin and whites of the eyes (newborn jaundice)
  • Problems breathing due to immature lungs, pneumonia, or patent ductus arteriosus
  • Severe intestinal inflammation (necrotizing enterocolitis)

A premature infant will have a lower birth weight than a full-term infant. Common signs of prematurity include:

  • Abnormal breathing patterns (shallow, irregular pauses in breathing called apnea)
  • Body hair (lanugo)
  • Enlarged clitoris (in female infants)
  • Less body fat
  • Lower muscle tone and less activity than full-term infants
  • Problems feeding due to trouble sucking or coordinating swallowing and breathing
  • Small scrotum that is smooth and has no ridges, and undescended testicles (in male infants)
  • Soft, flexible ear cartilage
  • Thin, smooth, shiny skin that is often transparent (can see veins under skin)

Common tests performed on a premature infant include:

  • Blood gas analysis to check oxygen levels in the blood
  • Blood tests to check glucose, calcium, and bilirubin levels
  • Chest x-ray
  • Continuous cardiorespiratory monitoring (monitoring of breathing and heart rate)

Treatment

When premature labor develops and can't be stopped, the health care team will prepare for a high-risk birth. The mother may be moved to a center that is set up to care for premature infants in a NICU.

After birth, the baby is admitted to the NICU. The infant is placed under a warmer or in a clear, heated box called an incubator, which controls the air temperature. Monitoring machines track the baby's breathing, heart rate, and level of oxygen in the blood.

A premature infant's organs are not fully developed. The infant needs special care in a nursery until the organs have developed enough to keep the baby alive without medical support. This may take weeks to months.

Infants usually cannot coordinate sucking and swallowing before 34 weeks gestation. A premature baby may have a small, soft feeding tube placed through the nose or mouth into the stomach. In very premature or sick infants, nutrition may be given through a vein until the baby is stable enough to receive all nutrition through the stomach.

If the infant has breathing problems:

  • A tube may be placed into the windpipe (trachea). A machine called a ventilator will help the baby breathe.
  • Some babies whose breathing problems are less severe receive continuous positive airway pressure (CPAP) with small tubes in the nose instead of the trachea. Or they may receive only extra oxygen.
  • Oxygen may be given by ventilator, CPAP, nasal prongs, or an oxygen hood over the baby's head.

Infants need special nursery care until they are able to breathe without extra support, eat by mouth, and maintain body temperature and body weight. Very small infants may have other problems that complicate treatment and require a longer hospital stay.

Support Groups

There are many support groups for parents of premature babies. Ask the social worker in the neonatal intensive care unit.

Outlook (Prognosis)

Prematurity used to be a major cause of infant deaths. Improved medical and nursing techniques have increased the survival of premature infants.

Prematurity can have long-term effects. Many premature infants have medical, developmental, or behavioral problems that continue into childhood or are permanent. The more premature an infant and the smaller the birth weight, the greater the risk for complications. But, it is impossible to predict a baby's long-term outcome based on gestational age or birth weight.

Possible Complications

Possible long-term complications include:

  • Long-term lung problem called bronchopulmonary dysplasia (BPD)
  • Delayed growth and development
  • Mental or physical disability or delay
  • Vision problem called retinopathy of prematurity resulting in low vision or blindness

Prevention

The best ways to prevent prematurity are to:

  • Be in good health before getting pregnant.
  • Get prenatal care as early as possible in the pregnancy.
  • Continue to get prenatal care until the baby is born.

Getting early and good prenatal care reduces the chance of premature birth.

Premature labor can sometimes be treated or delayed by a medicine that blocks uterine contractions. Many times, however, attempts to delay premature labor are not successful.

Betamethasone (a steroid medicine) given to mothers in premature labor can make some prematurity complications less severe.

References

American Academy of Pediatrics website. Preemie. www.healthychildren.org/English/ages-stages/baby/preemie/Pages/default.aspx. Updated 2015. Accessed November 20, 2018.

Carlo WA. The high-risk infant. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 97.

Phillips RM, Goldstein M, Hougland K, et al. Multidisciplinary guidelines for the care of late preterm infants. J Perinatol. 2013;33(Suppl 2):S5-S22. PMID: 23803627 www.ncbi.nlm.nih.gov/pubmed/23803627.

Simhan HN, Iams JD, Romero R. Preterm labor and birth. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 29.

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    • NICU consultants and support staff

      Animation

    •  

      NICU consultants and support staff - Animation

      If your newborn needs to be admitted to the neonatal intensive care unit, or NICU, a group of different medical professionals will be there to help. Here's a rundown of some of the consultants and support staff you can expect to meet in the NICU. Each person who works in the NICU has a different specialty: Your bedside NICU nurses work most closely with your baby, providing care and observing closely for important changes. A neonatologist specializes in the health problems of newborns. They supervise and coordinate care. A cardiologist is trained to diagnose and treat diseases of the heart and blood vessels. If a baby has a heart defect, a cardiovascular surgeon will perform the surgery to fix it. An infectious disease specialist treats babies who have serious infections, including infections of the blood, brain, or spinal cord. A neurologist diagnoses and treats conditions of the brain, nerves, and muscles. You might see a neurologist if your baby has seizures, or is born with a nervous system condition like spina bifida. When the problem needs to be corrected with surgery, a neurosurgeon will perform the operation. An endocrinologist diagnoses and treats hormone problems, such as diabetes. Gastroenterologists are expert at treating digestive problems of the stomach and intestines. A hematologist-oncologist treats blood disorders and cancer. An infant might see this type of doctor for a problem with blood clotting. A nephrologist focuses on diseases of the kidneys and urinary system. If your baby was born with a kidney problem, you will talk to this doctor about treatments, and possibly the need for surgery. Pulmonologists treat newborn lung problems, such as respiratory distress syndrome. You might see this doctor if your baby was born with a breathing condition. Then you'll work with a respiratory therapist to treat the problem. If you had a very high-risk pregnancy, you'll work with a maternal-fetal medicine specialist. This doctor can help if your baby was born prematurely, or you had twins or other multiples. Babies who are born with eye defects see an ophthalmologist, a doctor who diagnoses and treats eye problems. If your newborn needs x-rays, an x-ray technician will take the test, and a radiologist will read the results. Sometimes babies are born with or at risk for developmental delays. If that is the case, a developmental pediatrician will test your child, and help you find the right care once you leave the NICU. The pediatrician may recommend that you see an occupational or physical therapist to assess your baby's reflexes, movement, and feeding. While you're in the NICU, you'll also see a neonatal nurse practitioner. This specialist will work closely with your doctor to make sure your baby gets just the right care. Being in the NICU can feel scary and new at first. Don't be afraid to ask questions. Your NICU medical team is there to care for your baby, and to make sure you're prepared to take over that care once you get home.

    • NICU consultants and support staff

      Animation

    •  

      NICU consultants and support staff - Animation

      If your newborn needs to be admitted to the neonatal intensive care unit, or NICU, a group of different medical professionals will be there to help. Here's a rundown of some of the consultants and support staff you can expect to meet in the NICU. Each person who works in the NICU has a different specialty: Your bedside NICU nurses work most closely with your baby, providing care and observing closely for important changes. A neonatologist specializes in the health problems of newborns. They supervise and coordinate care. A cardiologist is trained to diagnose and treat diseases of the heart and blood vessels. If a baby has a heart defect, a cardiovascular surgeon will perform the surgery to fix it. An infectious disease specialist treats babies who have serious infections, including infections of the blood, brain, or spinal cord. A neurologist diagnoses and treats conditions of the brain, nerves, and muscles. You might see a neurologist if your baby has seizures, or is born with a nervous system condition like spina bifida. When the problem needs to be corrected with surgery, a neurosurgeon will perform the operation. An endocrinologist diagnoses and treats hormone problems, such as diabetes. Gastroenterologists are expert at treating digestive problems of the stomach and intestines. A hematologist-oncologist treats blood disorders and cancer. An infant might see this type of doctor for a problem with blood clotting. A nephrologist focuses on diseases of the kidneys and urinary system. If your baby was born with a kidney problem, you will talk to this doctor about treatments, and possibly the need for surgery. Pulmonologists treat newborn lung problems, such as respiratory distress syndrome. You might see this doctor if your baby was born with a breathing condition. Then you'll work with a respiratory therapist to treat the problem. If you had a very high-risk pregnancy, you'll work with a maternal-fetal medicine specialist. This doctor can help if your baby was born prematurely, or you had twins or other multiples. Babies who are born with eye defects see an ophthalmologist, a doctor who diagnoses and treats eye problems. If your newborn needs x-rays, an x-ray technician will take the test, and a radiologist will read the results. Sometimes babies are born with or at risk for developmental delays. If that is the case, a developmental pediatrician will test your child, and help you find the right care once you leave the NICU. The pediatrician may recommend that you see an occupational or physical therapist to assess your baby's reflexes, movement, and feeding. While you're in the NICU, you'll also see a neonatal nurse practitioner. This specialist will work closely with your doctor to make sure your baby gets just the right care. Being in the NICU can feel scary and new at first. Don't be afraid to ask questions. Your NICU medical team is there to care for your baby, and to make sure you're prepared to take over that care once you get home.

       

      Review Date: 10/11/2018

      Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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