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Can a baby survive at 37 weeks


Babies born at 37 and 38 weeks at higher risk for adverse health outcomes -- ScienceDaily

Babies considered "early-term," born at 37 or 38 weeks after a mother's last menstrual period, may look as healthy as full-term babies born at 39-41 weeks, but a study published by University at Buffalo physicians in JAMA Pediatrics has found that many of them are not.

The study is considered the first population-based, countywide assessment of neonatal morbidity among early-term infants based on individual medical records in the U.S.

"Our results show the need for an increased awareness among health care providers that even though we consider babies born at 37 or 38 weeks almost term, they are still, to a large extent, physiologically immature," says Shaon Sengupta, MD, corresponding author and formerly a UB medical resident in the Department of Pediatrics and Women and Children's Hospital of Buffalo. She is currently doing a neonatal-perinatal medicine fellowship at Children's Hospital of Philadelphia.

The UB researchers found that these early-term babies were at significantly higher risk for adverse outcomes. They also found that birth by elective cesarean section pushed those risks even higher, from 9.7 percent risk of admission to neonatal intensive care with vaginal deliveries to 19 percent following cesarean section.

The research covered nearly 30,000 live births in Erie County (which includes the city of Buffalo) from Jan. 1, 2006 through Dec. 31, 2008.

In an accompanying editorial, William Oh of Brown University and Tonse N. K. Raju of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said that the findings "…have important implications for obstetric and neonatal care and research. The findings reinforce the concept that maturation is a continuum and any preset gestational age cannot be assumed to provide a clear separation between immaturity and mature."

The study was precipitated by observations among neonatologists that babies born at 37 or 38 weeks had more adverse health outcomes than those born at 39 to 41 weeks,

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according to Satyan Lakshminrusimha, MD, senior author on the study, associate professor of pediatrics in the UB School of Medicine and Biomedical Sciences and chief, division of neonatology at Women and Children's Hospital of Buffalo. He has worked in the hospital's Neonatal Intensive Care Unit (NICU) since 1996.

"We were seeing a significant number of infants born at 37 weeks who looked big and pretty healthy, but who, within a few hours of birth were developing low blood sugar, difficulty in breathing or needed antibiotics, necessitating admission to the neonatal intensive care unit," says Lakshminrusimha.

After evaluating admission patterns among newborn infants between 37 and 41 weeks of gestation at Women and Children's Hospital, Lakshminrusimha, Sengupta and colleagues found that these early-term infants were more likely to suffer some morbidity within a few hours of birth.

To see if these patterns were valid in a wider population, they undertook the larger, county-wide study, conducting an analysis of births at Women and Children's, Millard Fillmore Suburban, Sisters of Charity Hospital and Mercy Hospital, located either in the city of Buffalo or its nearby suburbs.

These data showed similar patterns. Adverse outcomes experienced by the early term babies included hypoglycemia (4.9 percent versus 2.5 percent of full-term babies), admission to the neonatal intensive care unit (8.8 percent versus 5.3 percent, the need for respiratory support (2.0 percent versus 1.1 percent), the need for intravenous fluids (7.5 percent versus 4.4 percent) intravenous antibiotics (2.6 percent versus 1.6 percent) and mechanical ventilation or intubation, which was required in .6 percent of early term babies versus .1 percent in full-term babies.

"Although these early-term babies appeared to be mature, providing a false assurance to clinical providers and parents, and they did well on the Apgar scores, they are nevertheless physiologically immature," notes Lakshminrusimha.

The data revealed, for example, that twice as many of these early term babies needed mechanical ventilation and the need for lung surfactant use was seven times higher than in term babies.

The data also show that early term babies delivered by cesarean section were at a higher risk -- by 12. 2 percent -- for admission to the NICU compared with full-term babies and at 7.5 percent higher risk for morbidity compared with term births.

In particular, the study points out that cesarean delivery is a strong predictor of neonatal morbidity at early-term gestation. Lakshminrusimha notes that the need for respiratory support is increased for babies delivered by cesarean section who may retain their fetal lung fluid, since they do not experience the hormonal changes of labor, which clear the fluid from the lungs.

Premature baby | Pregnancy Birth and Baby

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What is a premature baby?

Most pregnancies last 40 weeks. A baby born before the 37th week is known as a premature or pre-term baby. Medical advances have meant that more than 9 out of 10 premature babies survive, and most go on to develop normally.

In Australia, almost 1 in every 10 babies is born prematurely. Most Australian premature babies are born between 32 and 36 weeks and don't have any serious long-term problems.

Very premature babies are at a higher risk of developmental problems. It is possible for babies born at 23 to 24 weeks to survive, but it is risky.

Most babies born before 32 weeks, and those weighing 2.5 kg or less, may need help breathing and may be cared for in a neonatal intensive care unit (NICU) until they have developed enough to survive on their own. Babies born between 32 and 37 weeks may need care in a special care nursery (SCN)

Why are babies born prematurely?

The cause of premature birth is unknown in about half of all cases. However, some of the reasons babies are born prematurely include:

  • problems with the cervix, when it is too weak to hold the weight of the baby and uterus so it starts to open prematurely (called cervical incompetence)
  • multiple pregnancy (twins or more)
  • the mother gets an infection
  • the mother has a medical condition that means the baby must be delivered early, such as pre-eclampsia
  • problems with the placenta such as placental insufficiency, placenta praevia, placenta accreta or placental abruption
  • preterm premature rupture of membranes, when the amniotic sac spontaneously ruptures
  • the mother has a health condition like diabetes
  • a history of premature birth

If you are less than 37 weeks pregnant and you experience any of the signs of premature labour, such as contractions, your waters breaking, bleeding, a 'show' of mucus from your vagina or a sudden decrease in your baby's movements, contact your doctor or nearest delivery suite immediately. It may be possible to slow down or stop the labour. But each day the baby stays inside your womb, the greater their chance of survival.

In most cases labour starts by itself, and the signs will usually be the same as labour that starts at full term.

The signs of premature labour include:

  • pressure in the pelvis, as if the baby is pushing down
  • cramping in the lower part of the belly
  • diarrhoea, nausea or vomiting
  • constant lower back pain
  • a change in your vaginal discharge, or more discharge than normal
  • mucous, blood or fluid leaking from your vagina
  • waters breaking
  • regular contractions, or contractions that come more than 4 times an hour
  • baby’s movements slowing down or stopping

Find out more about the signs of labour and what happens.

What should I do if I experience the signs of premature labour?

If you have any of the signs listed above, contact your midwife or doctor straight away. If you are going to have your baby early, it’s important to get help as soon as possible.

You should also contact your midwife or doctor if you experience swelling in your face, hands or feet, or double vision, blurred vision or other eye disturbances. These are signs of pre-eclampsia, which is a common cause of pre-term deliveries.

If you go into labour prematurely, you will need to be treated in a hospital that has facilities for the newborn, such as a neonatal intensive care unit (NICU) or special care nursery (SCN).

You can find your nearest suitable hospital on the Miracle Babies Foundation website.

How is a premature labour managed?

At the hospital, you will probably have a pelvic examination or an ultrasound. The medical team will check whether your cervix has started to open for labour and monitor the baby.

It is best for very premature babies to be born at a hospital that has an NICU. If the hospital where the baby is born does not have an NICU, you and your baby may be transferred to another hospital.

When you are in labour, you may be given medicines to stop the contractions for a while. This allows you to be transferred to another hospital if necessary. You may also receive injections of corticosteroids 12 to 24 hours before the birth. Steroids will reduce the risk of the baby suffering from the complications of being born very early (particularly breathing difficulties and bleeding).

Premature babies can be born very quickly. They will usually be born through the vagina. However, in some cases the doctor may decide it is safest to deliver the baby via caesarean. Your doctor will discuss this decision with you.

A medical team from the neonatal (newborn) unit will be there for the birth. As soon as your baby is born, they will care for the baby in your room, possibly using a neonatal (baby) resuscitation bed. The team will keep your baby warm and help them to breathe with an oxygen mask or breathing tube, and possibly medicine. Some babies need help to keep their heart beating with cardio-pulmonary resuscitation (CPR) or an injection of adrenalin.

Once your baby is stable, they may be transferred to the NICU or SCN.

Will I be able to hold my baby?

How soon you are able to hold your baby will depend on their medical condition. You may be able to hold them on the day they are born, but you might need to wait a few days or weeks until they are stable enough.

Holding you baby, known as kangaroo care, is important part of your baby’s health and wellbeing, and the maternity staff will support you as soon as you are able.

Will I be able to feed my baby?

After your baby is born, you’ll be asked to start expressing breastmilk. Maternity staff, lactation consultants and Australian Breastfeeding Association counsellors will help you. Breastmilk is full of antibodies and nutrients that will be very important for your baby’s health and growth.

What will my premature baby look like?

Babies born at 36 to 37 weeks usually look like small full-term babies. Very premature babies will be small (perhaps fitting in your hand) and look very fragile.

  • Skin: it might not be fully developed, and may appear shiny, translucent, dry or flaky. The baby may not have any fat under the skin to keep them warm.
  • Eyes: the eyelids of very premature babies may be fused shut at first. By 30 weeks they should be able to respond to different sights.
  • Immature development: your baby might not be able to regulate its body temperature, breathing or heart rate. They may twitch, become stiff or limp or be unable to stay alert.
  • Hair: your baby may have little hair on its head, but lots of soft body hair (called 'lanugo').
  • Genitals: the baby's genitals may be small and underdeveloped.

Will my premature baby's development be delayed?

Some common issues for premature babies include:

  • breathing problems
  • heart problems
  • problems in their digestive tract
  • jaundice
  • anaemia
  • infections

Most premature babies will develop normally, but they are at higher risk of developmental problems so will need regular health and development checks at the hospital or with a paediatrician. If you are worried about your child's development, talk to your doctor.

Problems that may occur later in children who were born prematurely include:

  • language delays
  • growth and movement problems
  • problems with teeth
  • problems with vision or hearing
  • thinking and learning difficulties
  • social and emotional problems

How do I calculate my baby's correct age?

When you're judging whether your premature baby is developing normally, it is important to understand their 'corrected age'.

The corrected age is your baby's chronological age minus the number of weeks or months they were born early. For example, a 6-month-old baby who was born 2 months early would have a corrected age of 4 months. That means they may only be doing the things that other 4-month-olds do. Most paediatricians recommend correcting age when assessing growth and development until your child is 2 years old.

When will my baby be able to come home?

The hospital will not send your baby home until they are confident both the baby and you are ready. Staff will make sure you understand how to care for your baby at home. They will also show you how to use any equipment you may need.

You will need appointments to see a neonatologist (newborn baby doctor) or paediatrician. Your local child health nurse will also see you regularly.

It is normal to feel a little worried when you are looking after your baby yourself after so long in hospital. Take it slowly in a calm and quiet environment until you both get used to being at home.

Who can I talk to for advice and support?

If you need support, contact the Miracle Babies Foundation's 24-hour support line on 1300 622 243.

The Australian Breastfeeding Association can provide advice and support on feeding your baby on 1800 686 268.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.

Sources:
Australian Institute of Health and Welfare (AIHW) (Mothers and babies), Raising Children Network (Premature labour, birth and babies), Raising Children Network (Your premature baby's appearance), Raising Children Network (Premature baby development concerns), Raising Children Network (Going home with your premature baby), Women’s and Children’s Health Network (Premature babies), NSW Pregnancy and Newborn Services Network (Birth before 32 weeks), Miracle Babies (What is prematurity?), Miracle Babies (Treatment of preterm labour), Queensland Government (Queensland Clinical Guidelines; Preterm labour and birth)

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: March 2020


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Related pages

  • Neonatal intensive care unit (NICU)
  • Special care nursery (SCN)
  • What is kangaroo care?

Need more information?

Premature birth & premature babies | Raising Children Network

This essential guide for parents of premature babies covers gestational age, premature birth risk factors, premature labour and premature development.