Infants born prematurely
literally start life a little bit behind. Their lungs may not be
well enough developed to absorb oxygen and discharge carbon dioxide.
Their intestinal tracts may not absorb food well and their central
nervous systems may not allow them to maintain temperature stability.
Occasionally they
may need extra oxygen by tube, nasal prongs or even need a respirator.
Intravenous calories can nourish and sustain the most vulnerable
preemies and a gradual transition from tube feeding to breast
or bottle will let the stomach and intestines mature without risking
harm.
Even babies born
a week or two early can have "respiratory distress syndrome
of prematurity"--or RDS as it's called--but this is much
more likely under 34-35 weeks gestation (5-6 weeks early.) If
premature delivery is anticipated and can't be stopped, an obstetrician
will give the mother-to-be an injection of steroids to speed up
lung maturation. This relatively simple and apparently harmless
medication has saved countless babies' lives and kept others from
prolonged hospitalizations. Your doctor may not have a lot of
time to explain this fully to you when it's needed on an emergency
basis but please know that it works and is safe.
Below I answer
frequently-asked questions about the impact of prematurity on
infant survival, development, vaccination decisions, and family
dynamics.
Q: My
sister-in-law delivered 5 weeks early. She smokes, and I've heard
that smoking can trigger early labor. Is that true? What are my
chances of having a premature baby?
A: Yes,
smoking and poor (or absent) prenatal care increase the risk of
prematurity. Low maternal weight, poor nutrition, drug abuse,
maternal age under eighteen years or over forty may lead to prematurity.
An attentive doctor in partnership with a healthy aware mom-to-be
should recognize many of the risk factors and then the signs of
pre-term labor. Premature labor can often be stopped with decreased
activity, bed rest and medication. Please make sure you discuss
these signs and symptoms with your doctor in early pregnancy visits.
Anatomical problems
such as an incompetent cervix, fibroid tumors and unusual uterine
shape may predispose a woman to early labor and delivery, too.
Q. "My friend's baby has been diagnosed with cerebral
palsy. He was born 8 weeks early, was in the hospital for over
six weeks and had quite a few complications during that hospitalization.
Is cerebral palsy associated with prematurity?"
A. Babies
with neurological abnormalities or physical anomalies may be born
early. We're not quite sure why.
We're also not
sure if "cerebral palsy" (a broad diagnosis which encompasses
motor and intellectual problems of infancy, childhood and beyond)
is the cause of the premature birth. The other possibility is
that babies who go through hard deliveries and then require extra
oxygen, develop infections and have rocky hospital course suffer
some injury to the nervous system and develop the neurological
problems which we call cerebral palsy.
This is a medical
and a medicolegal issue and an extremely difficult discussion
with your doctor. The prognosis for recovery is tremendously varied
and I have seen many babies who looked pretty bad at the beginning
make great recoveries as the months and years go by. I have become
certain that optimism is almost always warranted.
Here's the hardest
part: Very few people have spent much time in a Newborn Intensive
Care Unit. Here is what you will see: The premature infant will
have at least one and sometimes as many as three IV lines. One
or two may originate from the belly button where the umbilical
blood vessels provide the best access for fluids and medicine.
Extra oxygen may be delivered with a hood, mask, nasal prongs
or through an endotracheal tube from a respirator. A preemie can
look much more fragile and much sicker than he actually is and
the first reaction may be panic and fear. Make certain that everything,
absolutely everything, is explained to you during those first
hours and that re-explanations and updates are given frequently.
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