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What is a premature birth?(top)
A premature birth occurs when a woman gives birth to a baby before the end of the normal period of pregnancy. The normal period of pregnancy ranges from 37 to 42 weeks after a woman begins her last menstrual period prior to becoming pregnant. Births that take place between 20 and 37 weeks of pregnancy are said to occur preterm.
At one time, a birth weight of less than 5½ pounds (2.5 kilograms) was the only measure for determining prematurity. Today, it is understood that a baby can weigh more than 5½ pounds and still be functionally immature, while an infant of less than 5½ pounds can be functionally mature.
Most premature infants that weigh more than 3¼ pounds (1.5 kilograms) at birth grow up as healthy as babies born after a normal pregnancy. Premature babies weighing less than 2¼ pounds (1 kilogram) at birth have the poorest chance of survival.
What are the statistics for premature birth? (top)
In the United States, about 7 per cent of white babies and 14 to 15 percent of non-white babies are born prematurely, making a total of 475,000 each year. Of these, 135,000 babies - almost 2% of all babies - are born more than 6 weeks early.
A woman who has had a premature baby or a miscarriage has about a 20 per cent chance of again giving birth prematurely.
The rate of premature birth increased 29 percent between 1981 and 2002 (9.4 to 12.1 percent).
Pre-maturity accounts for 75% of all deaths in the first month of life and 50% of long-term handicaps.
Why does premature labour occur?(top)
There are four main reasons why premature labour occurs:-
Maternal or foetal stress. Chronic psychosocial stress in the mother or physical stress (such as insufficient blood flow from the placenta) in the foetus appears to result in production of a stress-related hormone called corticotropin-releasing hormone (CRH). CRH may stimulate production of a cascade of other hormones that trigger uterine contractions and premature delivery.
Infections. Studies suggest that premature labour is often triggered by the body's natural immune response to certain bacterial infections, such as those involving the genital and urinary tracts and foetal membranes. Even infections far away from the reproductive organs, such as periodontal disease, may contribute to premature delivery.
Bleeding. The uterus may bleed, due to problems such as placental abruption (when the placenta peels away, partially or almost completely, from the uterine wall prior to delivery). Bleeding triggers the release of various proteins involved in blood clotting, which also appear to stimulate uterine contractions.
Stretching. The uterus may become overstretched by the presence of two or more babies, excessive amounts of amniotic fluid, or uterine or placental abnormalities, leading to release of chemicals that stimulate uterine contractions.
Which women are most at risk to have premature babies?(top)
Three groups of women are at greatest risk of preterm labour and birth:-
- Women who have had a previous preterm birth.
- Women who are pregnant with twins, triplets or more.
- Women with certain uterine or cervical abnormalities.
Some studies have found that certain lifestyle factors may put a woman at greater risk of preterm labour. These factors include:-
- Late or no prenatal care
- Smoking
- Drinking alcohol
- Using illegal drugs
- Exposure to the medication DES
- Domestic violence, including physical, sexual or emotional abuse
- Lack of social support
- Stress
- Long working hours with long periods of standing
Certain medical conditions during pregnancy may increase the likelihood that a woman will have preterm labour. These conditions include:-
- Urinary tract infections, vaginal infections, sexually transmitted infections
and possibly other infections ·
- Diabetes
- High blood pressure
- Clotting disorders (thrombophilia)
- Bleeding from the vagina
- Certain birth defects in the baby
- Being pregnant with a single foetus after in vitro fertilization (IVF)
- Being underweight before pregnancy
- Obesity
- Short time period between pregnancies (less than 6-9 months between birth and the beginning of the next pregnancy)
Why is prematurity such an important problem and what are the costs? (top)
Premature birth is one of the greatest health hazards of humankind. In fact, prematurity is the single most common cause of sickness and death among newborn babies worldwide. In addition, it imposes major financial costs on the family, health care system, society, and economy.
On average, hospital charges for newborns without complications run to $1,300. Costs for hospital stays for infants with a principal diagnosis of prematurity average a startling $75,000.
In 2001, hospital charges for all infants totalled $29.3 billion. Nearly 50 percent of these costs were for babies who were born too soon or too small. The costs of prematurity often don't stop when babies leave the hospital. About 25 percent of the youngest and smallest babies live with long-term health problems, including cerebral palsy, blindness and other chronic conditions.
What are the chances of survival for a premature baby? (top)
Many factors determine an individual baby's chances of survival. The most important of these are:-
- The baby's gestational age (number of completed weeks of pregnancy) at the time of birth
- The baby's weight
- The presence or absence of breathing problems
- The presence or absence of congenital abnormalities or malformations
- The presence or absence of other severe diseases, especially infection
In the smallest infants, gestational age is usually most important because it determines if the infant's organs, particularly the lungs, have developed enough to allow the baby to live within the limits of our current technology.
At the moment over 50% of babies are surviving when born 24 weeks after the last menstrual period and over 90% are surviving if born after 27 weeks.
What are the most common problems of premature infants? (top)
Some problems are so common you should expect your baby to have them, especially if they are more than four to six weeks early. These include: jaundice, apnea, and inability to nipple or breast feed. Other problems are common, but may or may not occur in your baby. These include: anaemia, low blood pressure, difficulty with sugar balance, respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTNB), patent ductus arteriosus (PDA), retinopathy of prematurity (ROP), reflux, hernias, and infection.
Less common, but very important problems include: air leak (includes Pneumothorax, Pneumomediastinum and Pulmonary Interstitial Emphysema), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL). Progress in medical technology and the Neonatal Intensive Care Unit (NICU) have made the survival of smaller and smaller infants possible. As a result, we now have a new kind of human being: The Preterm Infant. Of course, preemies are in many ways small versions of the full term infant. But preemies also are very different from full term infants, and they live in a world that is very different from that of either the foetus in the womb or the full-term infant at home. Therefore, it is unfair to think of the preemie as either a foetus or a mini full-term baby: preemies are unique, and deserve unique and special treatment. The preemie of 24 weeks gestational age would normally expect about 16 more weeks in the womb, where:
- oxygen and food are provided by the placenta, thus there is no need to breathe or digest.
- temperature is comfortable and stable.
- there is protection from injury.
- the effects of gravity are not felt, and the baby moves easily and stays comfortably curled-up (flexed).
- there is constant motion, thus the baby is rocked gently much of the time.
- the baby feels the rhythms of the mother's changing day-night activity.
- the baby's nervous system does not have to respond to lots of different kinds of things (sights, sounds, touches).
- there are no intense lights, sounds and touches, although the baby does hear the mother's rhythmic heart and bowel sounds, can hear speech, and feels gentle touch from their own limbs and the fluid and sides of the womb.
How can you help preemies to develop well?(top)
- Learn to read your baby's behaviours - You will come to know when your baby is stressed and needs some rest time, and when he or she is relaxed, can be handled, and is ready to respond to you.
- Learn how to interact with your baby - What are the things he or she likes, doesn't like; what are the best times during the day; how long at a time does he/she have the strength to respond to you?
- Make the environment as comfortable for the baby as you can:
o keep light and noise levels moderate.
o keep the baby's position flexed.
o allow undisturbed periods of sleep.
o provide opportunities to interact when he/she is awake. - Accept that each baby is different and may be a challenge to understand, and that progress will take time.
- Give yourself permission to feel disappointed, helpless, or incompetent when you can't figure out what the baby wants or needs; your baby may not know, either. Feel happy and proud when you can read your baby. The important thing is that you are trying to understand what your baby is telling you.
- Trust your instincts - You have known your baby longer than anyone
The physical environment can be changed to:
- reduce the amount of sound
- reduce the amount of light
- provide rhythms in light levels
- provide some support for the baby's position
- make treatments less stressful
- reduce the number of times that the baby is disturbed
Why is controlling sound important? (top)
Loud sound is a concern because:
- it may damage the baby's ears and lead to loss of hearing,
- the baby feels it as stressful.
Loud or sharp sounds can cause physiological changes (high heart rate, fast breathing, apnea, a drop in blood oxygen levels). They also may startle the baby and disturb sleep. Sound levels can be reduced by talking quietly, closing doors and portholes gently, not dropping things on top of the incubator, turning down machine alarms and phone ring levels, and turning off radios. The sound that seems to impress preemies the most is the sound of your own voice. Providing a tape recording of you talking and reading to your infant may be one way to provide sound that will calm your baby. Keep in mind, however, that for the very small preemie, extra sound when other things are going on may be disturbing. It is important, therefore, to watch your baby when you turn on the tape to be sure that he or she likes it.
Why is controlling light important? (top)
Light is a concern because:
- bright light may cause injury to the eye;
- constant light may disturb body rhythms;
- bright light may keep your baby from opening his/her eyes and looking around.
Incubators can be covered to block the amount of light reaching your baby. Laying a blanket over the top of the incubator is the easiest thing to do. Letting the blanket drape over the sides, or using a specially fitted cover (now available commercially), can block light from the sides as well as the top of the incubator. In many nurseries, a "quiet time" is held during the day, when lights are dimmed for several hours and your baby is not disturbed unless a procedure is really needed. In some nurseries, lights are dimmed at night. This helps in starting a day/night sleep schedule and supports daily changes in hormone and temperature levels. The dimmed light also gives some extra protection from the higher light levels needed for daytime activities.
What is important to know about positioning? (top)
Positioning is important because:
- The preemie cannot get into a comfortable position on his/her own.
- Over time, positioning affects your baby's motor development.
The preemie does not have the muscle strength to control movements of arms, legs or head that full term infants have. It is hard for them to move against the force of gravity. Therefore they tend to lie with their arms and legs straight, or "extended", rather than tucked in, or "flexed". Being in an extended position for long periods of time can lead to stiffness - "abnormal tone" - in the shoulders and hips, and this can delay the baby's motor development. It probably is not very comfortable for the preemie to be on its back out straight, or extended. If left this way, some preemies may try hard to get into a more relaxed, curled up position, using up energy that could be used for growing. Small preemies maintain better oxygen levels and temperature, and sleep better, when on their tummies or sides than when on their backs. (However, when the baby goes home, he/she should be put on the tummy only when awake, not for sleep.)
Guidelines for positioning include:
- Place the baby on tummy (when in the NICU and on monitors) or side, with arms and legs flexed.
- Cover, clothe, wrap or swaddle the baby, to help keep the flexed position. This also gives them the feeling of being cuddled.
- Make a 'nest' around the baby so that they are held in a flexed position. Nurseries use different ways to do this. Some use blanket rolls. The inserts made for car seats make good nests - the baby lies on the insert, therefore it stays in place better than blanket rolls.
- Leave the baby's hands free so that they can get them to the face. Sucking on fingers or hand, and even just touching the face, is one way babies calm themselves.
- As a part of the nest, give the baby something to push against with his/her feet. This allows the baby to feel more stable.
- Encourage the baby to hold on to - grasp - something, like your finger, the edge of the blanket, or a small rolled-up cloth. This helps the baby feel more stable.
Why is the way a preemie is held important? (top)
How preemies are handled is a concern because:
- It may lead to physiologic stress.
- It may lead to behavioural stress.
When handled for medical care, preemies often show that this is physiologically stressful by a rising heart rate or dips in heart rate (bradycardia); rising respiration rates or periods of holding the breath (apnea); falling levels of blood oxygen (desaturations); colour changes to dusky or flushed; and other responses such as hiccups or yawning. Even pulling adhesive tape off can cause these responses. During daily care, such as diapering and feeding, preemies may react in the same ways. When handled, preemies also may show in their behaviour that this is stressful, for example, by more moving, more jerks, startles and tremors, and fussing/crying. Handling can be made less stressful to the preemie by using a "developmental approach". This means:
- Position the baby comfortably and securely, and provide special supports to hold the baby in a flexed position during the handling. This includes "containing" or holding in the baby's arms and legs to keep them flexed and to prevent jerky movements.
- Pace the care according to how the baby reacts. For example, stop (give the baby a break) and gently contain the baby when they start to get upset, and don't start again until the baby has settled down.
- Give the baby ways to keep calm. This would include a pacifier, something to hold onto, something against which to brace his/her feet, and helping them to keep hands up near the face to allow sucking on fingers.
- Keep other stimulation at a minimum. This would include not talking or trying to make eye contact if the baby shows signs of stress, and keeping general noise levels low.
- Most of all, adjust to the preemie's behaviour as much as possible, letting them tell you what feels okay and what doesn't, and when to keep going, when to stop, and when to start up again.
Why is touch important?(top)
Handling is touching. The sense of touch develops very early in foetal life. For very small preemies, the skin is so fragile that touching has to be done with great care. For preemies younger than about 30 weeks gestational age (GA), studies show that touch may be more stressful than soothing. For older preemies, however, gentle touching can be helpful.
Preemies react in different ways to different kinds of touch. A light, feathery touch may be upsetting. A firm, steady touch is more likely to calm the baby. Giving the stable preemie gentle human touch or massage for a short period every day has been shown to be helpful, for example, it may help babies gain weight faster. As with everything, how and how often the preemie is touched needs to be based on his/her responses.
When can my baby go home? (top)
Many nurseries do not have a specific weight criteria for discharge. Instead the baby must meet the following criteria:
- Be able to keep his/her body temperature normal in an open crib
- Be on complete breast and/or bottle feeds, taking in an adequate number of calories.
- Be gaining weight on all breast or bottle feeds
- Not have any apneas (pauses in breathing) causing slow heart rate (bradycardia) or change in colour. Some nurseries send infants home on apnea monitors if they are having short self-limited apneas (no colour change or severe bradycardias and not needing stimulation to breathe again).
- Most babies are off oxygen when discharged, but some infants who will need oxygen for a long time are sent home on oxygen.
The average baby meets these criteria about 2 to 4 weeks before their "due date", but there are big individual differences. Hospital stays vary from a few days to many months. Infants who stay beyond their "due date" usually are infants who:
- were on breathing machines and oxygen the longest
- were born with malformations
- needed surgery.
How warm should I keep the temperature in my house? (top)
A low to mid-70's temperature is warm enough as long as the baby is dressed appropriately.
How warm should I dress my baby? (top)
One rule of thumb is to dress your baby like you are dressed for that kind of day and a similar amount of activity (usually sleeping or quiet). The best way to tell if your baby is dressed warm enough is to look and touch his skin:
- If your baby's hands are cold, blue or blotchy, add socks, hat, sweater or another blanket.
- If your baby seems restless or fussy and his skin is flushed or reddened, remove a piece of clothing or blanket.
- When your baby is sleeping, add one blanket
If these things do not make a difference and your baby continues to be uncomfortable, take your baby's temperature; your baby could be sick.
Why is clothing important for preemies? (top)
When a baby is in an incubator in a hospital, parents can sometimes feel that their baby does not really belong to them. The baby is somehow "on loan" to them and the care of their baby is controlled by the hospital staff.
Dressing the baby individually in comfortable, well-designed clothes that fit, and in the right materials to maintain correct temperature, becomes very important. It can make parents feel that they are somehow more in control and are participating more actively in the day-to-day care of their baby.
WeanieWear would like to think we can help the morale of preemie parents at a time when there may be stress. Our aim is to supply a wide selection of quality clothing at affordable prices, which are not readily available on the High Street. What's more parents who buy from us don't have the problem of travelling to town or the shopping mall, which can be so difficult with a baby in hospital and indeed even when the baby returns home.
We would like to wish all parents the very best of luck with their babies.
