What is premature baby?

Your baby is small, but his or her basic needs are the same as those of any newborn baby. You will spend most of your time feeding, diapering, and comforting your baby. You may feel overwhelmed at times. Remember that it is normal to be concerned about your premature baby's health. But good nutrition, home care, and lots of love will help your baby grow.

You can expect your baby to be smaller than average for up to 2 years or more. In time, most premature babies will have caught up to full-term babies.

Infants born before 28 weeks of pregnancy are called "extremely premature." If your infant is born this early, you likely will face some hard decisions.

Your premature infant has a much greater chance than ever before of doing well. A baby has the best chance of survival in a neonatal intensive care unit (NICU) that has a staff with a lot of experience.

When a baby is born too early, his or her major organs are not fully formed. This can cause health problems. Your infant may not respond well to attempts to keep him or her alive. Often it's not clear whether treatment will help an infant live—with or without disability—or will only make the dying process take longer. A specialist called a neonatologist can give you some idea of what may happen. But no one can predict what exactly will happen. In the end it will be up to you to decide how far to continue treatment.

Having a premature baby may be stressful and scary. To get through it, you and your partner must take good care of yourselves and each other. It may help to talk to a spiritual adviser, a counselor, or a social worker. You may be able to find a support group of other parents who are going through the same thing.

Most infants born at 36 and 37 weeks' gestation are mature enough to go home from the hospital. But babies born earlier may need care in the neonatal intensive care unit (NICU), where they can be:

• Watched closely for infections and changes in breathing and heart rate.
• Kept warm in enclosed cribs called isolettes until they can maintain their body heat.
• Fed through a vein (intravenously) or through a tube in their nose, if needed. Tube-feeding continues until a baby is able to breathe, suck, and swallow and can take all feedings by breast or bottle.

Sick and very premature infants may need other treatments, depending on what problems they have. A baby who needs help breathing may have an oxygen tube or a machine, called a ventilator, that moves air in and out of the lungs. Some babies may need medicine or surgery.

After delivery, the neonatal staff will watch over and stabilize your preterm infant. If your baby’s gestational age is less than 36 weeks, your baby may be moved to the neonatal intensive care unit (NICU) for specialized care. The obstetric staff will care for you. This will take at least a few hours.

General health

• If your doctor prescribed medicines for your baby, give them as directed. Call your doctor if you think your child is having a problem with a medicine.
• Give iron, vitamins, and other supplements your doctor recommends.
• If your baby gets home oxygen, follow instructions for its use.
• Never give your baby honey in the first year of life. Honey can make your baby sick.
• Wash your hands often and always before holding your baby. Keep your baby away from crowds and sick people. Be sure all visitors are up to date with their vaccinations.
• Keep babies younger than 6 months out of the sun. If you cannot avoid the sun, use hats and clothing to protect your child's skin.
• Do not smoke or expose your baby to smoke. Smoking increases the chance of sudden infant death syndrome (SIDS), ear infections, asthma, colds, and pneumonia. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Immunize your baby against childhood diseases. Premature babies should get these shots on the same schedule as full-term babies.

Feeding

• Your baby may come home with a feeding schedule. This will tell you how often to nurse or bottle-feed. Do not go longer than 4 hours between feedings.
• Small feedings may help reduce spitting up. Talk to your doctor if your baby spits up a lot during or after feedings.
• If your baby has a feeding tube, follow instructions for its use.

Sleeping

• Put your baby to sleep on their back, not on the side or tummy. This reduces the risk of SIDS. Use a firm, flat mattress. Do not put pillows in the crib. Do not use sleep positioners, head shaping-pillows, or crib bumpers.
• Most premature babies sleep more than full-term infants. But they don't sleep for very long each time. You may wake up with your baby a lot until 6 months after your due date. And premature babies do not stay awake very long until about 2 months after your due date. It may seem like a long time before your baby responds to you the way you might expect.
• Too much light, touch, sound, or movement may upset your baby. Make the baby's room calm and restful.
• Ask your doctor if it is okay to swaddle your baby in a blanket. If you swaddle your baby, keep the blanket loose around the hips and legs. If the legs are wrapped tightly or straight, hip problems may develop. Hold your baby as much as possible.

Diaper changing and bowel habits

• You can tell if your newborn gets enough breast milk or formula by the number of wet and soiled diapers in a day.
• For the first few days, your baby may have about 3 wet diapers a day. After that, expect 6 or more wet diapers a day throughout the first month of life.
• Many newborns have at least 1 or 2 bowel movements a day. By the end of the first week, your baby may have as many as 5 to 10 a day. But as your baby eats more and matures during the first month, the number of bowel movements may decrease. By 6 weeks of age, your baby may not have a bowel movement every day. This usually is not a problem, as long as your baby seems comfortable and is growing as expected, and as long as the stools aren't hard.

Your child will reach the same growth and development milestones as other children. During the first 2 years of life, your child may seem to reach these milestones later than full-term children of the same age. But this is because your child was born early. Your child will catch up around age 2.

When your child starts school, be alert for signs of learning problems. Problems with learning, reading, and math due to preterm birth may first show up during the early school years.

The earlier in pregnancy that a baby is born, the greater the risk that the newborn will have medical problems, such as lung disease or jaundice.

• Babies born at 23 to 26 weeks of pregnancy are very underdeveloped. They have a much higher risk of disability or death than those born later.
• Babies who've reached 32 weeks of pregnancy are less at risk than those born earlier.
• Babies born at 34 to almost 37 weeks of pregnancy (late preterm) aren't likely to have as many problems as infants who are born earlier. But they are still at risk for both short-term and long-term problems.

If the baby can't breathe, the first decision that may be faced by parents and doctors is whether to resuscitate the infant. This means bringing the baby alive by getting the heart and lungs to work. When resuscitation doesn't work or isn't done, babies get care that makes them comfortable instead of treatment to keep them alive.

Treatment decisions are usually based on whether the infant's brain has been damaged. This can happen from bleeding in the brain or a lack of oxygen. Other things that affect treatment decisions include how physically healthy the baby looks and how many weeks old the baby appears to be.

The first month after the birth is when most major problems occur. It is a critical decision-making period for parents. There may be laws in your area that affect your decisions. Talk to your doctor about this.

Your child will reach the same growth and development milestones as other children. During the first 2 years of life, your child may seem to reach these milestones later than full-term children of the same age. But this is because your child was born early. Your child will catch up around age 2.

The earlier in pregnancy that a baby is born, the greater the risk of medical problems. Babies born at 23 to 26 weeks of pregnancy have a much higher risk of disability and death than those born later. Babies who've reached 32 weeks of pregnancy are less at risk than those born earlier.

A preterm birth may happen suddenly or after days or weeks of waiting. If you know you may deliver early, you can be better prepared.

During preterm labor, both you and your baby are considered high-risk. This means that you will have less freedom to move about and fewer choices about the birth.

Monitoring.

• You'll be on constant fetal heart monitoring. The monitor will limit your movement, but it's a good way for the doctor to learn how well your baby is doing.
• You'll also be checked regularly for changes in your heart rate, body temperature, and uterine contractions.

Medicines.

You can refuse pain medicine during preterm labor. But medicines such as antibiotics or corticosteroids can be important to ensure your infant's chances of good health after birth.

Delivery.

You'll probably deliver vaginally. But if your health or your baby's health is at risk, you may need a cesarean section (C-section).

A preterm baby is considered ready to go home when he or she:

• Is able to take all feedings by nipple and keep gaining weight.
• Can maintain body heat in an open infant bed.
• Breathes well. (An infant whose lungs have suffered damage may be sent home with portable oxygen.)
• Has normal breathing and a normal heart rate for a week. (A baby who is otherwise mature enough yet still stops breathing sometimes or has lung disease or other breathing problems may be sent home with a device to monitor breathing.)

Some babies are ready to go home as early as 5 weeks before their due date. Other infants, usually those who have had medical problems, may be sent home later.