Milestone Mondays!- Pre-term baby milestones

preemie-feet

Since Kim Kardashian had her baby 5 weeks early, I thought there would be a little discussion about pre-term babies or preemie babies but I didn’t see any.  S0 thought I would highlight those milestones here!

In this post, I discuss:

  • Helpful resources to learn about prematurity
  • What is premature birth?
  • What happens after the NICU?
  • Neonatal milestones
  • Common medical problems preemies encounter

Most of this information was gathered from Medline Plus, another Medline Plus site, and the CDC and the Mayo Clinic and KidsHealth.

I also have a past post about a great article from a parent’s perspective of their experiences with a micro-preemie in the NICU.

Another great resource is the March of Dimes website.  March of Dimes’ mission is: We help moms have full-term pregnancies and research the problems that threaten the health of babies.

First, what is premature birth?

It is a birth that is at least three weeks before a baby’s due date. It is also known as preterm birth (or less than 37 weeks—full term is 40 weeks). Important growth and development occur throughout pregnancy—especially in the final months and weeks.

Depending on how early a baby is born, he or she may be:

  • Late preterm, born between 34 and 37 weeks of pregnancy
  • Very preterm, born at less than 32 weeks of pregnancy
  • Extremely preterm, born at less than 25 weeks of pregnancy

Most premature births occur in the late preterm stage.  Due to many recent advances, more than 90% of premature babies who weigh 800 grams or more (a little less than 2 pounds) survive. Those who weigh more than 500 grams (a little more than 1 pound) have a more than 60% chance of survival, although their chances of complications are greater.

The earlier a baby is born, the more severe his or her health problems are likely to be. Although babies born very preterm are a small percentage of all births, these very preterm infants account for a large proportion of infant deaths. More infants die from preterm-related problems than from any other single cause. Some premature babies require special care and spend weeks or months hospitalized in a neonatal intensive care unit (NICU).

What happens after the NICU? (From Kidshealth)

Preemies often require special care after leaving the NICU, sometimes in a high-risk newborn clinic or early intervention program. In addition to the regular well-child visits andimmunizations that all infants receive, premature infants receive periodic hearing and eye examinations.

Careful attention is paid to the development of the nervous system, including the achievement of motor skills like smiling, sitting, and walking, as well as the positioning and tone of the muscles.

Speech and behavioral development are also important areas during follow-up. Some premature infants may require speech therapy or physical therapy as they grow up. Infants who have experienced complications in the NICU may need additional care by medical specialists.

Also important is support of the family. Caring for a premature infant is even more demanding than caring for a full-term infant, and the high-risk clinics pay special attention to the needs of the family as a whole.

Neonatal milestones after 22 weeks:  For info on the early milestones from birth-3 months, see my past post here

  • Week 22 of pregnancy (gestational age)
    • Lanugo hair covers entire body.
    • Eyebrows and lashes appear.
    • Nails appear on the fingers and toes.
    • The baby is more active with increased muscle development.
    • The mother can feel the baby moving.
    • The fetal heartbeat can be heard with a stethoscope.
  • Weeks 23 to 25 of pregnancy (gestational age)
    • Bone marrow begins to make blood cells.
    • The lower airways of the baby’s lungs develop but still do not produce surfactant (a substance that allows the alveoli to open for gas exchange).
    • The baby begins to store fat.
  • Week 26 of pregnancy (gestational age)
    • Eyebrows and eyelashes are well formed.
    • All eye parts are developed.
    • The baby has a hand and startle reflex.
    • Footprints and fingerprints are forming.
    • Air sacs form in lungs.
  • Weeks 27 to 30 of pregnancy (gestational age)
    • Rapid brain development occurs.
    • The nervous system is developed enough to control some body functions.
    • The eyelids open and close.
    • The respiratory system, while immature, has developed to the point where gas exchange is possible.
  • Weeks 31 to 34 of pregnancy (gestational age)
    • A rapid increase in the amount of body fat occurs.
    • Rhythmic breathing movements occur, but the lungs are not fully mature.
    • The bones are fully developed, but still soft and pliable.
    • The baby’s body begins storing iron, calcium, and phosphorus.
  • Week 38 of pregnancy (gestational age)
    • Lanugo begins to disappear.
    • Body fat increases.
    • Fingernails reach the end of the fingertips.
  • Weeks 39 to 42 of pregnancy (gestational age)
    • Lanugo is gone except for on the upper arms and shoulders.
    • Fingernails extend beyond fingertips.
    • Small breast buds are present on both sexes.
    • Head hair is now coarse and thicker.

Common health problems with preemies: (from kidshealth)

Hyperbilirubinemia

A common treatable condition of premature babies is hyperbilirubinemia, which affects 80% of premature infants. Infants with hyperbilirubinemia have high levels of bilirubin, a compound that results from the natural breakdown of blood. This high level of bilirubin causes them to develop jaundice, a yellow discoloration of the skin and whites of the eyes.

Apnea

Apnea is another common health problem among premature babies. During an apnea spell, a baby stops breathing, the heart rate may decrease, and the skin may turn pale, purplish, or blue. Apnea is usually caused by immaturity in the area of the brain that controls the drive to breathe. Almost all babies born at 30 weeks or less will experience apnea. Apnea spells become less frequent with age.

In the NICU, all premature babies are monitored for apnea spells.

Anemia

Many premature infants lack the number of red blood cells (RBCs) necessary to carry adequate oxygen to the body. This complication, called anemia, is easily diagnosed using laboratory tests. These tests can determine the severity of the anemia and the number of new red blood cells being produced.

Low Blood Pressure

Low blood pressure is a relatively common complication that may occur shortly after birth. It can be due to infection, blood loss, fluid loss, or medications given to the mother before delivery.

Respiratory Distress Syndrome

One of the most common and immediate problems facing premature infants is difficulty breathing. Many things can cause breathing difficulties in premature infants, but the most common is called respiratory distress syndrome (RDS).

In RDS, the infant’s immature lungs don’t produce enough of an important substance called surfactant. Surfactant allows the inner surface of the lungs to expand properly when the infant makes the change from the womb to breathing air after birth. Fortunately, RDS is treatable and many infants do quite well.

Although most premature babies who lack surfactant will require a breathing machine, or ventilator, for a while, the use of surfactant has greatly decreased the amount of time that infants spend on the ventilator.

Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD), or chronic lung disease, is a common lung problem among preemies, especially those weighing less than 1,000 grams (2.2 pounds) at birth. The lungs of those babies usually improve over the first 2 years of life, but many of them continue to have asthma-like symptoms.

Infection

Infection is a big threat to preemies because they’re less able than full-term infants to fight germs that can cause serious illness. Infections can come from the mother before birth, during the process of birth, or after birth. Practically any body part can become infected. Reducing the risk of infection is why frequent hand washing is necessary in the NICU.

Patent Ductus Arteriosus

The ductus arteriosus is a blood vessel that is an essential part of fetal blood circulation, allowing blood to bypass the lungs, because oxygen for the blood comes from the mother and not from breathing air.

In full-term babies, the ductus arteriosus closes shortly after birth, but it frequently stays open in premature babies. When this happens, excess blood flows into the lungs and can cause breathing difficulties and sometimes heart failure.

Retinopathy of Prematurity

The eyes of premature infants are especially vulnerable to injury after birth. A serious complication is retinopathy of prematurity (ROP), which is abnormal growth of the blood vessels in an infant’s eye. About 7% of babies weighing 1,250 grams (2.75 pounds) or less at birth develop ROP, and the resulting damage may range from mild (the need for glasses) to severe (blindness).

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Categories: Milestone Mondays

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