Common Health Issues of Premature Babies

African American female nurse examining premature baby
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Parents of premature babies have many questions, especially about the complications of prematurity. Learning about what health problems your premature baby is facing can help you understand the treatments and know what questions to ask doctors and nurses. Here are the most common health issues that premature babies may face.

Apnea of Prematurity

Because the pathways between their lungs and brains are not fully developed, premature babies are at high risk for apnea, periods when breathing briefly stops. Apnea occurs in 85% of babies born at 30 weeks and 20% of babies born at 34 weeks. Apnea may come with periods of bradycardia (or “bradys”) when heart rate slows down.

Stimulation, either with touch or by an automated device, usually helps the baby start breathing again, and monitors make sure that episodes are caught right away. Medication and short-term respiratory support, like nasal continuous airway pressure or a ventilator, may also help.

Jaundice

Jaundice is yellowed skin caused by bilirubin, a product of red blood cells. It affects about 60% of term babies and up to 80% of preemies.

Babies with jaundice are often treated with exposure to special lights in a warm, enclosed bed. Premature infants are at risk for a rapid rise in bilirubin and are treated more often than term babies to prevent kernicterus, a complication where high levels of bilirubin damage the brain. Giving your baby plenty of fluids will encourage bowel movements, which help remove bilirubin.

Respiratory Distress Syndrome

Respiratory distress is common in all preemies and affects almost all babies born before 28 weeks old. Full-term babies make surfactant, a chemical that helps keep the lungs inflated. Without enough surfactant, premature babies’ lungs don’t inflate well. Preemies may need artificial surfactants or may need help breathing while their lungs mature.

Reflux

The American Academy of Pediatrics (AAP) calls gastroesophageal reflux "almost universal" in preterm babies. In reflux, stomach contents come back up the esophagus, and the baby will usually spit up. Still-developing swallowing reflexes, as well as the use of feeding tubes, contribute to the higher rate of reflux in preemies.

Some preemies have gastroesophageal reflux disease, or GERD. These babies may vomit more forcefully, seem to choke frequently, and can also have breathing, heart, or growth issues associated with their reflux.

Medication may be given to treat the condition, which preemies tend to outgrow with time. But since reflux medicines don't always work and may increase the risk of other conditions, nurses and doctors in the neonatal intensive care unit (NICU) often try other techniques, such as changing up feeding schedules (smaller, more frequent feedings often help) or formula types (extensively hydrolyzed and amino acid formulas have been shown to temper reflux).

Intraventricular Hemorrhage (IVH)

Very premature babies have fragile blood vessels in their brains. If those vessels break, an intraventricular hemorrhage (IVH) may occur. Babies born more than 10 weeks early or who have respiratory distress syndrome or unstable blood pressure are at higher risk for IVH.

There is no way to stop a brain bleed once it starts, but doctors can monitor and control side effects with treatments, including blood transfusions. Severe bleeds can have serious consequences, such as developmental delays. But less than half of babies with mild IVH cases will have long-term problems.

Retinopathy of Prematurity (ROP)

Preemies are born with immature eyes. In retinopathy of prematurity (ROP), blood vessels in the eye grow abnormally and can result in retinal detachment and blindness. ROP primarily affects babies weighing less than 2¾ pounds who are born before 31 weeks.

An eye exam at 1 to 2 months of age screens for ROP. About 90% of babies with ROP have mild cases that don't need treatment and their condition improves on its own. More advanced cases are usually treated with laser surgery or cryosurgery, which may help prevent the development of vision problems associated with ROP.

Patent Ductus Arteriosus (PDA)

Before birth, babies depend on the placenta for oxygen. Once a baby is born and begins breathing on their own, a blood vessel called the ductus arteriosus naturally closes, redirecting blood through the lungs to pick up oxygen before it flows to the heart. If this vessel remains open, your baby might have ductus arteriosus, or PDA.

Occurring in 8% of premature babies and twice as common in girls, PDA causes abnormal circulation and may lead to other difficulties, such as infections and breathing problems. Your baby may seem short of breath and tired from minor exertions, like feeding. Medication or surgery may be needed to close the ductus.

Bronchopulmonary Dysplasia (BPD)

Bronchopulmonary dysplasia (BPD) is a chronic lung condition caused by airway inflammation. It affects infants who were on a ventilator for long periods and can cause difficulty breathing and low blood oxygen levels.

BPD is rare in babies who are born after 32 weeks. Most newborns affected by BPD are born more than 10 weeks early, weigh less than 2 pounds at birth, and have breathing troubles early on. There is no cure for BPD, but babies' lungs often heal and develop quicker with certain medications. Others benefit from supplemental oxygen or respiratory support for a while.

Necrotizing Enterocolitis (NEC)

Necrotizing enterocolitis (NEC) affects the intestines of an estimated 7% of very low birth weight babies in the NICU. In this condition, the lining of the intestines becomes infected and dies. Symptoms include a distended belly, lethargy, and feeding intolerance.

When it’s caught early, NEC is treated with antibiotics. Feedings are stopped, and infants receive nutrition through an IV. Serious cases may require surgery.

Sepsis

Caused by bacteria in the blood, sepsis is a serious problem in preemies. Early-onset sepsis in the first week of life may occur early from exposure to bacteria in the womb or birth canal. It occurs in 6 in 1000 babies born before 34 weeks and 20 in 1000 babies born before 29 weeks. Later sepsis cases may stem from contaminated equipment or IV lines.

Symptoms of sepsis in your baby include breathing problems, lethargy, and a swollen belly. Antibiotics are used to treat sepsis, which is most easily treated when caught early.

Health Challenges at Different Gestational Ages

It's important to remember that preemies born at different gestational ages are very different, and will face different challenges. When thinking about what health problems your baby is at risk for, think about how premature they were at birth and what caused the prematurity.

A Word From Verywell

While your newborn preemie may be vulnerable to certain complications, you can help their chance of overcoming these challenges by understanding what causes health issues and why. Knowing what to expect can prepare you mentally when symptoms surface, and arm you with potentially life-saving knowledge to help your baby.

It's a good idea to discuss potential problems with your doctor as soon as possible after your preemie is born so you can develop a game plan together should issues arise. With attentive care, premature babies not only survive most newborn complications but go on to thrive in the long term.

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10 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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