(This is the second of two stories.)
Babies born before 37 weeks gestation are considered premature and often have multiple heath issues.
For example, premature infants often have trouble breathing.
In the latter stages of pregnancy a baby will start to produce a detergent that lines the inside of its lungs called surfactant, which allows the lungs to expand easily.
If born before she starts making it, a premature baby can struggle to breathe or have to breathe faster to try to get oxygen.
These babies frequently need surfactant placed in their lungs through a tube down their windpipes.
They may need to be on a ventilator or at least need supplemental oxygen given in the nose or by a special hood over their heads.
Since a premature baby’s respiratory drive center in his brain may not be fully mature, he may forget to breathe at times. This is called apnea of prematurity.
It is often detected by monitoring the baby’s heart rate and oxygen levels: both will drop if he stops breathing. If persistent, it is often treated with caffeine!
A premature baby’s immune system is usually weak. As a result, she can be more susceptible to infection.
Since temperature instability, respiratory distress and apnea can also be signs of infection in preemies, they are closely monitored for infection.
Antibiotics are frequently used until the preemie is deemed to be infection-free.
Infants born before 34 weeks gestation cannot usually suck and swallow effectively. They do not have much in the way of fat stores or sugar stores, so hypoglycemia is a big concern.
Depending on how early they are born, preemies are usually fed intravenously.
Oral feedings are usually started and increased slowly, often through a feeding tube that runs down their esophagi into their stomachs.
If fed too quickly or too early (or for other reasons), part of the premature infant’s bowel lining may die.
This is a very serious condition called necrotizing enterocolitis. It may require surgery in some cases.
A premature infant’s brain grows rapidly. This makes it very susceptible to intracranial hemorrhages. Mainly seen in babies born before 32 weeks gestation, most of these resolve without problems.
Some, though, lead to developmental delay, seizures, fluid accumulation in the brain or cerebral palsy.
Also sometimes seen in those born before 32 weeks gestation is a condition called retinopathy of prematurity (ROP).
Retinas (the part of the eye that registers what is seen) can grow abnormally or stop growing. This can lead to vision problems later.
Despite all the health issues preemies face, progress continues to be made in both preventing and treating prematurity.
Dr. Charles Ison is a University of Kentucky graduate who has practiced in his hometown of Lexington since 1993. He is a partner in Pediatric and Adolescent Associates.