While not all premature babies experience complications, being born too early can cause short-term and long-term health problems for preemies. Generally, the earlier a baby is born, the higher the risk of complications. Birth weight plays an important role, too.
Some problems may be apparent at birth, while others may not develop until later.
In the first weeks, the complications of premature birth may include:
Breathing problems. A premature baby may have trouble breathing due to an immature respiratory system. If the baby's lungs lack surfactant — a substance that allows the lungs to expand — he or she may develop respiratory distress syndrome because the lungs can't expand and contract normally.
Preemies may also develop chronic lung disease known as bronchopulmonary dysplasia. In addition, some preemies experience prolonged pauses in their breathing, known as apnea.
Heart problems. The most common heart problems premature babies experience are patent ductus arteriosus (PDA) and low blood pressure (hypotension). PDA is a persistent opening between two major blood vessels leading from the heart.
While this heart defect often closes on its own, left untreated it can cause too much blood to flow through the heart and cause heart failure as well as other complications. Low blood pressure may require adjustments in intravenous fluids, medicines and sometimes blood transfusions.
Brain problems. The earlier a baby is born, the greater the risk of bleeding in the brain, known as an intraventricular hemorrhage. Most hemorrhages are mild and resolve with little short-term impact. But some babies may have larger brain bleeding which causes permanent brain injury.
Larger brain bleeds may lead to fluid accumulation in the brain (hydrocephalus) over a number of weeks. Some babies who develop hydrocephalus will require an operation to relieve the fluid accumulation.
Temperature control problems. Premature babies can lose body heat rapidly; they don't have the stored body fat of a full-term infant and they can't generate enough heat to counteract what's lost through the surface of their bodies. If body temperature dips too low, hypothermia can result.
Hypothermia in a preemie can lead to breathing problems and low blood sugar levels. In addition, a preemie may use up all of the energy gained from feedings just to stay warm, not to grow bigger. That's why smaller preemies require additional heat from a warmer or an incubator until they're larger and able to maintain body temperature without assistance.
- Gastrointestinal problems. Preemies are more likely to have immature gastrointestinal systems, leaving them predisposed to complications such as necrotizing enterocolitis (NEC). This potentially serious condition, in which the cells lining the bowel wall are injured, can occur in premature babies after they start feeding. Premature babies who receive only breast milk have a much lower risk of developing NEC.
Blood problems. Preemies are at risk of blood problems such as anemia and infant jaundice. Anemia is a common condition in which the body doesn't have enough red blood cells. While all newborns experience a slow drop in red blood cell count during the first months of life, the decrease may be greater in preemies, especially if your baby has a lot of blood taken for lab tests.
Infant jaundice is a yellow discoloration in a newborn baby's skin and eyes that occurs because the baby's blood contains an excess of a yellow-colored pigment from the liver or red blood cells (bilirubin).
- Metabolism problems. Premature babies often have problems with their metabolism. Some preemies may develop an abnormally low level of blood sugar (hypoglycemia). This can happen because preemies typically have smaller stores of glycogen (stored glucose) than do full-term babies and because preemies' immature livers have trouble converting stored glycogen into glucose.
- Immune system problems. An underdeveloped immune system, common in premature babies, can lead to infection. Infection in a premature baby can quickly spread to the bloodstream causing sepsis, a life-threatening complication.
In the long term, premature birth may lead to these complications:
Nov. 27, 2014
- Cerebral palsy. Cerebral palsy is a disorder of movement, muscle tone or posture that can be caused by infection, inadequate blood flow or injury to a preemie's developing brain either during pregnancy or while the baby is still young and immature.
- Impaired cognitive skills. Premature babies are more likely to lag behind their full-term counterparts on various developmental milestones. Upon school age, a child who was born prematurely might be more likely to have learning disabilities.
- Vision problems. Premature infants may develop retinopathy of prematurity, a disease that occurs when blood vessels swell and overgrow in the light-sensitive layer of nerves at the back of the eye (retina). Sometimes the abnormal retinal vessels gradually scar the retina, pulling it out of position. When the retina is pulled away from the back of the eye, it's called retinal detachment, a condition that, if undetected, can impair vision and cause blindness.
- Hearing problems. Premature babies are at increased risk of some degree of hearing loss. All babies will have their hearing checked before going home.
- Dental problems. Preemies who have been critically ill are at increased risk of developing dental problems, such as delayed tooth eruption, tooth discoloration and improperly aligned teeth.
- Behavioral and psychological problems. Children who experienced premature birth may be more likely than full-term infants to have certain behavioral or psychological problems, such as attention-deficit/hyperactivity disorder (ADHD). However, more recent research suggests that — at least for late preterm babies — the risk of ADHD may be the same as it is for children who were born at full term.
- Chronic health issues. Premature babies are more likely to have chronic health issues — some of which may require hospital care — than are full-term infants. Infections, asthma and feeding problems are more likely to develop or persist. Premature infants are also at increased risk of sudden infant death syndrome (SIDS).
- Cunningham FG, et al. Williams Obstetrics. 24th ed. New York, N.Y.: The McGraw-Hill Companies; 2013. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=46. Accessed Oct. 3, 2014.
- Creasy RK, et al., eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 7th ed. Philadelphia, Pa.; Saunders Elsevier: 2014. http://www.clinicalkey.com. Accessed Sept. 30, 2014.
- Cook WJ, et al. Mayo Clinic Guide to Your Baby's First Year. Intercourse, Penn.: Good Books; 2012:503.
- Kliegman RM, et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.clinicalkey.com. Accessed Oct. 13, 2014.
- Hay WW, et al. Current Diagnosis & Treatment: Pediatrics. 21st ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://accessmedicine.mhmedical.com/book.aspx?bookid=497. Accessed Oct. 17, 2014.
- Fenton TR, et al. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatrics. 2013;13:59.
- Norwitz ER. Prevention of spontaneous preterm birth. http://www.uptodate.com/home. Accessed Sept. 30, 2014.
- Robinson JN, et al. Risk factors for preterm labor and delivery. http://www.uptodate.com/home. Accessed Sept. 30, 2014.
- Mandy GT. Short-term complications of the premature infant. http://www.uptodate.com/home. Accessed Oct. 18, 2014.
- Cerebral palsy. March of Dimes. http://www.marchofdimes.org/baby/cerebral-palsy.aspx. Accessed Oct. 18, 2014
- Stewart J. Care of the neonatal intensive care unit graduate. http://www.uptodate.com/home. Accessed Oct. 18, 2014.
- Common NICU tests. March of Dimes. http://www.marchofdimes.org/baby/common-nicu-tests.aspx. Accessed Oct. 18, 2014.
- Mandy GT. Long-term complications of the premature infant. http://www.uptodate.com/home. Accessed Oct. 18, 2014.
- Harris MN, et al. ADHD and learning disabilities in former late preterm infants: A population-based birth cohort. Pediatrics. 2013;132:e630.
- Pertussis: Summary of vaccine recommendations. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vpd-vac/pertussis/recs-summary.htm. Accessed Oct. 18, 2014.
- Grieger JA, et al. Preconception dietary patterns in human pregnancies are associated with preterm delivery. Journal of Nutrition. 2014;144:1075.
- Hypertension in pregnancy. Washington, D.C.: American College of Obstetricians and Gynecologists. http://www.acog.org. Accessed Oct. 10, 2014.
- Hofmeyr GJ, et al. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems (Review). Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001059.pub4/abstract. Accessed Oct. 10, 2014.
- Stampalija AZ, et al. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy (Review). Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008991.pub2/abstract. Accessed Oct. 10, 2014.
- Goya M, et al. Cervical pessary in pregnant women with a short cervix (PECEP): An open-label randomised controlled trial. The Lancet. 2012;379:1800.
- Abdel-Aleem H, el al. Cervical pessary for preventing preterm birth (Review) Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007873.pub3/abstract. Accessed Oct. 10, 2014.
- Ferguson KK, at al. Environmental phthalate exposure and preterm birth. JAMA Pediatrics. http://archpedi.jamanetwork.com/article.aspx?articleid=1769137. Accessed Oct. 10, 2014.
- Harms RW (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 23, 2014.