Why are some babies born early

Why Are Babies Born Early? (for Parents)

Reviewed by: Thinh Phu Nguyen, MD

Fetal Medicine at Nemours Children's Health

en español ¿Por qué algunos bebés nacen antes de tiempo?

Most babies are born healthy at or near their due date. Sometimes, though, babies are born early and might have health problems.

Why Are Some Babies Born Early?

Babies born before 37 weeks are premature. A premature birth is more likely to happen when a mother has a health problem — like diabetes — or does harmful things during her pregnancy, like smoke or drink. If she lives with a lot of stress, that also can make her baby be born too early.

Many things can cause a baby to be born early or with health problems. Some of these things can be controlled, but others can't.

Here's what you can do to have a healthy pregnancy.

How Can I Stay Healthy During Pregnancy?

During pregnancy, help your baby grow strong and healthy. Be sure to:

Start prenatal care as soon as you think you're pregnant. Prenatal care is the health care that you get during pregnancy. All pregnant women should see a health care professional as soon as they think they're pregnant, and should plan regular prenatal visits throughout pregnancy.
Get health problems treated. It's best to have any health problems (like diabetes, depression, or high blood pressure) under control before becoming pregnant. But if you don't, talk to your doctor right away about a treatment plan.
Eat a healthy diet. It's important to eat a variety of healthy foods before and during pregnancy. Take a prenatal vitamin to be sure you're getting enough folic acid, iron, and other important nutrients.
Gain the right amount of weight. How much weight you should gain depends on how much you weighed before you were pregnant. Most women who are at a healthy weight should gain about 25 to 35 pounds during pregnancy. Overweight women should probably gain less.
Don't smoke, drink alcohol, or take illegal drugs. Staying away from tobacco, alcohol, and drugs can help you and your baby avoid many serious health problems, like fetal alcohol syndrome and neonatal abstinence syndrome (NAS). If you do any of these things, get help to quit.
Wait at least 12 months between pregnancies. Increasing the time between pregnancies may lower the chances of preterm birth, especially if you had a premature baby before.

Things You Can't Control During Pregnancy

Some things that may increase the chances of a premature birth are out of your control. This doesn't mean that your baby will be born sick or too early. Remember, most babies are born healthy.

Here are some things you can't control during pregnancy:

Your age. Mothers who are 17 or younger or 35 or older are more likely to have a premature baby. Teen moms are more likely to get high blood pressure during pregnancy and less likely to get the health care they need. Older women are more likely to have health problems before they get pregnant.
The number of babies (multiples). The chances of having a premature baby go up if the mother is pregnant with twins, triplets, or more. More than half of all twins are born early.
Your health. Moms with problems like diabetes, depression, or high blood pressure may need to see their health care professional more often to keep these conditions under control.
Problems with an earlier pregnancy. A woman who has had a previous early delivery, or a baby born with health problems or a birth defect, is more likely to have problems in future pregnancies too.
Other factors. It's not clear why, but black women are more likely to have premature babies than white and Hispanic women.

If you're pregnant or are planning to be, talk with your health care professional. Women who get regular prenatal care are more likely to have a healthier pregnancy and baby.

Reviewed by: Thinh Phu Nguyen, MD

Date reviewed: August 2022

When Your Baby's Born Premature (for Parents)

What Is Prematurity?

Babies born more than 3 weeks earlier than their expected due date are called "premature." Premature babies (preemies) didn't have enough time to grow and develop as much as they should have before birth.

Why Was My Baby Born Early?

Most of the time, doctors don't know why babies are born early. When they do know, it's often because a mother has a health problem during pregnancy, such as:

diabetes (high blood sugar)
hypertension (high blood pressure)
heart or kidney problems
an infection of the amniotic membranes or vaginal or urinary tracts

Babies also may be born early if:

there's bleeding, often due to a low-lying placenta (placenta previa) or a placenta that separates from the womb (placental abruption)
the mother's womb is not shaped typically
they're part of a multiple birth (twins, triplets, or more)
their mother was underweight before pregnancy or didn't gain enough weight during pregnancy
their mother smoked, used drugs, or drank alcohol while pregnant

Does My Baby Need Special Care?

Yes, preemies may have many special needs. Younger and smaller babies tend to have more health problems than babies born closer to their due dates. So they often need care in a neonatal intensive care unit (NICU).

Why Must My Baby Stay Warm?

Preemies don't have enough body fat to hold their body temperature. Incubators or radiant warmers keep them warm in the NICU:

Infant warmers: These small beds with heaters over them help babies stay warm while being monitored. Because they are open, the team has easy access to babies to provide care.
Incubators: These small beds are enclosed by clear, hard plastic. Temperature in the incubator is controlled to keep a baby's body temperature where it should be. Doctors, nurses, and others can give care to the baby through holes in the sides of the incubator.

What Are My Baby's Nutritional Needs?

Breast milk is the best nutrition for all babies, especially preemies. It has proteins that help fight infection. Most preemies can't feed straight from the breast or bottle at first. Mothers pump their milk and it's given to babies through a tube that goes through the nose or mouth and into the stomach.

If that is not an option, doctors may suggest giving the baby donor milk from a milk bank, which is safe.

If you don't breast feed or pump milk, your baby will get formula. Preemies need more calories, proteins, and other nutrients than full-term babies do. So extra nutrients called fortifiers may be added to pumped milk or specially designed preterm formulas may be used to help your baby grow.

Preemies are fed slowly because they can get necrotizing enterocolitis (NEC), a serious intestinal problem that affects preemies.

Some babies who are very small or very sick get their nutrition through intravenous (IV) feedings called total parenteral nutrition (TPN). TPN has a special mix of nutrients like proteins, carbohydrates, fats, vitamins, and minerals that can fully support a baby’s growth until they can feed.

Doctors and dietitians watch the diets of preemies very carefully and make changes when needed to make sure the babies get the nutrients needed to grow.

What Health Problems Can Happen?

Because their organs aren't fully ready to work on their own, preemies are at risk for health problems. In general, the earlier a baby was born, the greater their chances of health problems.

These problems include:

anemia, when babies don't have enough red blood cells
apnea, when a baby stops breathing for a short time; the heart rate may lower; and the skin may turn pale or blue
bronchopulmonary dysplasia and respiratory distress syndrome, problems with breathing
hyperbilirubinemia, when babies have high levels of bilirubin, which is produced by the normal breakdown of red blood cells. This leads to jaundice, a yellowing of the skin and whites of the eyes.
necrotizing enterocolitis, a serious disease of the intestines
patent ductus arteriosus, a problem with the heart
retinopathy of prematurity, a problem with the eye's retina
sepsis infections that babies can get before, during, or after birth

What Else Should I Know?

Preemies often need special care after leaving the NICU, sometimes in a high-risk newborn clinic or early intervention program. Depending on their health, they may need care from specialists, such as doctors who treat problems with the brain and nervous system (neurologists), eyes (ophthalmologists), and lungs (pulmonologists).

Preemies must go to all doctor visits (including well-child checkups), get the vaccines that all babies need to stay healthy, and have routine hearing and eye exams. As your little one grows, doctors will check your baby's:

growth
development, including speech and language, learning, and motor skills
muscle tone, strength, and reflexes

Looking Ahead

Caring for a preemie can be more demanding than caring for a full-term baby.

Take care of yourself by eating well, resting when you can, and getting exercise. Spend one-on-one time with your other children when you can, and get help from others. Look for support from friends, family, and support groups. You also can get support online from groups such as:

March of Dimes
Graham's Foundation
Life's Little Treasures Foundation
Hand to Hold

Reviewed by: Lynn M. Fuchs, MD

Date reviewed: October 2021

Why babies are born prematurely

Login
Registration

Password

To remember me

Forgot your password?

Registration with:

Password

Confirm password

By registering on the site or logging in through social networks, you accept the terms of the User Agreement, including the terms of the Privacy Policy.

Receive the most interesting from our site by mail (we promise not to spam)

December 7, 2011

Scientists cannot say with certainty what triggers the process of childbirth. But the causes of premature birth are well known.

If delivery occurs before 37 weeks of gestation, the World Health Organization (WHO) defines the baby as preterm and preterm. The term "prematurity" also means that the child was born before the due date of intrauterine development and is not sufficiently developed . The weight of premature babies usually ranges from one and a half to two and a half kilograms. The modern level of medicine allows such children not only to survive, but also fully developed . However, some time must pass before such babies begin to feed on their own and can leave the maternity hospital.

Prematurity and consequences

There are several degrees of prematurity in newborns. A mild one, as a rule, does not pose a danger to the baby's health, while a severe one requires serious medical care. Find out the dangers of having a baby prematurely.

Are all premature babies born prematurely?

Not all low weight babies are born before 37 weeks. Some of them failed to gain enough weight during pregnancy. Experts believe that with the same degree of readiness of the baby's body for independent existence , normal birth weight is always an advantage .

Placental insufficiency
One of the causes of low birth weight is placental insufficiency, in which the placenta ceases to function normally. Because of this, the fetus does not receive enough nutrients for normal growth. Placental insufficiency occurs with complications of pregnancy, for example, with gestational diabetes - a violation of glucose metabolism caused by malnutrition of a pregnant woman.
If mother smokes
An equally serious cause of growth retardation is maternal smoking. Depending on the number of cigarettes smoked during pregnancy , the growth of the baby slows down to varying degrees. In pregnant women who smoke daily, the risk of having a baby weighing less than 2500 g is doubled.
Other causes
Other causes of low birth weight are malformations and chromosomal abnormalities in the child. Most of them are detected during screening in the second trimester of pregnancy.
Also, various infectious diseases that affect both the mother's body and the child during intrauterine development lead to low birth weight.

Why are babies born prematurely?

Despite numerous studies, scientists still cannot say with certainty what triggers the birth process. In recent years, the most popular theory among specialists is that the child's body independently determines the optimal time for childbirth. The pituitary gland of the child is presumably responsible for this mechanism. The causes of preterm birth, on the other hand, are well known.

Active pregnancy

Many women, fearing for the health of the child, almost completely stop moving while waiting for the baby. While physical activity during pregnancy protects against complications.

Stress
Often, early childbirth causes stress and hard physical work. Thus, the results of studies show that the death of close relatives, job loss or divorce can lead to premature birth.
Infections
Also, premature birth can be triggered by an infection of the urinary and genital tract of a woman. Experts believe that the bacteria secrete chemicals that cause uterine contractions. Often such diseases are asymptomatic, and a woman may not know that she is sick. The risk of preterm birth can be reduced by identifying and treating the infection before or early in pregnancy. Currently, there are a sufficient number of drugs that do not harm the baby.
Cervical weakness
In about 20 percent of preterm births, cervical weakness is the cause. This disorder is easy to detect during pregnancy if you visit a doctor regularly. The weakness of the cervix is eliminated by strengthening the tissues with a surgical thread.
Other causes
In addition, preterm labor often begins with multiple pregnancies, uterine bleeding of various origins, high blood pressure and pregnancy complications.
Also, according to some reports, the tendency to early childbirth can be inherited. Mothers who were born prematurely are more likely to have preterm births.

Essential

A premature baby can be born prematurely due to stress or illness of the mother. However, the birth of an underdeveloped child can also be provoked by the mother herself, if she smokes during pregnancy, eats improperly and neglects frequent visits to the doctor during the entire period.

To leave a comment - you must be an authorized user

Your baby was born prematurely | Regional Perinatal Center

Premature babies

If your baby is born too early, the joy of having a baby can be overshadowed by health concerns and thoughts about the possible consequences.

Instead of returning home with the baby, holding him and caressing him, you will have to stay in the department, learn to cope with the fear of touching the baby, realize the need for treatment and various manipulations, get used to the complex equipment that surrounds him.

In this situation, not only your baby needs help, you need it too! The best assistants are your loved ones, their love and care, as well as professional advice and recommendations from doctors and psychologists. This section of articles will help you improve your knowledge of preterm infant care, development and nutrition.

Your help for the baby

Previously, parents were often not allowed into the ward for newborns and, especially, into the intensive care unit because of the fear of infection of the baby, but now the contact of the parent with the child is recognized as desirable and is prohibited only in exceptional cases (for example, if parents have acute infections)

Close communication between you and your baby is very important from the first days of his life. Even very immature premature babies recognize the voices and feel the touch of their parents.

The newborn needs this contact. Studies have shown that it greatly contributes to the faster adaptation of an immature child to new conditions and the stabilization of his condition. The baby's resistance to therapy increases, he absorbs large amounts of food and quickly begins to suck on his own. Contact with the child is important for parents. Taking part in the care of the baby, they feel their involvement in what is happening and quickly get used to a new role, especially when they see how he reacts to their presence.

By constantly and attentively observing the baby, parents can notice the smallest changes in his condition before others. In addition, communication in the hospital is a good practice that will undoubtedly come in handy after discharge. For parents, early physical contact with the baby is very valuable, because it allows them to feel him, despite the incubator and other obstacles, and show him their love.

Treatment in the neonatal intensive care unit requires parents to have full confidence in all medical staff.

Nursing premature babies in the hospital

Many premature babies cannot breathe, suckle and regulate their body temperature sufficiently after birth. Only in the last weeks of pregnancy is the maturation of the lungs, gastrointestinal tract, kidneys, brain, which regulates and coordinates the work of all organs and systems.

Constant attention requires fluid loss due to the immaturity of the skin of premature babies and the insufficiency of thermoregulation processes. Modern approaches focused on nursing premature babies help to cope with these problems.

Heat regulation incubator

Premature babies are very susceptible to temperature fluctuations. At the same time, clothing can interfere with the monitoring of the baby's condition and its treatment. That is why an incubator is used to provide the conditions necessary for premature babies. It maintains a certain temperature and humidity, which change as the child grows. When the body weight of a premature infant reaches 1500-1700 g, he can be transferred to a heated bed, and after reaching a weight of 2000, most premature babies can do without this support. There are no strict rules here: when nursing children with low body weight, doctors are guided by the severity of the condition of each premature baby and its degree of maturity.

In incubators, very young premature babies are placed in special "nests" - soft hemispheres in which the baby feels comfortable and assumes a position close to intrauterine. It must be protected from bright lights and loud noises. For this purpose, special screens and coatings are used.

Critical treatments during the first days of life of premature babies with low and very low birth weight:

Use of an incubator or a heated bed.

Oxygen supply for respiratory support.

If necessary, artificial ventilation or breathing using the CPAP system.

Intravenous administration of various drugs and fluids.

Carrying out parenteral nutrition with solutions of amino acids, glucose and fat emulsions.

Don't worry: not all premature babies need such extensive treatment!

Mechanical ventilation and CPAP for respiratory support

When it comes to nursing, the provision of oxygen is of the utmost importance for premature babies. In a child born before the 34-35th week of pregnancy, the ability of the lungs to work independently is not yet sufficiently developed. The use of a constant flow of air with oxygen, which maintains a positive airway pressure (CPAP), leads to an increase in blood oxygen saturation.

This new method made it possible for the majority of even very immature children to do without mechanical ventilation. The need for intubation of children has disappeared: during treatment with CPAP, oxygen is supplied through short tubes - cannulas that are inserted into the nasal passages. CPAP or mechanical ventilation is continued until the lungs can function at full capacity on their own.

In order for the lungs to expand and remain in this state in the future, a surfactant is needed - a substance that lines the alveoli from the inside and reduces surface tension. Surfactant is produced in sufficient quantities starting from the 34-35th week of pregnancy. Basically, it is by this time that the formation of the lungs is completed. If the baby was born earlier, modern technologies allow the introduction of surfactant into the lungs of premature babies immediately after their birth.

Parenteral nutrition - administering nutrient solutions by vein

Premature babies, especially those born weighing less than 1500 g, are not able to get and absorb enough nutrients, even when fed through a tube. For the rapid growth of the baby, a large amount of nutrition is needed, and the size of the stomach is still very small, and the activity of digestive enzymes is also reduced. Therefore, such children are given parenteral nutrition.

Special nutrients are injected into a vein using infusion pumps that deliver solutions slowly at a predetermined rate. In this case, amino acids necessary for building proteins, fat emulsions and glucose, which are sources of energy, are used. These substances are also used for the synthesis of a number of hormones, enzymes and other biologically active substances. Additionally, minerals and vitamins are introduced.

Gradually, the amount of enteral nutrition increases, and parenteral nutrition decreases until it is completely canceled.

Premature infants with gastrointestinal disease require parenteral nutrition for a longer period of time.

By the time your grown baby is discharged from the hospital, everything should be well prepared at home. And this applies not only to the environment, clothes and means of caring for the child.

All family members should be ready to receive the baby. Of course, the main care will fall on the shoulders of the parents. Although you have already gained some experience in the hospital, it is important to feel the support of others, especially in the early days.

Older children can also help. The discharge of your baby is a great joy that you want to share with all your relatives.

While you are getting used to your new role, it is important that nothing distracts you from communicating with your child. Now all the care and responsibility for the baby lies entirely with you. Everything you need to take care of him should be at hand.

Getting ready to be discharged from the hospital

Before you are discharged, you must make sure that:

The crib, bath and changing area are prepared, preferably a changing table. A crib should be placed in the parents' bedroom, the child should not be left alone even at night. A stroller is also required. you have baby milk that was recommended by the doctor before discharge (if the child is on mixed or artificial feeding). As a rule, this is a specialized medical product. You need a certain number of small bottles and teats of the appropriate size, as well as a sterilizer. All premature babies will need pacifiers.
You have fully mastered breastfeeding or bottle feeding.
If your baby is not yet sucking all the necessary milk from the breast and is supplementing from a bottle, you have purchased a breast pump that you have learned to use; you may also need it if you have a lot of breast milk.
You have asked your doctor how often your child's weight should be monitored.
If your baby still needs medication, you have the required amount at home. And you know exactly how and when to give them to your child.
You know which warning signs to look out for.
After the baby is discharged, a pediatrician and a neonatologist will look after the baby, to whom you will give the discharge summary from the hospital.
You know how the hospital from which your child is being discharged will provide follow-up care after discharge.
You know which specialists and how often should examine your baby (oculist, neuropathologist, etc.).
All the necessary emergency phone numbers are at your fingertips.

When can a child go home

This question is very difficult to answer because all children are different. The stay in the hospital can last from 6 days to 6 months, depending on the degree of prematurity of the child, the severity of his condition, as well as the presence of certain complications.

Of course, all parents look forward to the moment when the baby can be brought home. Long-term nursing of a premature baby is often a difficult test for you. But we must not forget that safety comes first, and the baby can be discharged home only when the doctors are confident in the stability of his condition. It is certainly in your interest as well.

The rate of increase in body weight and length

Weight gain is the main indicator of the growth of the baby and the adequacy of the treatment. The weight of the child, especially in the first days and weeks of life, is influenced by a number of factors: the presence of milk in the stomach (immediately after feeding), the time of bowel movement, the degree of filling of the bladder, the presence of edema. Therefore, if an edematous child does not gain weight for several days, and perhaps even loses it, do not worry. It should be remembered that children grow unevenly and periods of high weight gain alternate with lower ones. It is better to focus not on weight gain per day, but on the dynamics of this indicator over several days or a week.

It is currently accepted that in the interval corresponding to 28-34 weeks of pregnancy, the normal weight gain of the child is 16-20 g/kg per day. Then it is reduced to 15 g/kg.

It is also important to take into account the rate of increase in body length. With malnutrition, at first the child gains less weight (or even loses it), and with a more pronounced deficiency of nutrients, his growth is also disturbed.

The weight must not only increase at a certain rate, but also correspond to the length of the baby. An important parameter characterizing the development of the baby is an increase in the circumference of the head. The brain most actively increases in size during the first 12–18 months of life. But an excessively rapid increase in head circumference, as well as a slowdown in its increase, indicate neurological disorders.

A premature baby can be discharged from the hospital if:

he is able to independently maintain the required body temperature;
does not need breathing support and constant monitoring of the work of the respiratory and cardiovascular systems;
can suck out the required amount of nutrition by itself;
does not need round-the-clock monitoring and frequent determination of biochemical or other indicators;
supportive care may be provided at home;
he will be under the supervision of a local pediatrician and neonatologist at the place of residence.

The decision to discharge home is made for each patient individually. In addition to the state of health of the baby, the degree of preparedness of parents, their ability to provide high-level care for a premature baby is also taken into account.

Feeding a premature baby after discharge

Breastfeeding is the ideal way to feed premature babies.

However, if the baby was born much prematurely and his birth weight did not exceed 1800-2000 g, his high nutritional requirements cannot be met by breastfeeding. The growth rate will be insufficient. Moreover, over time, the content of many nutrients, including protein, in milk decreases. And it is the main material for building organs, and primarily brain tissue. Therefore, proteins must be supplied to the body of a premature infant in the optimal amount.

In addition, premature babies have a significantly increased need for calcium and phosphorus, which are essential for bone formation.

In order for the baby's nutrition to be complete even after discharge from the hospital, special additives - "enrichers" are introduced into breast milk in a certain amount, already less than in the hospital. They make up for the lack of protein in it, as well as some vitamins and minerals. As a result, the child receives them in the optimal amount. The duration of their use will be determined by your doctor. If there is not enough milk or it does not exist at all, children born prematurely should be transferred to artificial feeding. Complementary feeding of premature babies is carried out with special children's dairy products designed for children with low birth weight. This baby milk is ideally suited to both the ability of immature children to digest and assimilate nutrients, and their needs.

Premature infant milk contains more protein, fat and carbohydrates than term infant milk, resulting in a higher calorie content. In specialized baby milk, the concentration of many minerals is higher, especially iron, zinc, calcium, phosphorus, as well as vitamins, including vitamin D. Long-chain polyunsaturated fatty acids of the Omega-3 and Omega-6 classes are introduced into such products, which are necessary for proper development of the brain and organ of vision, as well as nucleotides that contribute to the optimal development of immunity. However, when the child reaches a certain weight (2000-2500 g), you should gradually switch to feeding with standard baby milk, but not completely. Specialized baby milk can be present in the diet of a premature baby for several months. This time, as well as the volume of the product, will be determined by the doctor. He will answer all your questions about how to feed your baby.

At present, specialized children's dairy products have been developed and are being used to feed premature babies after discharge from the hospital. In its composition, it occupies an intermediate position between a specialized product for premature babies and regular baby milk. Your baby will be transferred to such baby milk while still in the hospital. You will continue to give it to your child at home, and the doctor, watching him, will tell you when it will be possible to switch to regular standard baby milk. If the baby was born with a very low body weight or is not gaining weight well, special baby milk can be used for a long time - up to 4 months, 6 or even 9months. The beneficial effect of such children's dairy products on the growth and development of the child has been proven in scientific studies.

Feeding needs for premature babies

Increased calorie intake because they need to gain weight faster than term babies.

More protein because premature babies grow faster.

More calcium and phosphorus for bone building.

More trace elements and vitamins for growth and development.

A premature baby grows faster than a term baby. Nutrition for such children is calculated taking into account body weight at birth, the age of the baby and its growth rate. As a rule, the calorie content of the daily diet is about 120-130 calories per 1 kg of body weight.