One of the most terrifying things when you’re pregnant is finding out that your baby is coming early – and it’s no secret why. Premature births are the leading cause of death in kids under the age of five, the March of Dimes notes, and a premature baby is more likely to face long-term health complications than their fully gestated counterparts.
Having a baby prematurely also raises a whole new set of questions and concerns that parents wouldn’t have otherwise. In honor of World Preemie Day, which falls on Nov. 17, 2017, we spoke with Dr. Girija Natarajan, the chief of neonatology at the Children’s Hospital of Michigan to find out what parents should know about premature births and raising a premature baby.
Stages and causes of prematurity
Though there is no known reason for premature births, the American Pregnancy Association notes that there are several factors that can increase the risk.
For example, women who are pregnant with multiple babies are at a higher risk. Women that have repeated bladder, kidney, urinary tract or vaginal infections are also at a greater risk, as are women who are over- or underweight before pregnancy and those who smoke, drink, have high levels of stress and those that seek out little or no prenatal care.
Premature babies, Natarajan says, are separated into three categories of prematurity: late pre-term, born at 34 to 36 weeks; moderate pre-term, born 30 to 32 weeks; and extremely pre-term, born at 28 weeks or under.
Each one of these stages can cause health problems, which will vary from baby to baby, but get more serious as you get further away from the baby’s due date.
“The late pre-term babies are short by a month or so, but we still have found problems … transitioning to breathing by themselves … some babies have more spit-up (and) they are at a higher risk of having jaundice,” she explains. “(With) extremely preterm babies, depending on how late they’re born, there is a chance of dying.”
Extremely pre-term babies could also develop chronic lung disease and other health complications that could last into their teen years. They could also have a slower growth rate, hearing or vision problems and cerebral palsy.
“Some of them may even risk mortality after they leave the NICU,” she adds.
Care after NICU
“Depending how premature, the main concern of the parent is the survival, Natarajan says. “The NICU is a scary place. (The baby is) on a ventilator, they are on monitors (and parents) are afraid to touch and interact (with the baby).”
As the baby gets closer to being discharged, parents begin to worry about the baby’s breathing and eating habits, when they should bring the baby back to the hospital, if they should put the baby in therapy, long-term issues the baby might have and the extra care that they need to provide, she explains.
“The most critical period is soon after birth and the first couple years after discharge with the catch-up,” she adds. In this time period, parents should be watching for developmental delays and should report anything they notice to their pediatrician so that they can do a developmental screening, keep an eye on the child’s early milestones and recommend a course of treatment.
Treatment plans will also vary from baby to baby and some may be sent home with oxygen or a feeding tube that must be tended to. Early identification of any issues that arise is key. Natarajan also recommends that a premature baby, as well as all infants, be kept away from second-hand smoke and be kept up-to-date on their immunizations, under the instruction of the child’s pediatrician.
Preemie questions, answered
With such high stakes immediately after birth, parents of preemies have some serious questions about how to care for their baby. Here are answers to some common ones:
Can I still deliver my baby how I planned?
When a baby is born prematurely, the focus is on the child’s survival, therefore, the baby will be delivered in the manner that is most safe for him or her.
How long will my baby be in the hospital?
As a rule of thumb, she says most premature babies will stay in the hospital up to, or near to, their original due date. If the baby is born two months early, you can expect around a two-month hospital stay.
Can I breastfeed my baby?
“Breast milk is something that is still considered the best for pre-term babies,” Natarajan says.
You may not be able to breast-feed right away but she recommends pumping and storing your milk supply for when the baby is ready.
The amount you should be feeding your premature baby should be discussed with your NICU staff.
Can I touch my baby?
Depending on the child’s treatment, you may not be able to touch your baby after birth, however, you should try to talk to your baby in the NICU, if the doctors allow, and do skin-to-skin contact once the baby is stable.
Do I have to do something different in regular day-to-day care?
Day-to-day care really depends on how premature the baby was and what technology the child was sent home with, Natarajan explains. Parents of babies sent home on a ventilator or with additional needs will also be sent home with a care plan to follow.
Parents of preemies should also be more vigilant about illness but other than that, “they still essentially are being cared for just like other babies. … They are going to grow bigger and get better,” she says.
When can I take my baby outside?
“The concerns about going out in public are the their risk of catching respiratory infections and exposure to loud noises and bright lights,” Natarajan explains. “It depends on the baby (but) don’t go into places that are too crowded or carry too many germs.”
Instead, she recommends a quiet walk in your subdivision when the weather is nice. Family gatherings are OK after three months, but anyone that wants to handle the baby should always wash their hands first.
How fast should my baby grow?
“For the first two years of life, we account for prematurity in growth and development,” Natarajan explains. “No matter how old they are you have to consider the age from their due date and compare them with babies that are their age.”
However, medical professionals do expect kids to developmentally catch up, first in head size and then in height and weight by the time the child is two.
She adds that parents should do some of their own research about premature babies, keep themselves updated on the child’s individual care plan and ask questions when they need to.