There are short and long term risks surrounding preterm birth. Gestational age plays a significant factor in the risk of health compilcations.

It is important to be aware that not all babies born preterm will have difficulties, either severe, moderate, or mild, but it is also sensible to be aware of the risk factors so that you, as parents, can do all you can to optimise development, and limit the impact of early exposure to sensory stimulation. Be prepared and armed with knowledge about premature birth, enables you the ability to seek out help and keep abreast with intervention programs, developmental optimisation, and when professional testing may be valuable.

Health Outcomes at 22 weeks gestational age

Very few babies survive who are born this early. Research has reported rates of between 2% to 15%

The survival of infants at this gestational age is largely anecdotal so specific data regarding disability and other health outcomes on this group are limited.  

Health Outcomes at 23 to 25 weeks gestational age(micro preemies)

Breathing

Almost all preterm babies born this early will require help to breathe from a ventilator. It is likely they will have respiratory distress syndrome, which means that their lungs are too immature to breathe without help. It is not unusual when babies are this premature that they need extra oxygen up to, or more than 36 weeks post conception, but they may come off the ventilator and instead receive oxygen through nasal prongs. If your prem needs help beyond 36 weeks then there is a high chance they have chronic lung disease (also called bronchopulmonary dysplasia - BPD).

Approximately 65% of preemies born this early develop chronic lung disease. It usually resolves by the age of two.

A ventilator may also be used for preemie babies born this early because they are at higher risk for apnea of prematurity. The area of a premature baby’s brain, responsible for setting a regular pattern of breathing, is often immature and can result in irregular breathing patterns, shallowness of breath and pauses. Apnoea usually resolves by the time the infant is 36 weeks postmenstrual age.

Heart Function

Patent Ductus Arteriosus

Approximately 40% to 50% of micro preemies will have patent ductus arteriosus (PDA). PDA will sometimes close by itself and in mild cases doesn’t require treatment. If the PDA is affecting your baby’s breathing or heart function doctors may try medication or surgery. Approximately 10% of micro preemies need surgery to close their PDA.

Brain

Intraventricular hemorrhage (IVH) and Periventricular leukomalacia (PVL)

Approximately 15% to 20% preemies born 23 to 25 weeks’ gestation have large brain bleeds (grade 3 or 4). It is very difficult to predict what the long-term consequences are to severe brain bleeds; some of these babies recover without many major difficulties, while others develop cerebral palsy, or suffer from severe intellectual, visual, or hearing impairment. Most IVHs occur in the first 3 days of life, so babies will get an ultrasound to check for damage.

Eyes

Retinopathy of Prematurity (ROP)

Most micro babies develop ROP, abnormal blood vessels, but most of these will resolve on their own. Around 15% require surgery or other forms of treatment to prevent serious injury (retinal detachment, which causes blindness). NICU medical staff will test your baby’s eyes between 4 to 6 weeks.

Infection

Approximately 50% of micro preemies develop one or more infections during their stay in the hospital. Approximately 75% of these prems survive with the help of antibiotics and increased respiratory and nutritional support.

Stomach & Intestines

Necrotising Enterocolitis (NEC)

Approximately 5% to 10% of micro preemies develop inflammation of the intestinal tract, called necrotising enterocolitis. It is more common during the 2nd or 3rd week of life, after feedings have started. . Mild cases of NEC can cause feeding intolerance and recovery is usually quick. In more serious cases of NEC preemies may require antibiotics, intravenous nutrition, or sometimes bowel surgery. About 50% of prem’s with severe NEC need surgery.

(Dani, Poggi, Romagnoli, & Bertini, 2009; Johnson et al., 2009; Saigal, Rosenbaum, Hattersley, & Milner, 1989)(Anderson & Doyle, 2006; Bradford, 2003; Doyle & Anderson, 2005; Hack et al., 2005; Taylor, Espy, & Anderson, 2009)

 

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Health Outcomes at 26 to 28 weeks gestational age

Breathing

Babies born this early are also referred to as extremely preterm infants. Approximately 50% of these preterm babies develop respiratory distress syndrome (RDS) because their lungs are so immature. Most need help to breathe from a ventilator and most will also come off the ventilator after a few weeks. If extra oxygen is needed they will receive this through nasal prongs until they reach term.

If your prem needs help beyond 36 weeks then there is a high chance they have chronic lung disease (also called bronchopulmonary dysplasia - BPD). Around 50% of these preemies develop CLD. It usually resolves by the age of two.

A ventilator may also be used for preemie babies born this early because they are at higher risk for apnea of prematurity. The area of a premature baby’s brain, responsible for setting a regular pattern of breathing, is often immature and can result in irregular breathing patterns, shallowness of breath and pauses. Apnoea usually resolves by the time the infant is 36 weeks postmenstrual age.

Heart Function

Patent Ductus Arteriosus

Approximately 40% to 50% of extremely preterm infants will have patent ductus arteriosus (PDA). PDA will sometimes close by itself and in mild cases doesn’t require treatment. If the PDA is affecting your baby’s breathing or heart function doctors may try medication or surgery. Approximately 10% of extremely preterm infants need surgery to close their PDA.

Brain

Intraventricular hemorrhage (IVH) and Periventricular leukomalacia (PVL)

Approximately 5% to 10% preemies born extremely preterm have large brain bleeds (grade 3 or 4). It is very difficult to predict what the long-term consequences are to severe brain bleeds; some of these babies recover without many major difficulties, while others develop cerebral palsy, or suffer from severe intellectual, visual, or hearing impairment. Most IVHs occur in the first 3 days of life, so babies will get an ultrasound to check for damage.

Eyes

Retinopathy of Prematurity (ROP)

Approximately 75% of extremely preterm infants develop ROP, abnormal blood vessels, but most of these will resolve on their own. Around 5% require surgery or other forms of treatment to prevent serious injury (retinal detachment, which causes blindness). NICU medical staff will test your baby’s eyes between 4 to 6 weeks.

Infection

Approximately 30% of extremely preterm infants develop one or more infections during their stay in the hospital. Approximately 75% of these prems survive with the help of antibiotics and increased respiratory and nutritional support.

Stomach & Intestines

Necrotising Enterocolitis (NEC)

Approximately 5% to 10% of extremely preterm infants develop inflammation of the intestinal tract, called necrotising enterocolitis. It is more common during the 2nd or 3rd week of life, after feedings have started. Mild cases of NEC can cause feeding intolerance and recovery is usually quick. In more serious cases of NEC preemies may require antibiotics, intravenous nutrition, or sometimes bowel surgery. About 50% of prem’s with severe NEC need surgery.

(Dani, Poggi, Romagnoli, & Bertini, 2009; Johnson et al., 2009; Saigal, Rosenbaum, Hattersley, & Milner, 1989)(Anderson & Doyle, 2006; Bradford, 2003; Doyle & Anderson, 2005; Hack et al., 2005; Taylor, Espy, & Anderson, 2009)

 

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Health Outcomes at 29 to 33 weeks gestational age

Breathing

Babies born this early may have lungs that have developed enough to allow them to breathe by themselves or with just a little help with supplemental oxygen therapy. Approximately 25% develop respiratory distress syndrome (RDS) and 10% to 15% develop chronic lung disease (CLD). It usually resolves by the age of two.

Heart Function

Patent Ductus Arteriosus

Approximately 30% of these preemies will have patent ductus arteriosus (PDA). PDA will sometimes close by itself and in mild cases doesn’t require treatment. If the PDA is affecting your baby’s breathing or heart function doctors may try medication or surgery. Approximately 10% of these preemies need surgery to close their PDA.

Infection

Preemies born this early have a relatively small chance (15%) of developing an infection during their stay in the hospital. Approximately 75% of these prems survive with the help of antibiotics and increased respiratory and nutritional support.

(Dani, Poggi, Romagnoli, & Bertini, 2009; Johnson et al., 2009; Saigal, Rosenbaum, Hattersley, & Milner, 1989)(Anderson & Doyle, 2006; Bradford, 2003; Doyle & Anderson, 2005; Hack et al., 2005; Taylor, Espy, & Anderson, 2009)

 

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Health Outcomes at 34 to 36 weeks gestational age

Health outcomes

Although the health outcomes for older more mature preterm infants are favourable compared with those born earlier they are still at greater risk for some difficulties. The likelihood of severe disability is approximately the same as infants born at term however these preterm babies are at greater risk for mild cerebral palsy, developmental delay and school-related problems.

(Morse, Zheng, Tang, & Roth, 2009; Petrini et al., 2009)

 

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Technical Reference List

Anderson, P. J., & Doyle, L. W. (2006). Neurodevelopmental outcome of bronchopulmonary dysplasia. Seminars in Perinatology, 30(4), 227-232. Bradford, N. (2003). Your premature baby the first five years. Toronto: Firefly Books. Doyle, L. W., & Anderson, P. J. (2005). Improved neurosensory outcome at 8 years of age of extremely low birthweight children born in Victoria over three distinct eras. Arch Dis Child Fetal Neonatal Ed, 90(6), 121-128. Hack, M., Taylor, H. G., Drotar, D., Schluchter, M., Cartar, L., Andreias, L., et al. (2005). Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s. Jama, 294(3), 318-325. Taylor, H. G., Espy, K. A., & Anderson, P. J. (2009). Mathematics deficiencies in children with very low birth weight or very preterm birth. Dev Disabil Res Rev, 15(1), 52-59.

 

 

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