This pamphlet explains

what to expect if you give birth to an early preterm baby health problems that affect early preterm babies treatment options during pregnancy and delivery making decisions and finding support caring for a preterm baby

The earlier a baby is born, the more challenges he or she may face. Your health care provider will help you decide on the best treatment for you and your baby.

What You Can Expect

If you are at risk for having an early preterm baby, your health care provider will discuss with you your baby’s chances of survival. Survival depends on many factors. You need to be aware of the survival rates in your hospital for a baby with the same gestational age, sex, and birth weight as yours. You also need to be aware that early preterm infants who do survive often have serious, long-term health problems. Babies may be physically or developmentally disabled and need special medical care.

The National Institutes of Child Health and Human Development (NICHD) studies the outcomes of early preterm births in 16 hospitals. Between 1998 and 2002, the studies found that babies born before the 23rd week of pregnancy were not likely to survive. About one half of the babies born at the 25th week survived. By the 26th week of pregnancy, the survival chances increased to 76%. But most of the babies who survived had serious health problems 18–22 months later.

Although this information is helpful, every situation is different. Survival rates and outcomes vary from hospital to hospital. Always discuss your own situation with your health care provider.

Health Problems in Preterm Infants

The earlier an infant is born, the more likely he or she will have health problems. These problems can be short-term or long-term disabilities that may include the following:

• Respiratory distress syndrome (RDS)
• Bleeding in the brain
• Infection
• Problems with the digestive system
• Problems controlling body temperature
• Trouble communicating and making sounds
• Vision and hearing problems
• Cerebral palsy and other neurological problems
• Developmental delays

Some problems, like learning disabilities, may not show up until the baby is older.

How Birth Weight and Sex Affect a Baby’s Survival Chances and Risk of Health Problems Doctors consider these factors when making treatment decisions: Babies born weighing between 501 and 750 grams (1.10–1.65 pounds) have a 55% chance of survival. Of the babies who survive, 65% have serious health problems. Babies born weighing between 751 and 1,000 grams (1.66–2.20 pounds) have an 88% chance of survival. Of the babies who survive, 43% have serious health problems. Babies born weighing between 1,001 and 1,250 grams (2.21–2.76 pounds) have a 94% chance of survival. Of the babies who survive, 22% have serious health problems. Babies born weighing between 1,251 and 1,500 grams (2.76–3.31 pounds) have a 96% chance of survival. Of the babies who survive, 11% have serious health problems. Girls who are born at the 25th week of pregnancy and weigh about 700 grams (1 1/2 pounds) may have a higher chance of survival than boys born at the same age and weight. For twins, the chances for survival are less than for single births at the same age and weight.

Treatment During Pregnancy

If you are at risk of preterm birth, you may be referred to a maternal-fetal medicine (MFM) specialist, an obstetrician who specializes in treating high-risk problems affecting a pregnant woman and her baby. Medications sometimes can be given to women at risk of preterm birth to help the baby’s lungs mature (corticosteroids) or help prolong pregnancy (tocolytics or progesterone).

If you are between 24 and 34 weeks of pregnancy and your health care provider suspects that you may have your baby within the next week, you may receive an injection of a medication called a corticosteroid. This drug helps speed the development of your baby’s lungs and some other organs.

Doctors have found that giving the mother one course of corticosteroids will greatly increase the chances of a baby’s survival. The babies whose mothers received this treatment also were much less likely to have RDS and bleeding in the brain.

Drugs called tocolytics can be given to many women with symptoms of preterm labor. These drugs can slow or stop contractions of the uterus and may prevent labor for 2–7 days. Tocolytics may provide you with extra time to take corticosteroids for the baby’s lung development or to get to a hospital that offers specialized care for preterm babies. It is not clear whether there are any other benefits to prolonging pregnancy.

If you have a history of preterm birth, a drug called progesterone can be given. Progesterone can help prolong a pregnancy. This medication usually is given to women who are carrying only one baby.

Sometimes there are problems during a pregnancy that make preterm birth safer than allowing the pregnancy to go on. A doctor may decide that the baby needs to be born for his or her own safety or for that of the mother (see box).

When Preterm Birth is the Best Choice Doctors usually try to stop preterm birth. But sometimes things go wrong in a pregnancy that may make preterm birth the safer choice. If it is decided that the baby needs to be born for his or her own safety or for that of the mother, it is called an indicated preterm birth. An indicated preterm birth may be needed for the following reasons: Preeclampsia—This dangerous condition can damage the mother’s kidneys, liver, brain, heart, and eyes. It can affect the placenta as well and cause poor fetal blood supply. Premature rupture of membranes—The membranes that hold the amniotic fluid rupture before labor. Infection, such as chorioamnionitis Bleeding, which may mean there is a problem with the placenta Poor fetal growth—If the problem is severe, preterm birth may be attempted to avoid stillbirth. Other signs that the fetus may be having problems

Important Choices for Delivery

Where the baby is born may improve a preterm baby’s chances for survival. After the baby is born, prompt treatment may be needed to help the baby breathe.

Neonatal Intensive Care Units

Preterm infants who are delivered at hospitals with high-level neonatal intensive care units (NICUs) have a better chance of survival. High-level NICUs provide specialized care for infants with serious health problems. These units are better equipped and have doctors and nurses with advanced training and experience in caring for preterm infants. You and the baby usually will be cared for by a team of health care providers. The team may include a neonatologist, a doctor who specializes in treating problems in newborns.

You may be moved to such a hospital for delivery if you go into labor very early. It is better for the baby to be born at one of these hospitals than to transport the baby after birth.

Helping the Baby Breathe

When an early preterm baby is delivered, quick action may be needed to help the baby breathe. The baby’s lungs are not mature and not able to work well. If the baby is not breathing, a doctor will try to stimulate him or her and may use a ventilator, a device that breathes for the baby. Babies who are born before 23 weeks of pregnancy or who weigh less than 400 grams, or both, are not likely to survive even when these actions are taken.

Surfactant Replacement Therapy

Babies who survive but who are at risk of breathing problems may be given surfactant replacement therapy. Surfactant is a substance that helps the air sacs stay inflated in the lungs. The lungs begin making surfactant at around 23 weeks of pregnancy. Lack of surfactant is the main cause of RDS in preterm infants.

Infants who need surfactant replacement therapy often are very sick and need highly specialized care. For this reason, surfactant therapy is offered only in hospitals where the staff is specially trained in giving this treatment and caring for very sick babies.

If Your Baby Does Not Survive Parents who have to deal with the loss of their newborn need support. When dealing with your grief, remember you are not alone. There are many support groups for parents who are dealing with the loss of a newborn. You also can find online support groups for mothers and fathers who just want to read about how other parents have coped with this difficult situation. Talk with your doctor or nurse at the hospital, too, to see what kinds of services and counseling are available nearby.

Making Decisions

If you are likely to give birth to an early preterm infant, your doctor and NICU team will estimate the baby’s gestational age and weight. Treatment decisions made before the baby is born may change after the baby is born. Treatment depends on the baby’s condition at birth. Once the baby is born, the neonatologist will be better able to tell you what you can expect. Treatment decisions also may change based on how well the baby responds.

If your baby is not responding to treatment, there is only a very slim chance of survival. Your team of doctors and nurses will talk to you and your family about your options. It is possible that the baby will not be able to survive without the ventilator. It will be a difficult time for you and your family, but you may have to decide to remove your baby from the breathing machine. Your health care team will help you decide what is best for your baby.

Caring For a Preterm Baby

If your baby is healthy enough to overcome the challenges of being born preterm, he or she will still require special care. There are pediatricians who specialize in the care of preterm babies from birth through childhood. Some clinics focus on follow-up care for preterm babies. Make sure you find a doctor you like and trust. The doctor will closely watch how your baby grows and he or she will check to see if any other problems develop during childhood.

You also can find information for parents about caring for preterm babies. It is a good idea to become as informed as you can so you can give your baby the best care. As your child reaches school age, you may need to find a special school or teachers to help with any learning problems. For more information about preterm birth and caring for a preterm child, contact the following agencies:

March of Dimes
1275 Mamaroneck Avenue
White Plains, NY 10605
Phone: (914) 997-4488
Web site: http://www.marchofdimes.com

Eunice Kennedy Shriver National Institute of Child
Health and Human Development (NICHD)
PO Box 3006
Rockville, MD 20847
Phone: 1-800-370-2943
TTY: 1-888-320-6942
Fax: 1-866-760-5947
Email: NICHDInformationResourceCenter@mail.nih.gov
Web site: http://www.nichd.nih.gov

Finally...

For many reasons, some babies are born well before the mother’s due date. The earlier a baby is born, the more challenges he or she may face. If you give birth to an early preterm baby, your health care team will let you know what to expect. With this information, your health care provider will help you decide on the best treatment for you and your baby. No matter what the outcome, make sure to talk about your feelings with someone you trust or a trained professional who can help you.

Glossary

Amniotic Fluid: Water in the sac surrounding the fetus in the mother’s uterus.

Chorioamnionitis: Inflammation or infection of the membrane surrounding the fetus.

Corticosteroids: Hormones given to mature fetal lungs, for arthritis, or for other medical conditions.

Gestational Age: The number of weeks that have elapsed between the first day of the last normal menstrual period and the date of delivery.

Placenta: Tissue that provides nourishment to and takes away waste from the fetus.

Preeclampsia: A condition of pregnancy in which there is high blood pressure and protein in the urine.

Preterm: Born before 37 weeks of pregnancy.

Progesterone: A female hormone that is produced in the ovaries and that prepares the lining of the uterus for pregnancy.

Respiratory Distress Syndrome (RDS): A condition of some babies in which the lungs are not mature, which causes breathing difficulties.

Stillbirth: Delivery of a baby that shows no sign of life.

This Patient Education Pamphlet was developed by the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women’s health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as “superior.” To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations, taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice, may be appropriate.

Copyright © November 2009 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher

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