Common Health Issues of Premature Babies by Dr Lathiesh Kumar Kambham

• If the birth occurs between 34-36 weeks of gestation, it is called late preterm birth.
• Babies born between 32-34 weeks of pregnancy are of moderately preterm birth.
• Very preterm births occur between 25-32 weeks of pregnancy.
• Babies born even before 25 weeks of pregnancy come under extremely preterm babies. Such babies require careful medical intervention.

List of Top 6 Common Health Issues of Premature Babies

We have listed a few specific problems that occur with premature birth, their causes, and prevention.

Broadly, the common health issues of premature babies can be classified into problems related to lungs, heart, eyes, liver, and brain. There can be some additional issues too, all of which are listed below in detail.

1. Problems Related to Lungs

Premature babies face problems related to their lungs in their neonatal period. Proper medical intervention can help cure the problem. The two most common problems related to lungs in preterm babies are Respiratory Distress Syndrome and Bronchopulmonary Dysplasia.

a) Respiratory Distress Syndrome in Premature Babies

RDS is the most common problem affecting premature babies born before 32 weeks of pregnancy. A typical and healthy lung functioning requires the presence of a pulmonary surfactant.

A pulmonary surfactant

• Aids in the required expansion of lungs and thorax during respiration
• Helps avoid drying of airways and
• Regulates the size of alveoli.

The deficiency of pulmonary surfactant is the main reason for RDS in premature babies.

RDS results in respiratory distress in premature babies, it may also be seen in post-term babies. Respiratory distress occurs because of the immaturity of the lungs, and it becomes difficult for the baby to breathe.

The symptoms of Respiratory distress are

• Grunting (audible grunting sounds)
• Nasal flaring
• Retractions in the skin middle of the neck (suprasternal retractions)
• Apnea

These symptoms can be seen within 24 hours of birth.

Causes RDS in Premature Babies

Possible causes of respiratory distress syndrome and respiratory distress include

• Lack of pulmonary surfactant is the prime cause of respiratory distress syndrome.
• Premature birth causes respiratory distress in neonates.
• Very low birth weight.
• Tracheal, pulmonary, and other heart diseases that may lead to respiratory distress in preterm babies.
• Certain conditions related to gestation periods like diabetes and pregnancy-induced hypertension may also cause respiratory distress in babies.

How Can You Prevent RDS in Babies?

Here is how doctors can work on preventing RDS in babies.

• If the doctors expect a very low birth weight of neonates during birth, they may incur Constant Positive Airway Pressure to avoid obstructions in breathing.
• Administering CPAP for premature babies can help reduce the probability of ventilator usage in babies with RDS.
• An artificial surfactant is administered to reduce the risk of respiratory distress.
• Preterm neonates with RDS are treated by keeping them on mechanical ventilation in severe cases.
• Regular checks and monitoring of the levels of oxygen can also help manage RDS in premature infants.

b) Bronchopulmonary Dysplasia in Preterm Infants

Bronchopulmonary dysplasia is a chronic lung condition seen in preterm infants. It is a side effect of prolonged assisted respiratory treatments in infants. It is commonly seen in premature babies and babies with very low birth weight. Bronchopulmonary Dysplasia is a problem that arises in almost all premature babies with aggressive ventilation support. It is a chronic condition because treatment for BPD may prolong until the lungs are mature enough.

Causes Bronchopulmonary Dysplasia in Babies

Bronchopulmonary dysplasia is caused due to the following reasons

• Premature birth and low birth weight
• Exposure of immature lungs to high concentrations of oxygen
• Treating for primary lung disorders
• Aggressive breathing support (ventilator)

How Can You Prevent Bronchopulmonary Dysplasia in Babies?

Prevention lies in avoiding premature births and other medical interventions like the probable omission of ventilator usage by administering CPAP for premature children with Respiratory Distress Syndrome.

Parenteral (administering required nutrition through veins) nutrition for babies in NICU may also help reduce the chances of developing BronchoPulmonary Dysplasia in premature infants.

2. Problems Related to Heart

Premature babies, along with immature lung development, also face cardiac problems.
However, proper treatment and care can help them get over this trouble. Two such problems related to the heart in premature babies are Apnea and Bradycardia.

a) Apnea in Premature Babies

Apnea or apnea of prematurity (AOP) is a kind of problem in which the breathing of a premature baby stops for a maximum of 20 seconds. This condition is associated with the immaturity of respiratory control in premature babies. Apnea can also be a symptom of an underlying disease in premature babies. Chances of developing apnea are higher in extremely preterm babies (less than 28 weeks of gestation).

This condition of Apnea is also described as the failure in chemoreceptors (sensors that control respiration in the brain stem) functioning because of their immaturity. Apnea in premature babies is diagnosed within one or two days after the birth, and it happens in sleep. Apnea of Prematurity slowly regresses as the baby grows. If apnea persists for a longer period, then it may be an indication of other underlying causes like neurological, pulmonary, cardiac, gastrointestinal issues, and other infections.

What Causes Apnea of Prematurity?

Apnea of prematurity is caused due to

• Premature birth
• Immaturity of the brain stem to process respiration. (central apnea)
• Obstruction in airways. (obstructive apnea)
• Prolonged apnea in babies can be due to other underlying causes like infections and blood-related problems.

How to Prevent Apnea of Prematurity?

To prevent apnea, doctors may take controlled care of the premature infant in the NICU, like the positioning of the head and neck, continuous monitoring of oxygen saturation, and temperature maintenance in the incubator.

Surfactant replacement therapy can also help reduce the chances of apnea occurring in premature infants.

Preventing AoP and apnea in infants depends on the diagnosis of the underlying secondary causes. Doctors may conduct investigations like blood count, ultrasound, and tests for infections and treat the infant based on the result.

[Read : Sleep Apnea in Babies]

b) Bradycardia in Premature Babies

Bradycardia is majorly associated with Apnea of Prematurity. Because of prematurity, and an underdeveloped central nervous system, the coordination between the lungs and the brain (chemoreceptors) is poor, and hence the baby stops breathing for a few seconds (apnea).

This leads to a decrease in heart rate, which is called Bradycardia. A lower heart rate (100 beats per minute) than the usual 120-160 beats in premature babies is considered Bradycardia. Apnea and Bradycardia are called As and Bs, which eventually regress as the baby grows.

Causes of Bradycardia in Premature Babies

Bradycardia is caused due to

• Preterm birth, and very low birth weight.
• Bradycardia is also caused due to the presence of central and obstructive apnea, where both are associated with poor brain stem signalling for the lungs to breathe.
• Oxygen desaturation.

How to Prevent Bradycardia in Premature Babies?

Preventing bradycardia completely depends on ruling out other premature health conditions like apnea, RDS, and infections.

• Maintaining blood SpO2 may help manage bradycardia in premature babies.
• Providing the baby with proper respiratory support, and monitoring respiratory rates and heart rates can help manage the situation.

3. Problems Related to Eyes

Because of the underdeveloped nervous system, premature babies may also face problems related to the eyes. A specific diagnosis called Retinopathy of Prematurity is a commonly noticed problem in infants born before the 32nd week of gestation period.

a) Retinopathy of Prematurity in Premature Infants

Retinopathy of prematurity is a problem related to the eyes in premature infants. It is a retinal condition that multiplies in the blood vessels. This occurs in infants born before the 32nd week of gestation. A minor degree of ROP is seen in almost all premature babies but can regress on its own and it does not result in further concerned conditions. But, some may turn serious and require proper attention and treatment. ROP in some cases can potentially lead to blindness and can result in visually handicapped children.

Causes of Retinopathy of Prematurity in Babies

Retinopathy of prematurity is caused due to

• Premature births
• Prolonged NICU treatments for unstable premature babies.
• Persistent oxygen therapy may result in ROP in infants with prematurity.
• Higher levels of saturated oxygen in the blood may also lead to ROP in premature infants.

How to Prevent Retinopathy of Prematurity in Babies?

Prevention and treatment of Retinopathy of Prematurity depend on its type. There are two types of ROPs, type 1 and type 2 and these are classified based on the location, extent, severity, and the presence of plus disease in the eyes.

Plus disease refers to the presence of high level of vascular (blood vessels) abnormality (dilation and tortuosity). The severity of ROP can be decided based on the presence and absence of plus disease in infants.

ROPs till stages 1,2 and 3 may not require surgical intervention, while stages 4 and 5 may need surgeries. The presence of the plus disease may increase the urgent requirement of treatment for ROP in premature babies.

Surgical procedures for ROP include cryotherapy and laser treatments. However, avoiding premature births and proper oxygen usage while treating a baby may reduce the risk of contracting ROPs in babies.

[Read : Premature Baby And Eye Problems]

4. Problems Related to Liver

The liver is a vital organ that helps in breaking down bilirubin. Breakdown of bilirubin aids in proper metabolism by balancing the body’s vital activities. An infant’s liver is immature and may sometimes have trouble breaking down the bilirubin which results in jaundice. However, a premature baby’s liver is even more immature and does not function properly, often leading to jaundice.

a) Jaundice in Premature Babies

This is a common problem faced by premature babies and many full-term babies. Jaundice is caused due to the inability of the liver to break down bilirubin. It may lead to sickness and skin discoloration. Severe and undiagnosed jaundice may also lead to problems related to the brain. Neonatal jaundice can be diagnosed by looking at the baby’s skin and eyes. Deep yellow-colored skin and eyes are the characteristic symptoms of jaundice in premature babies.

Causes of Jaundice in Premature Babies

Jaundice in premature babies is caused due to

• Immature liver functioning.
• Blood group incompatibility between the mother and the baby.
• A rapid breakdown of red blood cells or hemolysis
• A condition called hemolytic anemia can contribute to the occurrence of jaundice in premature neonates.

How Can You Prevent Jaundice in Premature Babies?

Prevention of jaundice lies in proper hydration and breastfeeding. The liver functioning of an infant improves as they begin to grow and they can outgrow mild levels of jaundice successfully.

However, severe jaundice and jaundice in premature babies require treatments like phototherapy where a particular wavelength of light is used to break down the bilirubin levels in premature babies.

[Read : Jaundice in Newborn Babies]

5. Problems Related to Brain

Premature babies are at a higher risk of developing neurological problems, and developmental and other behavioral issues. Two of such common brain-related problems that we have discussed are Social and behavioral issues and Neurological problems.

a) Social and Behavioral Issues in Premature Babies

These come under the long-term health effects of premature babies, and may affect their skills in interaction, and self-control, and shorten their attention span. Extremely preterm babies may also exhibit symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). Sadly, such issues can be the result of the health complications that come with premature birth.

Causes of Social and Behavioral Problems in Premature Babies

The reasons behind social and behavioral issues in premature babies are

• Premature birth.
• Brain injuries like bleeding in extremely preterm babies.
• Chronic lung complications due to premature birth.
• Severe jaundice.

How Can You Prevent Social and Behavioral Problems in Preterm Babies?

Social and behavioral issues of premature children can be controlled by providing a comforting environment at home.

b) Neurological Problems in Preterm Babies

Preterm babies may also suffer neurological problems later in life. These can be the result of an underdeveloped nervous system and other extensive and prolonged respiratory treatments after birth. Neurological disorders include

• Intraventricular hemorrhage seen in babies less than 3 pounds.
• Periventricular leukomalacia, another neurological disorder associated with prematurity. It potentially causes weak muscles.
• Cerebral Palsy, a condition associated with prematurity affecting the coordination of muscles.

Causes of Neurological Problems in Premature Babies

Neurological problems in premature babies are caused due to

• Very low birth weight
• Extensive and aggressive respiratory treatments
• Severe jaundice in infancy

How Can You Prevent Neurological Problems in Premature Babies?

Preventing neurological problems for a preterm baby depends on the early diagnosis of primary health issues which trigger this. However, preterm birth can not be controlled and so the problems that follow it.

6. Other Prematurity Problems

There are other issues that premature birth can cause. Some of them are like

a) Temperature Regulation

Premature babies’ brains are not completely developed to control their body temperatures according to the environment. Their body temperature behaves irregularly which affects their metabolism. Hence, preterm babies are kept in incubators under controlled temperature. Incubators are made to maintain apt temperature control that is required for a human body.

b) Anemia

The placenta transports iron from the maternal blood circulation to the fetus. A premature baby is born before receiving enough blood from the mother. This results in anemia in premature babies. Anemia occurs due to incomplete fetal erythropoiesis in premature babies. Since premature babies are deprived of iron in their bodies, they may require supplements as a treatment for iron deficiency.

c) Intestinal Issues

A preterm baby’s intestines are not fully developed to digest breastmilk. However, small amounts of breastmilk is required for the baby during their first month to avoid Necrotizing Enterocolitis, a condition that leads to a decrease in blood supply resulting in the death of body tissues. Doctors may send the nutrition through the Peripherally Inserted Central Catheter (PICC) if the baby is not able to consume the milk orally.

d) Immunity Issues

Due to their low immunity, preterm babies are at high risk of catching infections. Hence, they are kept in a non-infective environment in the hospital. It is very important to keep the environment infection free for a preterm baby after discharge.

e) Long Term Problems

With that continuous respiratory support and other treatments, most preterm babies make it through the tough phase and continue to live healthy infancy after reaching their gestational age. But, even after beating all the odds, some preterm babies may also encounter other health problems.

f) Partial or Full Hearing Loss and Vision Problems

Premature babies tend to develop hearing issues later in life. Most hearing problems are diagnosed during the early stages of birth, while some get diagnosed later. Before discharge, doctors conduct a screening test for the baby to ensure there is no problem. A particular test called Brainstem Evoked Responses is performed for babies at the age of 3 months. A late-diagnosed hearing problem tends to persist for a lifetime and may also require a hearing aid.

Preterm babies may also encounter vision problems later in their lives. Some of them may require glasses to correct their refractive eye problems at a very early age.

Premature birth can be a difficult phase for the baby, yet survivable. Most babies get tough and cross the phase to live a healthy life. However, it is important to note that common health issues of premature babies should not be overlooked. A regular follow-up with your doctor can help the baby avoid unwanted developmental and growth issues.

FAQ’s

1. What is the Most Common Health Issue of a Premature Baby?

Premature babies majorly face issues related to the respiratory system. Problems like RDS (respiratory distress syndrome) may result in secondary health issues like bronchopulmonary dysplasia, apnea, and bradycardia.

2. Do Premature Babies Have Health Problems in Later Life?

Premature babies are at higher risk of encountering developmental and growth issues than their peers. However, extreme delay in development is very uncommon, and in most cases, you cannot differentiate between premature babies and normal full-term babies in growth aspects.

3. Are Premature Babies More Likely to Have Autism?

When compared to full-term babies, premature babies are at higher risk of having autism because of the neurological issues they face.

Read Also: Breastfeeding A Premature Baby