Surprises can be exciting. If you are the parent of a preterm infant, then you are well aware of the initial rush of emotions that this surprise arrival brought you. But, once your bundle of joy has left the hospital and settled in at home, you may not realize that his/her prematurity needs to remain a consideration beyond the hospital walls. In reality, even if your baby was born only a week or two ahead of schedule and looks just like a full-term infant, you should understand that he/she may have special vulnerabilities requiring a little more TLC.
While the term “preemie” often connotes “very preterm” (born before 32 weeks gestation, or weeks of growing, in the mother’s womb) or “moderately preterm” (born between 32 and 34 weeks gestational age), most premature babies are actually born between 34 and 36 weeks gestational age and are considered “late preterm.” The health risks associated with these late-preterm babies are often overlooked or misunderstood by parents because their child appears to be as healthy as a full-term baby. But, any preemie is still more vulnerable to health complications than full-term infants, and parents should work with their doctor to ensure their babies receive the special medical attention they require.
Early arrival disrupts development
Premature babies have not developed fully in the mother’s womb, making them more vulnerable overall to health problems and subsequent disabilities, including being more susceptible to infection, increased risk of chronic lung problems and neurological disorders.
Late-preterm babies often slip under the radar, compared with more severely premature babies, because they look for the most part like their full-term peers, only a bit smaller. They are also less likely to have severe health complications and therefore they often need less attention in the hospital than babies who are born very preterm.
Nevertheless, late-preterm infants are more vulnerable to health and developmental issues than full-term infants, including increased problems with breathing, feeding, temperature control and jaundice. For example, it is estimated that at 35 weeks gestational age, the weight of the brain is only around 60 percent that of full-term infants. Though late-preterm babies are unlikely to develop serious disabilities from this disrupted development of the brain, they may be at increased risk for subtle learning and behavior problems. In addition, at 32-35 weeks gestational age, the lung is nearly at the same stage of development than at 28-32 week gestational age, which can result in reductions in lung function into young adulthood and perhaps beyond. And, infants born before 36 weeks gestational age possess less protective maternal antibodies in their blood, putting them at greater risk for infection.
Be aware, not afraid
So, it’s important to know that even though your child was born premature and is doing well at home, he/she will need some extra TLC to protect him/her against later problems. To support you, find a trusted medical care provider who understands the specialized health needs of a preemie and can spend extra time with you and your child as needed.
For example, preterm babies are more vulnerable to seasonal infections such as respiratory syncytial virus (RSV), a common virus that spreads during the fall and winter months and can result in potentially serious problems for preemies because of their underdeveloped lungs and lack of antibodies needed to fight infections. RSV usually causes symptoms that mimic a cold, such as a runny nose or a low grade fever, and the symptoms generally run their course. But, parents of preemies should be especially aware of potential signs of severe RSV, such as persistent coughing or wheezing, rapid or gasping breath, blue color on the lips, around the mouth or under the fingernails, and a temperature of 100.4 degrees or higher, and consult their pediatrician with any concerns.
All parents of young babies should take extra precautions during the cold season by always washing their hands before touching their baby and making sure others do too, washing toys and bedding frequently, and shielding their baby from tobacco smoke, people with colds and unnecessary exposure to crowds. But, parents of preemies should be especially diligent – regardless of how premature their baby was born.
Help protect your preemie
Your premature baby is a unique gift to your family. Regardless of how early your child was born, empower yourself with knowledge, be especially diligent in monitoring and caring for your child and seek the support of your medical care provider as needed to help ensure your baby’s health needs are met.
Phyllis Dennery, MD is Chief of the Division of Neonatology at Children's Hospital of Philadelphia and Professor of Pediatrics at the University of Pennsylvania.