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Common Preemie Health Problems

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Updated June 09, 2014

premature baby in a incubator at the Neonatal Intensive Care Unit in hospitalview images from the same series:
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Parents of premature babies have many questions, especially about the complications of prematurity. Learning about what health problems your premature baby is facing can help you understand the treatments and know what questions to ask doctors and nurses.

Common health issues that premature babies may face include:

  • Apnea of prematurity: Because their brains and lungs are not fully developed, apnea, or periods where breathing stops, occurs in 85% of babies born before 34 weeks. Apnea may come with periods of bradycardia (or “bradys”), where the heart slows down. Stimulation usually helps the baby start breathing again, and monitors make sure that episodes are caught right away. Medication and respiratory support may also help.

  • Jaundice: Jaundice is yellowed skin caused by bilirubin, a product of red blood cells. It affects about half of term babies and up to 80% of preemies, and is treated with special lights. Premature infants are at risk for a rapid rise in bilirubin, and are treated more often than term babies to prevent kernicterus, a complication where high levels of bilirubin damage the brain.

  • Respiratory distress syndrome: Respiratory distress affects as many as 43% of premature babies born between 30 and 32 weeks, and almost all babies born before that time. Full-term babies make surfactant, a chemical that helps keep the lungs inflated. Without enough surfactant, premature babies’ lungs don’t inflate well. Preemies may need artificial surfactant, or may need help breathing while their lungs mature.

  • Reflux: Gastroesophageal reflux disease, or GERD, affects up to half of premature babies. In gastroesophageal reflux, stomach contents come back up the esophagus and the baby will spit up. Infants with GERD spit up too, but also have other symptoms. They may vomit, lose weight, or have respiratory problems like cough or pneumonia. Medication may be given to treat the condition, which preemies outgrow with time.

  • IVH: Premature babies, especially those born before 30 weeks, have fragile blood vessels in their brains. If those vessels break, an intraventricular hemorrhage (IVH) may occur. This bleeding into the brain, which occurs in up to 14% of infants born between 30 and 32 weeks and 36% of infants born before 26 weeks, may be mild or severe. Severe bleeds can have serious consequences, such as developmental delays. Mild bleeds usually have no long-term effects.

  • ROP: Preemies are born with immature eyes. In retinopathy of prematurity, or ROP, blood vessels in the eye grow abnormally, and can result in retinal detachment and blindness. The disease affects almost half of infants born before 26 weeks, but only 1% of preemies born after 30 weeks. An eye exam at 1 to 2 months of age screens for ROP, which is usually treated with laser surgery or cryosurgery.

  • PDA: Before birth, babies depend on the placenta for oxygen and have a different circulatory system from that after birth. One difference is the ductus arteriosis, an opening between the major vessels. The ductus usually closes at birth so that blood can flow normally. In preemies, it may remain open, causing patent ductus arteriosis, or PDA. A PDA, which occurs in 8% of infants born between 30 and 32 weeks and more often in younger preemies, causes abnormal circulation. Medication or surgery may be needed to close the ductus.

  • BPD: Bronchopulmonary dysplasia (BPD) is a chronic lung condition caused by airway inflammation. It affects infants who were on a ventilator for long periods of time, and can cause difficulty breathing and low blood oxygen levels. BPD affects as many as 62% of babies born before 26 weeks, but only 3% of those born between 30 and 32 weeks. Infants with BPD may need extra oxygen until the condition subsides.

  • NEC: Necrotizing enterocolitis, or NEC, affects the intestines of as many as 13% of babies born before 26 weeks, and 3% of babies born between 30 and 32 weeks. In this condition, the lining of the intestines becomes infected and dies. Symptoms include a distended belly, lethargy, and feeding intolerance. When it’s caught early, NEC is treated with antibiotics. Feedings are stopped and infants receive nutrition through an IV. Serious cases may require surgery.

  • Sepsis: Caused by bacteria in the blood, sepsis is a serious problem in preemies. Sepsis may occur early from exposure to bacteria in the womb or birth canal, or later from contaminated equipment or IV lines. Symptoms include breathing problems, lethargy, and a swollen belly. Antibiotics are used to treat sepsis, which is most easily treated when caught early.

It's important to remember that preemies born at different gestational ages are very different, and will face different challenges and have different NICU courses. When thinking about what health problems your baby is at risk for, think about how premature he or she was at birth and what caused the prematurity.

Sources:

Blackman, JA. “NICU micropreemies how do they fare?” Contemporary Pediatrics Feb 2007 24:64-73.

Centers for Disease Control and Prevention. CDC features: Premature Birth. Accessed: October 1, 2008. http://www.cdc.gov/Features/PrematureBirth/

Henry, Shawna M. RNC, MSN, RN. “Discerning Differences: Gastroesophageal Reflux and Gastroesophageal Reflux Disease in Infants.” Advances in Neonatal Care August 2004 4: 235–247.

Holditch-Davis, PhD, RN, FAAN, Diane. “Outcomes of prematurity and neonatal intensive care unit care.” Journal of Obstetric, Gynecologic, & Neonatal Nursing July-Aug 2007 36:364-5.

May, Caroline, Patel, Sabina, Peacock, Janet, Milner, Anthony, Rafferty, Gerrard, Greenough, Anne. “End-tidal Carbon Monoxide Levels in Prematurely Born Infants Developing Bronchopulmonary Dysplasia.” Pediatric Research April 2007 61:474-478.

Nielsen, Heber C. MD; Harvey-Wilkes, Karen MD; MacKinnon, Brenda BSN; Hung, Stephen MD. “Neonatal outcome of very premature infants from multiple and singleton gestations.” American Journal of Obstetrics and Gynecology September 1997 177: 653-659.

Schmidt, M.D., Barbara, Roberts, M.Sc., Robin S., Davis, M.D., Peter, Doyle, M.D., Lex W. Barrington, M.D., Keith J., Ohlsson, M.D., Arne, Solimano, M.D., Alfonso, Tin, M.D., Win. “Caffeine Therapy for Apnea of Prematurity.” The New England Journal of Medicine. 18 May 2006 354:2112-2121.

Stokowski, RN, MS, Laura A.“Fundamentals of Phototherapy for Neonatal Jaundice. Advances in Neonatal Care December 2006 6:303-312.

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