| Subject | Contents |
| Calling your health care provider | Call your health care provider if you are pregnant and believe you are going into labor prematurely. If you are pregnant, and not receiving prenatal care, call your health care provider or the State Department of Health. Most Health Departments have programs to ensure that pregnant mothers, whether covered by insurance or not, able to pay or not, receive adequate prenatal care. They will direct you to the appropriate provider. |
| Prevention | One of the most important steps to prevent prematurity is to begin prenatal care as early as possible and to continue prenatal care throughout the pregnancy. This cannot be stressed enough. Statistics clearly show that early and good prenatal care reduce the incidence of prematurity, small for gestational age babies (SGA), and morbidity associated with delivery and the neonatal period. Premature labor can sometimes be treated or delayed by a medication that inhibits uterine contractions. Many times, however, attempts to inhibit premature labor are not successful and thus a "cure" for prematurity remains elusive. |
| Definition | Any infant born before 37 weeks gestation . |
| Alternative Names | Preterm infant; Prematurity; Preemie |
| Causes, incidence, and risk factors | Each newborn is classified at birth as premature (less than 37 weeks gestation), full-term (37 to 42 weeks gestation ), or post-dates (born after 42 weeks gestation). Often, the cause of premature labor, or premature rupture of the membranes followed by premature labor, is unknown. Preeclampsia , a condition that can develop in the second trimester of pregnancy with high blood pressure , fluid retention, and protein in the urine may result in preterm labor. Other maternal disease processes such as kidney disease , diabetes mellitus , infection, or heart disease may also contribute to preterm labor. Multiple pregnancy (the presence of more than one fetus in the uterus) accounts for 15% of all premature births. The problems of premature infants are related to the immaturity of their organ systems. The infant requires specialized care in a nursery until its organ systems have developed enough to sustain life without specialized support. Depending on the extent of prematurity, this may take weeks to months. Common problems related to immature organ systems include: respiratory complications such as hyaline membrane disease (also known as respiratory distress syndrome or RDS ); central nervous system immaturity that results in difficulty coordinating sucking and swallowing, susceptibility of bleeding into the brain, or episodes of absent breathing ( apnea ); gastrointestinal immaturity that leads to feeding intolerance; and kidney immaturity. Risk factors that may contribute to preterm labor include: adolescent pregnancy (mothers less than 18 years old), lack of prenatal care, low socioeconomic status, poor nutrition, poor education and substance abuse. Problems inherent to the mother's health include: a history of a previous pre-term delivery, a high unexplained alpha-fetoprotein level in the second trimester, untreated disease or infection (such as urinary tract infection or infection of the amniotic membranes), abnormalities of the uterus or cervical incompetence, premature rupture of the membranes or placenta previa. Approximately 10% of all births in the U.S. occur before 37 weeks gestation. |
| Symptoms | low birth weight (<2500 grams which = 5 1/2 pounds) thin, smooth, shiny almost translucent skin veins are easily seen through the skin (transparent skin) wrinkled features soft, flexible ear cartilage body hair called lanugo irregular breathing pattern weak cry usually inactive, may be unusually active immediately after birth ineffective suck and swallow ( poor feeding ) enlarged clitoris (female infant) small scrotum , smooth without ridges (male infant) |
| Signs and tests | The infant may have a low body temperature . It may develop a rapid respiratory rate ( tachypnea ) or exhibit poor respiratory effort. Common tests on a premature infant include: chest X-ray to determine lung maturity and incipient onset of hyaline membrane disease (respiratory distress syndrome, RDS) blood gas analysis serum glucoseserum calcium serum bilirubineuglobulin lysis time |
| Treatment | When premature labor develops and cannot be stopped by medical intervention, plans for appropriate management of a premature baby and the mother are made, which may involve transport of the mother to a center with facilities to care for premature infants. In some cases, steroids may be given to the mother in order to facilitate lung maturity in the premature infant. To assure support of the respiratory and cardiac systems and anticipate other common problems associated with prematurity, immediate evaluation and , if necessary, resuscitation takes place after delivery. The infant will be admitted to or transported to a high-risk nursery with personnel trained in the care of premature infants. The infant is placed under a warmer or in an isolette with controlled temperatures where careful observation and care can be given. Feeding may be administered by inserting a tube into the stomach, since infants usually are unable to coordinate sucking and swallowing before 34 weeks gestation. Intravenous feeding may be indicated in extremely premature infants. Depending on the degree of prematurity, the infant may not start breathing after birth, or respiratory efforts may be inadequate to expand the chest and deliver oxygen to the body. In such cases, a breathing tube is inserted into the infant's trachea, and artificial breathing is delivered by a respirator. Supplemental oxygen is given (See Respiratory Distress Syndrome ). Nursery care is needed until the infant is able to take oral feedings, maintain body temperature, and achieve a body weight of about 5 pounds. However, other problems may complicate treatment, especially for very small infants, which could prolong the hospital stay. |
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| Expectations (prognosis) | Prematurity was formerly a major cause of infant deaths. Improved medical and nursing techniques have increased the survival of premature infants. A greater chance of survival is associated with increasing length of the pregnancy . Of babies born at 28 weeks gestation , approximately 80% survive. Prematurity is not without long term effects. A large proportion of premature infants have medical problems that persist into childhood or are permanent. As a rule, the more premature an infant, and the smaller the birth weight, the greater the risk of complications. It must be stressed, however, that it is impossible to predict the long term outcome for an individual baby merely on the basis of gestational age or birth weight. |
| Complications | hyaline membrane disease ( respiratory distress syndrome ) bleeding into the brain (intraventricular hemorrhage) retinopathy of prematurity and associated visual loss or blindness (retrolental fibroplasia) bronchopulmonary dysplasia (BPD) heart diseasenecrotizing enterocolitis (severe intestinal inflammation) jaundice infection or septicemia anemialow blood glucose (hypoglycemia) brain hemorrhage (intraventricular hemorrhage) delayed growth and development mental-motor retardation |
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