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.
Most premature babies develop normally, but they are at higher risk of developmental problems so will need regular health checks.
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:
- multiple pregnancy (twins or more)
- the mother has a problem with her uterus or cervix
- the mother gets an infection
- the mother has a medical condition that means the baby must be delivered early, such as pre-eclampsia
- 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.
What will happen at the birth?
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 to help your baby’s lungs function more efficiently.
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.
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.
Your premature baby’s development
Some common issues for premature babies include:
- breathing problems
- heart problems
- problems in their digestive tract
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 to calculate your baby’s corrected 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 it’s time to go 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 and family 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.
Caring for your premature baby at home
Your premature baby is home at last and now it’s up to you to make sure he’s fed, warm, washed and happy… Not to mention getting him to sleep at night!
In many ways, caring for your premature baby at home may not be so different from how you had imagined life with a new baby. You will have plenty of time to cuddle and play with him and watch him respond to everyday things he won’t have experienced in the baby unit – a breeze, sunlight, the smell of a flower or your dinner in the oven.
Adjusting to life at home with your premature baby
Many families relish the return to the privacy and comfort of their own homes. You can start to care for your baby in your way, and it can feel as if ‘real’ family life can finally begin. However, it will also be a big adjustment for all of you. If your baby needs extra care – for example for breathing difficulties – you may feel very let down by general parenting books and websites, as they may not reflect your experience. However, they may still offer helpful advice with tips about feeding, sleeping routines and other aspects of life with a baby.
The correct temperature
You need to make sure that you keep your baby at a temperature that is comfortable and safe. The best way to do this is usually with layers – for example, a vest, a sleep suit and blankets or a zip-up sleeping bag as necessary. You can easily add or remove an item depending on how warm or chilly the surroundings are.
If you’re not sure how much you need to wrap your baby up, ask a member of the healthcare team. He may get cold very quickly – especially if left undressed, for example after having a bath – but high temperatures have been linked with cot death (see sudden infant death syndrome below), so it’s equally important not to overload his cot with blankets.
Helping your baby sleep
Now that your baby is at home, you may find out that he didn’t sleep as much as you thought at night when you weren’t there! You can help your baby develop good ‘sleep hygiene’ by doing things such as providing a quiet, dimly lit environment at night time. In the early months, however, there’s only so much that you can do, because babies get hungry. Also, the smaller the baby, the more often they need to feed. Developing a good night’s sleep for you and the rest of your family may be a long-term project.
Sudden infant death syndrome (SIDS), also known as cot death
This is a syndrome in which apparently healthy babies die in their sleep, usually during the first six months of life. Premature babies are at higher risk for slightly longer than term babies. It’s still not known exactly what causes SIDS, but we do know a number of things that help reduce it. Since the following guidelines were put in place in 1991, the number of cot deaths has reduced drastically.
Tips for reducing cot death
- Lie your baby on his back, unless your healthcare team has advised otherwise, with his feet at the bottom of the crib.
- Use lightweight blankets – never duvets or pillows, Keep bedding away from your baby’s face, and tuck it in firmly.
- Make sure no one smokes in the house.
- Keep your baby in your room for the first six months, in his own crib.
- Never fall asleep with your baby on the sofa or in your bed, especially if you’re very tired or have been using alcohol, drugs or medication, or if your baby was premature or small at birth.
- Make sure your baby rests well away from radiators or heaters and out of direct sunlight.
- Keep the room at 16-20oC (61-68oF), but ideally at 18oC (64oF).
Washing your premature baby
How often you wash your baby will depend on how premature he is and the condition of his skin. For most babies – whether premature or term – plain water is fine for the first few months of life. This includes at nappy changing – initially you should just use water and soft cotton wool.
Caring for dry skin
If your baby has dry skin, don’t use any kind of moisturising product without asking your healthcare team for advice. You can gradually start introducing gentle baby products and wipes as your baby becomes older and his skin more robust.
Top and tail: When you wash your baby, use only water. You don’t need to give him a bath every day, it is usually enough just to ‘top and tail’ – using cotton-wool balls soaked with tepid water to wash his bottom, face and neck.
Snuggle him dry: When your baby’s skin is wet he will become cold very easily. Each time he becomes damp and dries off, he loses some body heat. Always wash him in a warm, draught-free place, and have a towel close by to wrap him in and dry him afterwards.
Growth and development after prematurity
Premature birth can affect the way your child develops. Assessments from your healthcare team are crucial in ensuring that your baby gets the right care.
Watching your child develop can be one of the most fascinating aspects of parenthood. As your baby’s brain and body grow and their pathways gradually connect up, babies learn to smile, then crawl, walk, speak – and develop many other skills along the way. If you’re concerned that your baby may have health problems, the excitement you feel as you watch them develop may be mixed with worry.
Factors influencing your child’s development
Premature birth can affect the way your child develops, and the earlier your child was born, the higher the risks, so you need to keep an eye out for any area where you think there could be a delay. However, it’s all about striking a balance: every child develops in their own unique way.
Your baby’s development will depend on a range of factors, including:
- genetic make-up
- the environment
- influences around him.
Development milestones are based on averages. Not meeting given milestones is not just an issue for pre-term babies. Term babies sometimes do not meet development milestones either.
How their time in hospital can affect premature babies
There can be some delays in the development of motor skills among premature babies, partly due to treatments when they are small, such as being on a ventilator, although growing awareness of positioning techniques is helping to reduce this.
If a baby’s experiences in the unit prevents them from developing appropriate muscle tone, this can have a knock-on effect. For example, if they achieve sitting later than expected, this in turn can delay subsequent skills, such as hand function.
Delays appear to be becoming less common among babies with a birthweight of 1 to 1.5kg.
Prematurity and growth
Premature babies start small, and although they do tend to catch up as they get older, children born very prematurely still tend to be smaller and lighter than their classmates. However, as our knowledge of nutrition continues to develop, and with extra supplements available to support premature babies’ dietary needs, this may change.
As premature babies develop through childhood and adulthood, it becomes harder to know which of their traits and characteristics are a result of premature birth rather than other factors.
As your child was born prematurely, they will be considered in a high risk group for developmental problems and they are likely to have more assessments of their progress than a term baby would. This is routine, not because there is something wrong or there will be something wrong but because early detection and diagnosis of any potential problems are key to prevention.
Many low-birth weight babies and their families are invited to attend follow-up or neurodevelopmental clinics so that the healthcare team can assess the baby’s progress and intervene early where treatment is needed.
Where possible specialty services will be co-ordinated so that you do not have to attend many appointments. Follow-up visits will also be scheduled during the first years of their life.
As well as looking at how your baby is developing, the healthcare team will regularly check their weight, head circumference and height (also known as length) to make sure they is growing as expected.
Understanding your baby’s growth chart
You will be given a Personal Child Health Record, or ‘red book’, which has growth charts to help plot your baby’s growth and compare it with the average growth for their age. Babies born at less than 32 weeks are plotted in the low-birth weight chart. Babies born at 32-37 weeks are plotted in the preterm chart until two weeks after their estimated due date and from then on are plotted in the main charts, but with their gestationally corrected age.
How centile charts work
Babies’ progress is described in measurements that are called centiles because they relate to average percentages. The curves on the chart show the usual progression for a baby, as a baby’s weight will normally increase and level off at certain ages. So, for example, if your baby’s height is in the fifth centile for their age, that means that if you lined up 100 children in order of height, your child would be at number five, with a child at the 100th centile being the tallest. There are separate charts for girls and boys, as boys tend to be heavier.
The centiles for weight and height should usually be similar – if they are very different from each other, this may indicate that your baby is overweight or underweight, and your team may need to adjust the feeding regime.
Rather than ‘targets’ to be measured, it’s more helpful to view milestones as signals that some premature babies might need extra help. Throughout your child’s early life, the healthcare team will observe their development and measure their progress against milestones.
These are usually carefully worked out targets based on the average age at which children tend to develop certain skills. For example, 8-18 months is the average age when a child will start trying to walk on their own. The milestones have been designed to help professionals spot problems early. Remember that term babies may not meet development milestones either.
Early babies are given time to catch up
If your baby is born prematurely, their milestones will be assessed from the time of their due date, not from when they were actually born. By the age of two, their development will often even out with their peers, and you can use their actual birth date instead. In very premature babies, sometimes this is extended to three years of age.
Making progress, step by step
Going back to our example of the walking milestone, if your child doesn’t start walking at 10-18 months, this does not necessarily indicate a problem, and your child may well catch up later on. The healthcare team will flag it up anyway, and may refer you to a specialist, as in some cases it could be a sign that they could need some treatment or therapy to support their development.
Using milestones to your advantage
You can use milestones to your advantage in three ways:
- To encourage your baby’s development. For example, if you know that babies can start to roll over from about two months of age, you might notice them trying to flip themselves over and you can give them a helping hand
- To keep your baby safe. You will be less likely to leave your baby lying on a sofa if you know there is a chance they could roll and fall off
- To spot whether your little one could be falling behind. If there may be a problem in a particular area, you can seek advice more quickly.
Try to avoid comparing your child to others
It’s easy to become very focused on comparing your child with other children. Some parents find themselves thinking of milestones as ‘targets’ that indicate the success or failure of their child. Instead, try to see them as signals that can open doors for you if help is needed. Missing a milestone doesn’t necessarily mean that there’s any kind of problem.