Health Concerns for a Moderately Preterm Baby

What does it mean if your health care provider tells you that your baby will be born "moderately preterm?" If you have a moderately premature baby, what can you expect?

There are many definitions of prematurity, but the mostly widely accepted are:

• Late preterm infants: Gestational age (GA) between 34 weeks and 36 weeks and 6 days
• Moderate preterm infants: GA between 32 weeks and 33 weeks and 6 days
• Very preterm (VPT) infants: GA at or below 32 weeks
• Extremely preterm (EPT) infants: GA at or below 28 weeks (also called a micro-preemie)

In the final months of pregnancy, the fetus is growing quickly. Therefore, a baby who is born moderately preterm will be very different from a baby born earlier or later. A baby who is moderately preterm will have different challenges, health concerns, and needs than other babies born prematurely.

What Does a Moderately Preterm Baby Look Like?

Although they are smaller than full-term babies, moderately preterm babies look much like babies who are born later. They no longer have the thin skin and lack of body fat that very premature babies have. They usually weigh between about 3 1/2 to 5 pounds.

If you are visiting a newborn moderately preterm baby in the neonatal intensive care unit (NICU), the equipment will probably be more intimidating than the tiny baby. In the NICU, you can expect to see:

• Feeding Tubes: Moderately preterm babies are not strong enough to take in enough nourishment to gain weight, A tube can be placed that goes from the baby's mouth (OG tube) or nose (NG tube) to the stomach. The tube will be used to give any milk feedings that the baby cannot take by breast or bottle.
• Incubators: Although moderately preterm babies have begun to fill out, most don't have enough body fat to keep themselves warm. A baby might be put in an incubator or, for the first several hours of life, under a radiant warmer.
• IV Lines: Moderately preterm babies have immature digestive systems, which means that milk feedings need to be slowly introduced and increased over a period of several days. Peripheral IVs are often used to give the baby nutrition while feeds are increased, although PICC lines and umbilical catheters may also be used.
• Monitoring Equipment: Stickers on a moderately preterm baby's chest and feet or wrists will monitor the baby's heart rate, breathing rate, and oxygen saturation.
• Respiratory Support: Moderately preterm babies may need respiratory support at birth. Nasal CPAP and nasal cannulas are most commonly used, although some moderately preterm babies need mechanical ventilation.

Medical Risks for Moderately Preterm Babies

A moderately preterm baby is usually mature enough at birth to escape the most serious health problems of prematurity. Most of the health concerns that are faced by moderately preterm babies are short-lived and resolve before NICU discharge.

• Apnea of Prematurity: Apnea (when breathing stops) and bradycardia (when the heart rate slows down) are common in premature babies. Moderately preterm babies may suffer from apnea of prematurity for several weeks while their bodies mature. Apnea of prematurity is treated with medication and close monitoring.
• Jaundice: Jaundice is caused by the normal breakdown of red blood cells after birth. During this breakdown, the body creates waste products that premature babies can't get rid of very well. Preemies may need to be treated for several days with phototherapy to help.
• Poor Feeding: Moderately preterm babies are not strong enough to take all of their feedings from the breast or bottle, and may not coordinate sucking, swallowing, and breathing well. It can be frustrating for parents to leave their babies in the NICU when they seem to be well in every way, just because they are not strong enough to breastfeed or bottle-feed.
• Respiratory Distress: Lung development isn't complete until a baby has reached full term, and moderately preterm babies sometimes have trouble breathing at birth. They may breathe too quickly (tachypnea), have low oxygen saturation, or show other signs that they are having trouble breathing. Respiratory support may be needed, especially during the first few days of life.

What Is Tachypnea?

Tachypnea is rapid breathing. Newborn babies usually breathe between 40 and 60 breaths per minute. A respiratory rate faster than 60 breaths per minute is called tachypnea.

Both premature babies and babies born at term may breathe rapidly if they have a mild condition called transient tachypnea of the newborn (TTN). Babies with TTN may require respiratory support but usually will start to breathe normally within 1 or 2 days.

In premature babies, tachypnea can be a sign of respiratory distress syndrome, a more serious condition that may take longer to recover from.

How Long Will They Stay in the NICU?

All preterm babies must meet certain milestones before they can be safely discharged from the NICU. They must be able to eat, breathe, and stay warm on their own. Moderately preterm babies take several weeks to meet these milestones and are usually discharged at approximately 36 weeks gestational age.

Long-Term Problems

Most moderately preterm babies will leave the NICU with no lasting effects of prematurity. Some babies might need short-term care after discharge (for example, they might be sent home with an apnea monitor or need oxygen at home for a few months).

Here are a few things that parents can do to help make sure that their babies have the best possible outcome.

• Explore early intervention: If your baby shows any signs of developmental delay or has any severe health problems in the NICU, talk to your pediatrician about early intervention (EI). Early intervention programs are free to parents and can help preterm babies catch up to their peers more quickly.
• Get prenatal care: Pregnant people can reduce their risk of delivering preterm by getting early prenatal care. Expectant parents should talk with their provider early on about their chances of​ having a premature baby.
• Spend time in the NICU: If you have given birth to a moderately preterm baby, spend as much time in the NICU as you can. Learn about your baby's condition, bond with your baby, and get good at feeding your preemie.