Premature Baby in an Incubator

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You might find the prospect of a premature birth and caring for a premature baby alarming, and it’s true that delivering your baby earlier than expected can be a difficult experience. Keep in mind, no two preterm births or preemies are the same and the complications (if any) can range from very mild to severe.

Whether you’re reading up on premature birth just in case, or you’re interested in the causes and signs of premature labour because of something you’re experiencing, read on. We’ll cover many aspects of premature labour and childbirth, as well as what care a premature baby typically gets after birth. Just keep in mind that every situation is unique and your doctor is the best source of personalised guidance and information.

What Is a Premature Birth?

A full-term pregnancy lasts for about 40 weeks calculated from the first day of your last menstrual period. This day is your estimated due date but, keep in mind, every pregnancy is different and most babies are actually born in the week either side of their due date—not necessarily exactly on their due date.

If your baby is born up to 3 weeks before you reach 40 weeks pregnant it is not necessarily classed as premature.

Under the guidelines applied in the UK, if your baby is born before the end of the 37th week of pregnancy he or she is classified as a ‘preterm’ or ‘premature’ baby.

However, not all ‘preemies’ fall into the same group. This is because the number of weeks your baby is premature affects his or her health and the type and amount of special care that may be needed in the weeks after being born.

Premature babies are grouped into three broad categories based on the week of pregnancy they were born:

  • Moderate to late preterm. Baby born at 32 to 37 weeks

  • Very preterm. Baby born at 28 to 32 weeks

  • Extremely preterm. Baby born before 28 weeks.

Birthweight Categories

You may also hear your preemie baby described in terms of how much he or she weighs at birth. As you might expect, premature babies tend to be smaller than babies born on or around their due date, because preemies have had less time to grow inside the uterus.

The categories of low birthweight are:

  • Low birthweight. Less than 2500 grams at birth

  • Very low birthweight. Less than 1500 grams at birth

  • Extremely low birthweight. Less than 1000 grams at birth.

In Summary

Babies born before 37 weeks of pregnancy are considered premature, but the survival rate and how much additional medical care and support they could need, varies a lot depending on how many weeks premature they are and how much they weigh at birth.

How Common Is Premature Birth?

In the UK, around 8 out of every 100 babies are born before 37 weeks. Most of these premature babies will be born moderate to late preterm. Very preterm births are far less common, while extremely premature babies – born between 22 and 28 weeks of pregnancy – are even rarer, at less than 1 in every 100 births.

Most premature births occur naturally, but around a quarter of babies born before 37 weeks are delivered early to protect the health of the foetus and/or mother.

How Early Can a Premature Baby Be Born and Survive?

With advances in medical science and standards of neonatal (newborn) care, the chances of extremely premature babies surviving are improving all the time.

It is difficult to assign an exact limit of viability — the minimum amount of time a foetus needs to spend in the uterus in order to survive outside — given that each baby is different.

Generally, babies born as early as after 24 weeks of pregnancy have a chance of survival, although sadly some will be too fragile to make it and the risk of disabilities is higher in babies born this early.

With modern neonatal care, babies born even earlier than this – at 22 to 24 weeks – sometimes survive as well, although the survival rate is lower and the risk of disabilities is higher. Babies born before 22 weeks pregnant are sadly too fragile for life outside the uterus.

What Problems Can Premature Babies Have?

What you may already have heard or read about the health challenges sometimes faced by premature babies may sound alarming, especially as – like all parents-to-be – your greatest wish is for a safe and problem-free birth and a happy and healthy child.

Keep in mind, however, that the most severe problems are usually associated with babies born extremely prematurely. And even then, although the risks and potential complications are undoubtedly more serious, modern neonatal care is capable of more than ever before.

The longer your foetus spends inside the uterus, the more time he or she has to develop and mature. This means that, generally, the more premature your baby is, the higher the risk of more serious complications.

Most cases of premature birth fall into the moderate to late preterm category, where the risk and severity of health issues is typically less serious.

With all this said, below you’ll find some potential problems and complications premature babies can have based on the week of pregnancy they were born:

Moderate to Late Premature Babies

If your baby was born moderate to late preterm (at 32 to 37 weeks), he or she may be pretty much like a full-term baby, only smaller, although some possible health complications may include:

  • Breathing problems

  • Jaundice

  • Low blood sugar levels

  • Reduced ability to fight infection.

Very Premature Babies

The survival rate of babies born at 28 to 32 weeks is much better than extremely premature babies (born at less than 28 weeks), although they do still face health challenges such as needing help with breathing. The specialist staff at the neonatal intensive care unit (NICU) will be able to explain any health issues.

These highly trained staff members will also be able to walk you through the best treatment and care options. In many cases, there may be few long-term adverse health consequences.

Extremely Premature Babies

Babies born before 28 weeks of pregnancy are considered extremely premature. The major organs of a baby born this early are not fully formed. Exactly what this means for an individual baby depends on lots of factors, including the number of weeks of prematurity, weight at birth and the health of the mum and the baby.

If your baby is born before 28 weeks, your midwife and the specialist NICU staff can help you make decisions about the treatment of the specific short or long-term health issues your baby is facing, and what other steps can be taken to help make your baby more comfortable.

In Summary

The amount of care and support your preemie needs will depend on how premature he or she is, and how well-developed. In many cases a period of monitoring in hospital will be enough, although for some babies more specialised and longer-term treatment may be necessary.

Causes of Premature Birth

Around three quarters of mums who give birth prematurely have gone into labour spontaneously. In many cases, precisely what has caused a mum to go into premature labour is unknown.

In the remaining quarter of all premature births, due to a complication affecting the mum-to-be or the foetus, doctors have recommended to either induce labour or perform a caesarean section before the pregnancy reaches full-term.

Although the precise reasons for giving birth prematurely are not always known, there are some factors that may make an induced or spontaneous preterm labour (or an early caesarean section) more likely.

The most common factors that increase the risk of premature birth include:

  • Twins, triplets or more. Twins are usually born between 34 and 36 weeks. If you’re pregnant with multiples and labour hasn’t started spontaneously after 37 weeks, you’ll likely be offered an induced labour as after this time the risk of complications increases. If you’re pregnant with twins (or other multiples), throughout your pregnancy you’ll be monitored more closely than you would with a complication-free single pregnancy. If your midwife or doctor have any concerns about the health of you or your foetuses, they may advise an early induction of labour or caesarean section.

  • Infections. Urinary tract infections, vaginal infections or respiratory illnesses such as influenza are known to be associated with premature birth. Gum disease has also been linked to an increased risk of prematurity. Even if there is no known infection at the time of a preterm birth, the placenta may show signs of infection.

  • Early breaking of waters. The membranes surrounding the baby in the uterus are a major barrier to infection. In rare cases they can break or rupture early, putting the foetus at risk of infection. This is known medically as premature, pre-labour rupture of membranes (PPROM). It only affects around 2 percent of pregnancies, but if it does happen and any signs of infection are detected in you or your foetus, an early delivery will be needed. In the meantime, you may be offered medicine to help prepare your foetus’s lungs for breathing outside the uterus.

  • Uterine or cervical abnormalities. Mums-to-be with an abnormally shaped uterus or short cervix have a higher risk of giving birth prematurely. These can be detected with a vaginal scan. If you have a short cervix you may be offered an injection of progesterone or a surgical procedure known as a cervical stitch to lower the risk of preterm labour.

  • A chronic health condition in the mother. If you have a condition such as diabetes, high blood pressure or kidney disease, this can increase the likelihood of a preterm birth.

Some other factors linked to a higher rate of preterm birth include:

  • A previous preterm delivery

  • Fertility treatment

  • A previous late miscarriage (after 14 weeks of pregnancy)

  • Vaginal bleeding after 14 weeks

  • Smoking.

In Summary

What causes premature birth is not known in every case, but the risk of giving birth preterm can increase if there is a health condition or infection in the mother and/or foetus, if the mum-to-be is pregnant with multiples, or if the mum-to-be has had a previous premature birth or late miscarriage. Lifestyle factors such as smoking can also play a role.

How Can You Decrease the Chances of Preterm Labour?

There’s no magic recipe for preventing preterm labour, but there are some things you can do to help lower the risk:

  • Attend all your antenatal appointments and let your doctor and midwife know about any acute conditions or possible risk factors you might have, such as a previous miscarriage, cervical surgery or a previous premature birth can help.

  • Get vaccinated against illnesses like the flu, as certain infections can increase the risk of premature birth and other complications. The flu vaccination is usually available from the end of September every year (before the start of the flu season), and it’s safe to take at any stage in pregnancy.

  • Quit smoking as smoking is associated with a higher risk of preterm labour.

  • Aim for healthy pregnancy weight gain. Being overweight may also increase your risk of health issues that can be associated with premature birth, such as diabetes or pre-eclampsia (a rare but serious blood pressure-related condition that could make an early delivery necessary). Keep in mind that experts only advise actively trying to lose weight before you become pregnant. Slimming during pregnancy is not recommended, but by sticking to a healthy, balanced diet and getting gentle exercise you can do a lot to help keep your pregnancy weight gain on track and reduce the risk of complications.

In Summary

There’s no sure-fire way of preventing preterm labour, but you can lower the risk of early childbirth by making healthy lifestyle choices, attending all of your antenatal appointments, and by taking steps to avoid or protect yourself from illness and infections that are known to be associated with a higher rate of premature labour.

Treatment to Prevent Preterm Labour

In some cases, if your midwife and doctor believe that you have a high risk of preterm labour – and if it’s suitable for you given your stage of pregnancy and other factors – you may be offered treatment to help prevent it from happening.

Treatment to help prevent premature labour could be a hormonal medicine (usually in the form of a vaginal tablet) or a surgical procedure known as a cervical stich.

Reasons for being offered treatment to help prevent preterm labour include if

  • you’ve had a premature baby before (born at less than 34 weeks pregnant)

  • you’ve had a miscarriage at 16 weeks pregnant or after in a previous pregnancy

  • your waters have broken before 37 weeks pregnant (either in your current pregnancy or a previous one)

  • you have had surgery or an injury to the cervix in the past

  • you have a short cervix.

In Summary

If you are considered to be at risk of premature birth, in some cases medical treatment to help prevent preterm labour may be offered. This can take the form of hormonal medicines or a surgical procedure called a cervical stitch. 

Stopping Preterm Labour

In some cases, preterm labour can be stopped or slowed down to give your foetus a little more time to develop in your uterus or so you can be moved to a hospital with more advanced preemie care facilities.

If you do go into preterm labour, you’ll be assessed to determine whether it’s best to go ahead with delivery or give you medicine to try to stop or slow down the labour.

Depending on how mature your foetus is when labour starts, you may also be offered injections of a steroidal medicine that can help prepare your foetus’s lungs for life outside the uterus and/or medicine to help the development of your little one’s brain.

Before making the decision, your midwife or doctor will discuss your situation with you, taking various factors into consideration, such as:

  • How far along you are in your pregnancy

  • Whether giving birth might be safer for your foetus (for example, if you have an infection)

  • What newborn care facilities are available where you are – in some cases you might need to be moved to a different hospital

  • Your wishes.

In Summary

If it’s judged to be the safest option for you and your foetus, you may be offered medicine to slow down or stop premature labour after it’s started. Depending how far along you are in your pregnancy, you may also be offered medicine to help prepare your foetus’s lungs and/or brain for life outside the uterus.

Signs of Preterm Labour

Call your midwife or the maternity unit where you plan to give birth straight away if you’re less than 37 weeks pregnant and think you might be experiencing signs of premature labour.

It’s important to determine as soon as possible whether labour really has started so that measures to ensure the safest possible birth – or delay delivery if this is the best course of action – are as effective as they can be.

Early signs of labour can include:

  • Regular contractions or tightening around your bump

  • Cramping or period-like pain

  • Fluid trickling or gushing from your vagina

  • An unusual backache.

Keep in mind, not all feelings of contractions indicate that labour has begun. You may be experiencing Braxton Hicks practice contractions. If you’re unsure about what you’re experiencing, call your midwife or doctor right away.

In Summary

Call your midwife or maternity unit immediately if you notice any possible signs of premature labour, such as regular contractions, cramping or period-like pains, fluid trickling or flowing from your vagina or an unusual backache.

What Happens at the Hospital After Your Preemie Is Born?

What happens after your preemie is born, depends on his or her needs. Babies that are very or extremely premature need more specialised care than those who are moderate to late premature.

There are three levels of neonatal care – as well as a transitional stage – for babies who are born prematurely or with other medical issues:

  • Transitional Care. This is for when your premature baby needs to stay in hospital but is strong and well enough for you to be his or her main carer with support from hospital staff. It’s a good way of learning to care for your preemie with trained staff close at hand to offer help when you need it. Your baby might go straight to transitional care after being born or could be moved to transitional care shortly before it’s time to go home after receiving more specialist care.

  • Level 1 – Special Care Baby Unit (SCBU). This kind of neonatal unit is for babies who have relatively straightforward needs but still need more specialist care, for example, monitoring of their breathing or heart rate, light therapy for jaundice or additional oxygen.

  • Level 2 – Local Neonatal Unit (LNU). Babies in a level 2 SCBU need closer medical and nursing attention, including short periods of intensive care, help with apnoea (when breathing stops for short periods) or drip-feeding.

  • Level 3 – Neonatal Intensive Care Unit (NICU). This is the highest level of support for babies who need breathing support with a ventilator, have serious respiratory problems or who need or are recovering from surgery.

At the Neonatal Unit

The staff at the SCBU or NICU will be providing your baby with round-the-clock care, and they will also be able to show you around and explain the various routines and procedures that have to be followed.

These include very strict rules on hygiene for visitors and staff, to prevent the fragile babies in the neonatal unit from being exposed to germs and infections.

The nurses and doctors at the neonatal will keep you updated with your baby’s progress and be available to answer your questions. You’ll have access to all your little one’s medical notes. Visiting policies may differ from hospital to hospital (and depend on the level of care), but some units also allow brothers and sisters to visit.

Where possible, the neonatal unit will provide a private space for expressing breast milk, spending time with your baby and discussing your baby’s treatment and condition with medical and nursing staff.

In Summary

Your premature baby will be given all the care needed to reach his or her full potential, either in transitional care with you as the main carer or in a special unit providing higher levels of support. The staff at the neonatal unit will be able to answer your questions, keep you updated about your infant’s progress and give you opportunities to spend as much time with your preemie as possible.

When Will Your Premature Baby Be Able to Leave the Hospital?

This varies a lot depending on your baby’s individual situation. If your baby’s feeding and weight gain are on track, it could be within two to four weeks of your infant’s original due date. If there are health conditions that still need to be addressed, your preemie may need a longer stay in the neonatal unit.

Before going home with your newborn, you’ll need to be confident that you

Rest assured that the neonatal unit staff will be there to help you with all these things and answer any questions or concerns you have about your preemie’s care both at the neonatal unit and after you return home with your child.

The staff at the neonatal unit will assess whether your baby is ready to go home based on various aspects of your preemie’s health and development, such as:

  • Whether your baby can control his or her own body temperature

  • How well your infant is feeding

  • If your preemie can be cared for outside the neonatal unit without round-the-clock professional support

  • Whether you, as the parent, feel confident that your baby is ready to come home

  • Whether you have all the information you need about caring for your child and how to manage any medical conditions or feeding difficulties.

In Summary

Your preemie will be discharged from hospital when the neonatal unit staff feel confident that your baby will be able to thrive without specialist medical supervision, and that you are also ready to start caring for your little one at home.

What Is a Preemie’s Corrected Age?

Your baby is special in lots of ways, but did you know that your preemie also has two ‘birthdays’? These are:

  • The day your baby was born (uncorrected age)

  • The date when your preemie was originally due (also known as your baby’s corrected age).

The corrected age is how old your preemie baby would be if he or she had been born on his or her estimated due date.

It’s easy to work out your preemie baby’s corrected age in two simple steps:

  1. Subtract how many weeks pregnant you were when your baby was born from 40 (the average number of weeks in a full-term pregnancy).

  2. Make a note of the result and subtract it from your baby’s actual age (in weeks) to find the corrected age.

So, for a premature baby born at the end of 32 weeks pregnant, just do this sum: 40 - 32 = 8.

This means the corrected age is eight weeks less than the uncorrected (actual) age. In other words, subtract eight from the actual age in weeks to get the corrected age.

For example:

Actual and Corrected Age of a Preemie Born at 32 Weeks

Uncorrected (actual) ageCorrected age
8 weeks0 weeks
12 weeks4 weeks
24 weeks16 weeks

 

You might not hold two birthday parties for your little one every year, but it’s important to be aware of your preemie baby’s corrected age, because this is the age your health visitor and doctor will take into consideration when checking your premature baby’s development.

Keep in mind that, even taking the prematurity of your baby into consideration, all children develop at different rates. So, your preemie may also reach certain growth and development milestones sooner or later than expected.

If your premature baby has an ongoing medical issue, this may also affect the pace at which he or she develops. Your child’s doctor, health visitor and/or home care team (if assigned) will be able to discuss your premature baby’s development and individual needs with you in detail.

In Summary

A premature baby’s uncorrected age is calculated from his or her actual date of birth. The corrected age is calculated from the original due date. Both these ages provide useful information for you, your health visitor and your baby’s doctor about the health and development of your baby.

Adjusting to Life at Home With Your Preemie

The arrival of a new baby is always a big event in any household, and a fragile baby can demand even more care and vigilance. This can be an emotional and sometimes challenging time for you and your family.

Here are some of the ways you and other members of your family might be affected by the arrival of your preemie:

You

It’s perfectly understandable if you find having a fragile baby stressful or scary. You may find that you were using a lot of energy to stay strong at the hospital’s neonatal unit, so your emotions only really catch up with you when you arrive home.

If you suddenly feel exhausted or tearful this is just a normal part of your body starting to relax as things start returning to normal. You may also find that strong emotions resurface on occasions like your baby’s first birthday or reaching important developmental milestones.

If you feel overwhelmed or unable to copy, don’t hesitate to ask your health visitor or doctor about what counselling or other support is available in your area.

Postnatal Depression

Postnatal depression (PND) affects around 1 in 10 of all new mums. Although it’s common to have spells of tearfulness or anxiety in the first couple of weeks after giving birth (sometimes known as the ‘baby blues’), the symptoms of PND last longer and may start later.

It’s important to remember that having PND doesn’t mean you’re going mad or a bad parent. It’s not your fault and lots of support is available. Depression, including PND, is an illness like any other, so the sooner you get help – for example by talking to friends and family or your GP and health visitor – the more effectively it can be treated.

Signs of postnatal depression can include:

  • A feeling of sadness that doesn’t go away

  • Loss of interest in the world around you

  • Constant tiredness and low energy

  • Sleeping problems

  • Having trouble bonding with your baby

  • Withdrawing from people

  • Having scary thoughts, such as about harming your baby.

Siblings

Older siblings might feel neglected with all the time you’re devoting to your newborn – either at the neonatal unit or later at home. You might experience some challenging behaviour or regression from your newborn’s brothers or sisters as they try to get your attention. Whenever possible, try to set aside a little time each day just for them.

It’s also helpful to include your other kids from the beginning. They’ll appreciate simple, honest descriptions of what’s going on. Making older children feel involved – for example by drawing pictures for the new baby or helping you change nappies – might also help and improve their behaviour.

Your Partner

Partners can also suffer from postnatal depression. If you think your partner is suffering from PND or is having trouble coping with the pressures of helping care for a preemie, it can help to provide a little encouragement and to be positive.

Sometimes just talking and sharing your feelings with each other can be enough, or at other times you might need professional help. The most important thing is to talk and listen to each other.

Visitors

Although you might be keen to share the joy of finally bringing your baby home with your friends and extended family, it could be better to limit the number of visitors at first.

This might sound tough, but it’s only until your little one gets used to the new environment. You and everyone else in your household will also probably need a little time to settle into the new routine of having a newborn baby in the house, especially if your baby is still fragile or needs special care.

With a preemie in the house, do your best to avoid contact with people who might have infectious respiratory or other diseases, to lower the risk of your little one catching an infection.

Follow-Up Appointments for Your Preemie

You may be asked to attend follow-up appointments after your baby has been discharged from the neonatal unit. At these appointments your baby’s health and development will be monitored by a paediatrician or neonatal consultant who specialises in premature babies.

Keep in mind that your child could reach some developmental milestones, like walking or acquiring other coordination and communication skills, at a later age than other children. Often, this is just because your preemie was born less developmentally mature than babies who were born at full-term.

This is why – until the age of 3 years old – your baby’s progress will be measured based on his or her corrected age, which is the age your baby would be if born when originally due.

Even after you bring your baby home, your health visitor will be there to answer any questions and give advice. If your preemie has additional medical needs, you may be assigned a home care team to provide extra assistance.

In Summary

Your preemie’s progress will be monitored either by your health visitor and your child’s doctor or by a specialist at follow-up appointments. Until the age of 3 years old, your child’s development will be measured based on his or her corrected age (your baby’s original due date) rather than your child’s actual age.

FAQS AT A GLANCE

  • Any birth that takes place before the end of the 37th week of pregnancy is considered premature, but not all premature babies are the same.


    The three main categories of premature baby are:

    • Moderate to late preterm: born at 32 to 37 weeks
    • Very preterm: born at 28 to 32 weeks
    • Extremely preterm: born before 28 weeks.
  • Yes, preterm labour can be stopped or slowed down in some cases, if this is judged safest for you and your foetus.


    The decision on whether to stop or slow down premature labour depends on

    • how many weeks pregnant you are
    • whether it might be safer for your foetus to be born straight away
    • whether you need to be moved to a hospital with special newborn care facilities
    • your wishes.


  • The reasons for a premature birth may not be known in every case, but some factors can make it more likely, such as:

    • If you are pregnant with multiples
    • An infection
    • Early breaking of waters
    • Abnormalities of the uterus or cervix
    • If you have a chronic health condition such as diabetes, high blood pressure or kidney disease
    • A previous preterm birth
    • Fertility treatment
    • A previous miscarriage after 14 weeks of pregnancy
    • Vaginal bleeding after 14 weeks of pregnancy
    • Smoking.


  • Call your midwife, doctor or maternity unit straight away if you notice any possible signs of preterm labour, such as:

    • Regular contractions that increase in strength and duration over time
    • Period-like cramping or pain
    • Fluid flowing or trickling from your vagina
    • An unusual backache.


  • That depends on why your first baby came early. If you have no known risk factors other than the history of a previous preemie, the chances are good that your baby will arrive close to the due date.


    However, if you have irregularities of the uterus or a chronic health condition such as diabetes or kidney disease, it's more likely that you will experience another premature birth.


    Your doctor or midwife is best placed to assess your risk based on your medical history.

The Big Picture

Preterm birth and caring for a preemie can be a worrying prospect for you as a parent, but keep in mind that most premature babies fall into the moderate to late premature group, where complications and health issues – if any – are often minor.

To keep any risks to a minimum, it’s important to let your doctor or midwife know as soon as possible if you experience any possible signs of preterm labour such as regular contractions, cramping or a discharge of fluid. In some cases, you may be offered options for stopping or slowing down your labour.

If your little one does arrive early and needs special care, rest assured that he or she will be in the best of hands. You’ll have access to the care and support you need to ensure that your little one has the best possible chance of thriving and reaching his or her full potential.

How we wrote this article
The information in this article is based on the expert advice found in trusted medical and government sources, such as the National Health Service (NHS). You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.