“How will this affect my baby in the long term?"
As a nurse in a neonatal intensive care unit (NICU), I hear this question often from parents. Whether an infant is born weeks or months early, parents worry about the long-term health effects of prematurity. They want to know what to expect, and how to prevent the problems caused by being born too soon.
The list of possible long-term problems of prematurity can terrify parents. But the news isn't all bad. Even among micropreemies weighing less than 800 grams (about 1 lb 12 oz) at birth, most (60%) have normal neurological exams at 20 months of age. As weight and gestational age increase, the risks decrease. These risks include:
Learning problems: The most common long-term effect of prematurity is some form of learning disability. Disabilities may be mild, severe, or somewhere in between, and often don’t become apparent until children begin school. Math is most commonly affected; vocabulary and reading are least commonly affected. Early intervention and programs like Head Start can help minimize learning problems to encourage school success.
Vision and hearing problems: Micropreemies are at risk for an eye condition called retinopathy of prematurity (ROP), a condition that can cause vision impairment or blindness. Because ROP is easiest to treat when it's caught early, premature infants are screened early, often while they are still in the hospital. The condition is treated with freezing or with laser surgery, and most infants recover completely.
Feeding and digestive problems: Premature infants often cannot drink from the breast or a bottle at birth, and may be fed with IV fluids or through a tube in the nose or mouth for several weeks. These early feeding challenges can cause long-term feeding difficulties, including food refusal and slow growth. Severe cases of necrotizing enterocolitis (NEC) may require bowel surgery, which can contribute to difficulty with feeding and digestion. Gastroesophageal reflux disease, also called GERD or reflux, is another problem that premature babies may have as they grow. Reflux may be mild or severe, and may need to be treated by a doctor.
Respiratory problems: Asthma, croup, and bronchitis are all more common in children who were born early than in children born at term. A more serious complication, bronchopulmonary dysplasia (BPD), is another possible risk of prematurity. Infants with BPD may need extra oxygen for longer periods of time, even after hospital discharge.
- Cerebral palsy: As many as 30% of micropreemies develop cerebral palsy, a condition that affects movement and coordination. The condition may be mild or severe, and mental impairment may or may not be present. Many children with cerebral palsy use braces, wheelchairs, or other assistive devices to get from place to place.
What Can Parents Do?
Most NICUs offer follow up clinics for parents of premature infants, from the time they leave the NICU until they are in their second or third year of life. Attending all follow-up clinic appointments helps assure that any long-term effects of prematurity are caught early and treated promptly.
Preschool is critical for children who were born early. Head Start programs and traditional preschools can help smooth the transition into kindergarten, enhancing preemies’ academic preparation and allaying some of the schooling challenges preemies may face.
When premature infants enter school, parents will need to take an active role in their education to ensure that any challenges to learning are identified quickly. Early intervention can help prevent minor problems from becoming major ones, and can help these tiny infants to maximize their abilities.
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/
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.
Medline Plus Medical Encyclopedia. “Premature Infant.” Accessed: October 1, 2008. http://www.nlm.nih.gov/medlineplus/ency/article/001562.htm
National Eye Institute. "Retinopathy of Prematurity.” Accessed October: 1, 2008. http://www.nei.nih.gov/health/rop/