Prematurity Risks and Complications

Baby IncubatorThe normal length of fetal gestation / pregnancy is 40 weeks. Anytime a baby is born prior to the end of the 37th week of pregnancy they are classified as premature (commonly called "preemies"). Premature birth significantly increases a baby's risk for health complications, birth injuries and almost everything else bad. The more premature a baby is the more at risk they are.

Risks & Complications of Prematurity

Premature babies are much more likely to have perinatal and neonatal birth injuries and health complications. There are 2 primary reasons for this. First, when a baby is born prematurely it often means that something went wrong during the pregnancy which triggered the early birth or forced doctors to induce it. The second reason is that when a baby is born too early their bodies are not fully developed which leaves them at risk for just about every possible neonatal health risk. Below are the most common complications and health risks associated with prematurity:

  • Undeveloped Lungs: the lungs are one of the last vital organs to form and develop during fetal gestation. A baby's lungs are not fully developed and mature until at least the 36th week of pregnancy. But individual fetal growth and development rates vary so a percentage of babies will not have mature lungs until sometime after 36 weeks. This is dangerous because if a baby is born prematurely their lungs may not be ready to supply necessary oxygen and without immediate medical intervention they could suffer a brain injury or worse from oxygen deprivation. Lung development is the primary concern in premature birth and most of the risks and complications of prematurity are directly related to under-development of the baby's lungs.
  • Respiratory Distress Syndrome: respiratory distress syndrome (RDS) is one of the complications related lung development in premature babies. RDS is a condition in which a preemie's immature lungs do not have enough pulmonary surfactant, a special protein compound which prevents the lung sacs from collapsing. As a result the baby's lungs do not function properly and they have severe difficulty breathing normally. Depending on the severity of RDS treatment options range from oxygen supplementation (with a respirator) or putting the baby on breathing tube and ventilator.
  • Bronchopulmonary Dysplasia: bronchopulmonary dysplasia (BPD) is a condition occurring when preemies are on a ventilator for long periods of time resulting in damage to their lungs from the constant pressure. BPD typically occurs only after a baby has been on a ventilator for a month or longer.
  • Neonatal Pneumonia: preemies born with immature lungs are at increased risk of developing pneumonia in the weeks after birth. Pneumonia is a pulmonary infection which causes inflammation that can disrupt the part of the lungs which interchange oxygen for carbon monoxide. When timely diagnosed pneumonia can be effectively treated with antibiotics and injury the baby can be avoided with oxygen supplementation. However, undiagnosed and untreated pneumonia in a preemie can be extremely damaging.
  • Infection: premature babies have immature skin and a weaker immune system which makes them less able to defend against various types of infections. This is why preemies are keep in incubators and controlled environments when in the Neonatal Intensive Care Unit (NICU) at a hospital. Preemies also have difficulty maintaining normal body temperature so the incubation spaces in the NICU also help to provide warmth.
  • Anemia: anemia is health condition in which the level of red blood cells in the body is abnormally low. Red blood cells are critically important because they deliver oxygen throughout the body so if they body does not have enough of them it can cause major problems. Anemia is a very common problem for preemies that must be carefully monitored. If the condition becomes severe blood transfusion may be required to supplement red blood cells.
  • Gastrointestinal Immaturity: the digestive and gastrointestinal systems are another part of the baby's body that develops late in gestation and is often not fully mature when premature birth occurs. This leaves many preemies not able to effectively process and absorb necessary nutrients from breast milk or formula. Many preemies with digestive immaturity in the NICU have to be fed intravenously for the first few days. Difficulty with nutrient absorption further complicates their situation.
  • Patent Ductus Arteriosus: patent ductus arteriosus (PDA) is heart problem in many preemies that occurs when a blood vessel called the ductus arteriosis doesn't have a chance to close before birth. The ductus arteriosis is like a valve separating 2 major blood vessels connecting the heart and lungs. During fetal gestation this valve stays open to facilitate lung growth. In the final stages of full term gestation hormones trigger the ductus arteriosis to close which allows for normal lung function after birth. When a baby is born prematurely the ductus arteriosis has not had a chance to close and is remains open when they are born. This can cause excessive blood to get pumped into the baby's immature lungs after birth. The buildup of fluid in the lungs can trigger heart failure if not managed. When PDA is timely diagnosed it can be effectively treated with synthetic hormones which trigger the ductus arteriosis to close.
  • Brain Bleeds: when a baby is very premature (born 34 weeks or earlier) their blood vessels in and around their brain are not fully formed and developed. The immature blood vessels in the brain are highly susceptible to tear or rupture, particularly under the stress of labor and vaginal delivery. Rupture of a blood vessel in the brain is known as an intraventricular hemorrhage (IVH) or brain bleed. Brain bleeds in preemies can cause permanent damage to the cells in the brain and result in life long disabilities such as cerebral palsy or cognitive delays. If premature birth is anticipated in advance there are precautions and prenatal medication that be used to reduce the risk of neonatal brain bleeds in preemies.