Prematurity

What will my premature baby look like?

A premature baby has had less time to develop all their body systems. You may notice differences between a term and preterm infant such as:

• Thin bodies: Preterm infants have not had the opportunity to grow as much fat on their bodies, which makes their bodies look smaller and thinner. This makes their head look larger in comparison.
• Translucent skin: Preterm babies’ skin hasn’t matured so it is thinner and may look more translucent (clear). When they are first born, their hands and feet can have a blue or dark color. Their fragile skin may show more bruising and may easily tear.
• Closed eyes: If infants are born very prematurely, their eyes may be closed. Their eyes are very sensitive to light, so they may choose to keep them closed most of the time. If a baby’s eyes are open, they may have uncoordinated movements.
• Increased flexibility: Preterm babies have less developed muscles and cartilage, which causes more flexibility of their arms, legs and ears. They also have a harder time moving their extremities on their own.

The late preterm infant may look more like a term baby, but they may behave differently. At 34 to 37 weeks, they begin to accumulate fat on their bodies and grow in length. Their movements become more coordinated during this time. Their eyes will begin opening for longer periods. During the preterm period from 34 to 37 weeks, babies will grow about 1 inch in length and increase their weight by 1 pound 12 ounces. They can grow another inch and gain another pound from 37 weeks to 40 weeks (term).

What are some health issues that premature babies may have?

• Feeding difficulties: Premature infants have immature rooting and sucking reflexes, which makes it difficult for them to swallow breast milk or formula. A rooting reflex is when a baby turns their head and makes a sucking motion after their cheek is stroked.
  
  Oral feedings for premature infants are started based on the infant’s abilities rather than an age or a weight. While there is no standard age to begin oral feedings, many premature infants may show interest in feeding by mouth at around 34 weeks gestation. When starting feedings by mouth, the premature infant can get tired easily and take in inconsistent amounts of human milk or formula. If premature babies are unable to take in enough milk by mouth, additional human milk or formula can be given through a nasogastric (NG) tube. Mothers of infants who are interested in providing breast milk to their babies may need breastfeeding support.
• Unstable body temperature: Babies born early have less body fat, increasing their risk of getting cold. A premature infant may require a special bed to control temperature, light and sound.
• Neurological problems: Premature babies have fragile blood vessels in their heads. Sometimes these blood vessels will break and cause extra blood to build up in their head, which can increase the risk of seizures and physical and developmental delays.
• Breathing problems: Babies begin to produce surfactant in their lungs at 25 weeks and produce adequate levels around 36 weeks. Surfactant is an essential mix of several proteins and lipids (fats or fat-like substances) that helps babies breathe better. When babies are premature, they may need help breathing with the support of a ventilator or other equipment.
  
  Because their lungs are fragile, different types of respiratory support can lead to lung damage, which can sometimes be permanent. Also, as their brain is growing when they are premature, the brain may not regulate breathing normally, which can cause them to stop breathing for a short period of time and can lead to low heart rates.
• Patent ductus arteriosus (PDA): PDA is a vessel for blood to bypass the lungs when the baby is in the womb. This vessel normally closes once babies are born. Preterm babies have a higher chance of this blood pathway staying open after the baby is born. When the PDA stays open, it causes oxygen-rich blood to return to the lungs instead of the rest of the body. The increased blood flow to the lungs can cause increased stress on the heart, breathing difficulties, blood pressure changes and potentially heart failure. Our special medical and surgical teams provide ongoing consulting, treatment and surgical interventions as needed to ensure the best outcomes possible.
• Anemia: Premature infants are more likely to develop anemia, (a low red blood cell count) as they will have lower iron and decreased ability to make red blood cells. Premature infants tend to have frequent blood draws, which increases the chances of anemia. If the baby’s red blood cell count becomes too low, they may need a blood transfusion.
• Necrotizing enterocolitis (NEC): NEC is a disease of the intestines that mostly affects premature infants. It is linked to several factors, such as feeding, loss of blood flow to the intestines and a bacterium in the intestine. Some, but not all, signs of NEC may include abdominal distention (enlarged or swollen), tenderness and discoloration of the abdomen. NEC is a serious, rapid-acting and life-threatening diagnosis. Diagnosis will require an X-ray for confirmation. Treatment may include emergent surgery and/or antibiotic administration.
• Hyperbilirubinemia: Premature infants are more susceptible to jaundice (hyperbilirubinemia), as noticed by the yellowing of the skin or eyes. If dangerously high levels of bilirubin remain in the body, kernicterus (a type of brain damage) can develop and cause physical and/or mental disabilities. The premature infant has immature organs that may not be able to remove bilirubin, a waste substance, from the body. If the bilirubin level becomes too high, a special light called phototherapy is used to help break down the waste and remove the bilirubin.

What are common tests for premature babies?

• X-rays: Premature infants require periodic X-rays to monitor the status of their lungs and intestines.
• Eye exams: Premature babies are born with immature blood vessels to the eyes because they don’t fully mature until around 40 weeks gestation (term). The more premature or lower birth weight the baby is, the higher chances a baby will develop retinopathy of prematurity (ROP). The more oxygen a baby requires, the higher their risk of ROP. If ROP is not treated, it can lead to blindness.
  
  For babies born before 30 weeks gestation, our specialized ophthalmologists begin eye exams about 4 to 6 weeks after babies are born to check for any developing ROP and every one or two weeks thereafter. Any baby developing ROP can be treated early to avoid or decrease negative vision outcomes from ROP.
• Phototherapy: Premature infants experiencing hyperbilirubinemia may require phototherapy. If the premature infant’s bilirubin level becomes too high, a special light called phototherapy is used to help break down the bilirubin so the baby can excrete it more easily. During this treatment, babies stay in their beds with their eyes covered and a phototherapy light is directed on them. Babies will spend several days or longer under the phototherapy lights until the bilirubin level is in a safe range. The number of days under phototherapy is determined by bilirubin lab values, which require drawing a small amount of blood from the baby.
• Head ultrasound: Premature babies’ brains and their blood vessels are very fragile, which increases their risk for bleeding and an intraventricular hemorrhage (IVH). Depending on the size and amount of the bleeding, a baby can experience no side effects or may have severe physical and mental disabilities or even death. Some symptoms could include seizures, decreased movement or increased agitation. A noninvasive head ultrasound can help determine the presence and size of an IVH.
• Hearing screening test: Premature infants are at a higher risk of hearing loss. Each preterm infant will receive a hearing screen before discharge from the hospital. Audiologists will perform the test by attaching noninvasive sensors and ideally perform this test while your baby is sleeping.
• Lab tests: Premature infants may require frequent blood tests. The blood may be drawn by in a few different ways. Some common blood tests check oxygen levels, kidney and liver function, blood sugar levels, electrolytes levels and possible infection. Depending on the results of the lab values, your baby may need breathing treatment changes, medications, blood or extra intravenous fluids.

What types of treatment does a premature baby need?

Babies who are born prematurely often need highly specialized care. The treatment a baby needs depends on the types of health problems they have. Treatment for premature babies may include:

• Breathing treatment: When they are first born, babies may need help with breathing. If born before 34 weeks, a medicine called surfactant may be given in the lungs to help babies breathe better. Various types of respiratory equipment may help them breathe. They may need a ventilator, continuous airway pressure (CPAP) or a nasal cannula to give them enough oxygen.
• Isolette: Premature babies are born with little to no fat on their bodies, which is needed to help keep them warm. Special beds, called isolettes, keep them warm. Babies born before 34 weeks gestation, or weighing less than 1500 grams, typically are placed in an isolette, which provides a warm, humid environment for the baby to grow.
• Feeding assistance: Sometimes learning to suck, swallow and breathe is hard for premature infants. While they are learning to eat, they may need a specialized feeding therapist (occupational/speech therapist), a swallow study and potentially feedings through a feeding tube.
  
  Our lactation team can help support mothers with breastfeeding and providing breast milk during this time. Our board-certified lactation consultants, all with NICU nursing backgrounds, provide expert assistance and consultation for breastfed babies both during and after your baby’s hospital stay. Our state-of-the-art human milk lab is located within the NICU. The milk lab stores and prepares human milk feedings and serves as a communication center for patient families and the lactation department.
• Physical therapy: Premature infants can have issues with movement and muscle tone. Specialized physical therapists can provide therapy to babies in the NICU to increase their strength and improve muscle tone.

Why choose us to care for your baby if they are born early and need specialized care?

If you have an extremely premature or underweight baby, you need highly specialized care for their unique needs. Children’s Colorado offers a dedicated Small Baby Care Program that is equipped to improve the long-term quality of life for these babies. Our program includes a clinical team featuring neonatologists, neonatal nurse practitioners, therapists, dietitians, pharmacists and more than 80 specially trained registered nurses to care for small babies. We are always monitoring data, reviewing best practices and conducting research to provide the best outcomes for our small baby population.

With our expertise as a regional referral center caring for preterm infants with serious complications and severe birth defects, we are equipped to provide the specialized care that preterm babies need. So whether your baby is underweight or born with a heart, breathing, neurological or other medical condition, we have some of the most qualified pediatric specialists in the country to care for them — and they are available 24/7. Here, your baby will never have to wait for care.

Helpful resources

• The NICU at Children’s Colorado provides family resources to support the whole family. Throughout your stay, our specialists will support you, answer questions and help you prepare to go home.
• The Young Mother’s Clinic at Children’s Colorado provides a variety of healthcare services and resources to help young mothers and their children.
• The March of Dimes is a nonprofit organization that supports moms throughout their pregnancy, advocates for policies that prioritize their health and pioneers research to find solutions to the biggest health threats to moms and babies.
• The Centers for Disease Control’s Division of Reproductive Health collaborates with a variety of health partners to do research that focuses on understanding and reducing preterm birth.