Kiddipedia

Kiddipedia

A premmie or premature or preterm baby is one who is born before 37 weeks (completed weeks of gestation). A term pregnancy is defined as at least 37 weeks with the usual duration of a pregnancy being quoted as 40 weeks. Other terms you might come across include “near term” which generally refers to babies born at 35-36 weeks, “early preterm” which refers to < 34 weeks, “very preterm” which refers to 28 to < 34 weeks “extremely” preterm which refers to < 28 weeks.

How many are there every year?

Every year in Australia, about 20,000 babies are born prematurely with about 5,000 of these are born before 32 weeks. Approximately 8% of babies are born prematurely.

What are some of the common causes of prematurity?

  • Multiple pregnancy – e.g. twins, triplets or other multiples
  • Having had a previous preterm birth
  • Conceiving through IVF
  • Problems with the uterus (womb), cervix (neck of the womb) or placenta (afterbirth)
  • Smoking cigarettes or using illicit drugs
  • Infections especially of the amniotic fluid (fluid around the baby) or lower female genital tract
  • Premature rupture of the membranes (breaking of the water)
  • Chronic conditions in the mother such as diabetes or high blood pressure
  • Abnormal maternal weight (under or overweight before pregnancy)
  • Stressful life events
  • Previous miscarriages or terminations
  • Physical Trauma
  • Bleeding from or between the placenta (afterbirth) and the uterus (womb)
  • More likely in indigenous Australians
  • Sometimes mothers go into preterm labour for no reason

What are some common issues with premmies?

Babies are not meant to be in the outside world before term. There are many short-term and long- term issues associated with being a premmie:

In the short term these might include:

  • Breathing difficulties include fast and laboured breathing and stopping of breathing (apnoea)
  • Cardiac (heart related) problems including poor heart pumping and failure of the ductus arteriosus to close (a communication between the main blood vessels going from the heart to the lings and body
  • Poor feeding as they have difficulty coordinating suck and swallow generally before 35 weeks and difficulty with digesting milk
  • Poor temperature control (below about 1800 grams birthweight)
  • Difficulty maintaining a normal blood sugar level
  • An immature immune system increasing a tendency to infections (particularly bacterial)
  • Brain bleeding and seizures
  • Anaemia
  • Jaundice (yellow discoloration of the skin)
  • Stress and separation for parent(s)

In the longer term these might include:

  • Cerebral palsy – permanent problems with muscle movement, tone or posture
  • Mental retardation
  • Learning difficulties
  • Problems with vision including blindness or the need for glasses
  • Problems with hearing including deafness or the need for hearing aids
  • Dental problems
  • Behavioural and psychological problems
  • Chronic health issues especially involving the lungs

It is important to note that most premmies do very well in the short and long term but some do die and the possibility of a poorer outcome increases the more premature the baby is when born.

Special care needed:

This might include:

  • Being nursed in an incubator to keep the baby warm (until about 1800 grams)
  • Breathing support including:
    • Oxygen
    • Nasal (in the nose) prongs
    • Tubes in the nose or the trachea (windpipe)
    • Being attached to a ventilator (breathing machine)
  • Being fed through a tube going through the nose or mouth into the stomach (often until 35-36 weeks)
  • Requiring an intravenous drip for:
    • Fluids (water and salt)
    • Sugar
    • Feeding (if unable to tolerate milk for long periods of time)
    • Medications including antibiotics and heart support
  • Being attached to equipment to monitor breathing, heart rate, blood oxygen levels and blood pressure
  • Breastfeeding support
  • Developmental care

Although many babies can be safely managed in Special Care Nurseries close to home some babies, especially if very premature, small or sick need to be managed or transported to a NICU (Neonatal Intensive Care Unit) in a larger city. This may occur before birth or afterwards with highly specialised state-run Newborn Emergency Transport Services (NETS). There is always the aim of transferring growing and convalescing (getting better) babies back closer to home in time.

 

DR Simon Fraser, Neonatologist and Life’s Little Treasures Foundation Board member

https://walkforprems.org.au/

https://lifeslittletreasures.org.au/