Prematurity
November 16, 2006
Every day 1 in 8 babies born in the U.S. arrives too soon. Premature birth can happen to any pregnant woman, and no one knows why. It is a serious, common and costly problem. The March of Dimes is leading the campaign to reduce premature birth by supporting research and by educating the public and health care providers.
Premature birth is a birth that occurs before 37 weeks of pregnancy. Most pregnancies last around 40 weeks. In 2004, there were over 500,000 premature births in the United States or about 12.5% of all live births. It is the leading cause of newborn deaths and the rate has increased over 30% since 1981.
Risk Factors for Preterm birth- It is impossible to predict your chances of giving birth prematurely. You may be at increased risk if you:
- Previously had a preterm delivery
- Are pregnant with twins or higher number multiples
- Are younger than 17 or older than 35
- Are African-American
- Are underweight
- Have had vaginal bleeding in more than one trimester
- Smoke, abuse alcohol, or use drugs (especially cocaine) during pregnancy
- Have given birth within the last 18 months
- The exact causes of preterm labor are not known. However, some things you can do to have a healthy pregnancy are:
- Seek early and regular prenatal care
- Eat healthy foods and do not skip meals
- Lead a healthy lifestyle; avoid alcohol, cigarettes, illicit drugs
- Be alert to signs of preterm labor
- Follow your doctor's advice
- Call your doctor or nurse right away if you notice any of these symptoms:
- Change in type of vaginal discharge (water, mucus, or bloody)
- Increase in amount of discharge
- Pelvic or lower abdominal pressure
- Constant, low, dull backache
- Mild abdominal cramps, with or without diarrhea
- Regular or frequent contractions or uterine tightening, often painless
- Ruptured membranes (your water breaks with a gush, or sometimes even a trickle of fluid)
- Respiratory distress syndrome (RDS). Babies with RDS lack a protein called surfactant that keeps small air sacs in the lungs from collapsing. Treatment with surfactant helps affected babies breathe more easily. Since treatment with surfactant was introduced in 1990, deaths from RDS have been reduced by about two-thirds.
- Apnea is an interruption in breathing and may be accompanied by a slow heart rate. Premature babies are constantly monitored for apnea.
- Intraventricular hemorrhage (IVH). Bleeding in the brain occurs in some very low birth weight babies, with the most premature babies at highest risk. The bleeds usually occur in the first three days of life and generally are diagnosed with an ultrasound examination. Most brain bleeds are mild and resolve themselves while more serious bleeds need surgical intervention.
- Patent ductus arteriosus (PDA). PDA is a heart problem that is commonly seen in premature babies. Before birth, a large artery called the ductus arteriosus lets the blood bypass the lungs because the fetus gets its oxygen through the placenta. The ductus normally closes soon after birth so that blood can travel to the lungs and pick up oxygen. In premature babies, the ductus may not close properly, which can lead to heart failure and lack of oxygen to the organs. PDA can be diagnosed with a specialized form of ultrasound (echocardiography) or other imaging tests. This condition may be treated with drugs and/or surgery.
- Necrotizing enterocolitis (NEC). The bowel may become damaged when its blood supply is decreased, and bacteria that are normally present in the bowel invade the damaged area, causing more damage. Some premature babies develop this potentially dangerous intestinal problem (usually 2-3 weeks after birth), which leads to feeding difficulties, abdominal swelling, and other complications. X-rays and blood tests are used to determine NEC. The baby will be given antibiotics and fed intravenously while the bowel heals. In some cases, surgery is necessary to remove damaged sections of the intestine.
- Retinopathy of prematurity (ROP). ROP is an abnormal growth of blood vessels in the eye. This condition can lead to bleeding and the formation of scars that can damage the retina of the eye, resulting in vision loss and blindness. Babies with mild ROP usually require no treatment because, in most cases, the eyes heal by themselves with little or no vision loss.
- Jaundice. Premature babies are more likely to develop jaundice because their livers are too immature to remove a waste product called bilirubin from the blood. Babies with jaundice have a yellowish color to their skin and eyes. Jaundice often is mild and usually not harmful. However, brain damage can occur if bilirubin levels get too high. Jaundice is treated with phototherapy, special lights that help the body eliminate bilirubin.
- Anemia. Premature infants often are anemic, which means they do not have enough red blood cells. Normally, the fetus stores iron during the later months of pregnancy and uses it late in pregnancy and after birth to make red blood cells. Infants born too soon may not have had enough time to store iron. Babies with anemia tend to develop feeding problems and grow more slowly; anemia also can worsen any heart of breathing problems. Anemic infants may be treated with dietary iron supplements, drugs that increase red blood cell production or, in severe cases, blood transfusion.
- Chronic lung disease (also called bronchopulmonary dysplasia). Chronic lung disease most commonly affects premature infants who require ongoing treatment with supplemental oxygen. These babies develop fluid in the lungs, scarring and lung damage, which can be seen on an X-ray. Affected babies are treated with medications that make breathing easier, and are slowly weaned from the ventilator. Their lungs usually improve over the first two years of life. However, many children develop chronic lung disease resembling asthma.
- Infections. Premature babies have immature immune systems that are inefficient at fighting off bacteria, viruses, and other organisms that can cause infection. Serious infections that are commonly seen in premature babies include pneumonia, sepsis (blood infection), and meningitis (infection of the membranes surrounding the brain and spinal cord). Babies can contract these infections at birth from their mothers or they may become infected after birth. Infections are treated with antibiotics or antiviral drugs.