Prematurity of the Newborn

HEALTH

by Alison Livada

Pregnancy is an exciting time for families as they anticipate the birth of a new child. Many pregnancies progress without complications, but sometimes, health conditions of the mother or baby can affect the pregnancy. A common complication of pregnancy is premature birth of the baby, which can affect between 5-18% of births [1]. However, newborns are extremely resilient, and we have many interventions to support premature babies.

What is prematurity?

Babies are born fully developed after 37 weeks of gestation. If babies are born prior to 37 weeks, they are considered premature. There are different categories of prematurity [1]:

• Late preterm: Born between 34 and 37 weeks
• Very premature: Born before 32 weeks
• Extremely premature: Born before 28 weeks

Prematurity can be associated with aspects of the mother’s health, lifestyle factors, or the pregnancy itself. Maternal factors associated with prematurity include prior premature birth, procedures on the cervix, or the mother having a short cervix [2]. Additionally, mothers younger than 17 years old or older than 35 years old also have a higher risk of premature birth [3]. Lifestyle factors, such as nutritional deficiencies or substance use (tobacco, cannabis, or cocaine) can also increase the risk of premature births [4]. Pregnancy factors associated with prematurity include having a twin pregnancy, having vaginal bleeding during the pregnancy, and having a serious infection during pregnancy [3].

What are the complications that occur in premature babies and how do we support them?

Babies born closer to term typically have fewer complications. Very premature or extremely premature babies can be small and not fully developed due to their early birth. Most of the issues that occur in premature babies are related to the fact that their organs are not fully developed.

For example, the lungs take a long time to develop and continue to develop until 18 years of age. As a result, premature babies have immature lungs and cannot breathe on their own. In this circumstance, these tiny newborns require some respiratory support to help with their breathing. This support can include a mask with oxygen to help them breathe or sometimes they need a breathing tube if they have very immature lungs [5].

Premature babies also often need help with regulating their body temperatures so they are kept in incubators to keep them warm [5]. They also may need help with maintaining their blood sugars which requires continuous monitoring [5].

Because of the need for some serious interventions, many premature babies are taken care of in the Neonatal Intensive Care Unit (NICU). There are specialized doctors that take care of these little babies in the NICU called neonatologists. They are entirely focused on taking care of babies and very familiar with the unique needs that these children have due to their prematurity. In the NICU, nurses and providers provide 24/7 care to these babies.

Despite the many medical challenges that premature babies may face, many of them do very well due to advancing medical care and their impressive resilience.

References

1. Khandre V, Potdar J, Keerti A. Preterm Birth: An Overview. Cureus. 2022 Dec 27;14(12):e33006. doi: 10.7759/cureus.33006. PMID: 36712773; PMCID: PMC9879350.
2. National Institute for Child Health and Development. What are the risk factors for preterm labor and birth? 2023 May 9. https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/who_risk
3. American College of Obstetricians and Gynecologists. Preterm labor and birth. 2023 April. https://www.acog.org/womens-health/faqs/preterm-labor-and-birth
4. Baer RJ, Chambers CD, Ryckman KK, Oltman SP, Rand L, Jelliffe-Pawlowski LL. Risk of preterm and early term birth by maternal drug use. J Perinatol. 2019 Feb;39(2):286-294. doi: 10.1038/s41372-018-0299-0. Epub 2018 Dec 20. PMID: 30573752.
5. Zivaljevic J, Jovandaric MZ, Babic S, Raus M. Complications of Preterm Birth-The Importance of Care for the Outcome: A Narrative Review. Medicina (Kaunas). 2024 Jun 20;60(6):1014. doi: 10.3390/medicina60061014. PMID: 38929631; PMCID: PMC11205595.

Alison Livada was born in the suburbs of Philadelphia. She studied biomedical engineering and Spanish at Penn State. She is completing her MD/PhD training at the University of Rochester School of Medicine and Dentistry and is an aspiring neonatologist. She is also interested in research with a focus on how blood cells respond to serious infections. She is passionate about caring for babies and working with families from diverse backgrounds.