Premature Birth

A premature birth is defined as one that occurs less than 37 weeks after conception. In the United States prematurity occurs in about 7 to 9 percent of pregnancies in white women and about 17 percent in black women. A presumptive reason (usually multiple pregnancy, maternal toxemia or hypertension, abnormal attachment of the placenta, or congenital malformation of the infant) can be found for 40 to 60 percent of premature births. Poor maternal health, hygiene, and nutrition increase the likelihood of prematurity; maternal accidents and acute illness are insignificant as causes. The chief specific causes of death among premature infants are respiratory disturbances, infections, and spontaneous hemorrhages, especially into the brain or lungs. With good care, about 85 percent of all live-born premature infants should survive; those of higher weight have a better chance.

Currently about 12 percent of newborns in the US are premature, and that figure is likely to continue to rise. As parents wait and watch they must learn to become a part of their babies' lives in unexpected ways, not only in traditional roles but as medical caregivers and supporters of each other in a team. Psychotherapist McDermott-Perez describes steps parents can take at every stage of the preemie experience, including preparing for the possibility a birth will be pre-term, coping strategies for immediately after the birth, understanding the needs of the "unfinished baby," dealing with the unexpected such as jealousy and going home alone, bonding, advocacy, taking the needs of others into consideration, self-empowerment, anxiety and the focus on the future, inspiration and hope, the role of the father, and what to do when all concerned are at the breaking point.( Lisa McDermott-Perez, 2007)

There are many things that affect the birth of babies before they are actually born into the mist of this world. While genetically, they are already different than any other baby even by the slightest bit, common everyday factors have the capability to alter these conditions and can make a change. These changes can be dramatic or slight, but this paper will describe the circumstances that cause the premature birth of infant.

Prematurity is to be distinguished from intrauterine growth retardation, in which weight and development are subnormal for fetal age. An estimated 1.5 to 2 percent of all babies are significantly below a birth weight proper to their fetal age. Deficiency of transplacental nutrition from various causes is frequently responsible. Other causes include fetal infections and some malformations. Generally, babies less than 5.5 pounds but carried for more than 37 weeks are considered growth-retarded rather than premature. (Khader YS, Ta’ani Q, 2005)

The outlook for babies born severely premature or at very low birth weights is now better understood and in many ways quite heartening, according to researchers at Case Western Reserve University School of Medicine and Rainbow Babies & Children's Hospital of University Hospitals of Cleveland (Ohio). The study followed 242 babies born between 1977 and 1979 weighing less than two pounds. The researchers assessed the level of education, cognitive and academic achievement, rates of chronic illness, and risk-taking behavior at 20 years of age (Child Health Research Project Special Report, (1999).

The young adults who had very low birth weight are more likely to have one or more chronic health problems, especially neurosensory conditions (cerebral palsy, blindness, or deafness), and are shorter than normal-weight babies. They also have lower IQs, score lower on academic achievement tests, and are less likely to have graduated from high school or have enrolled in a four-year college. However, 51% have IQ scores within the normal range; 74% have completed high school; and 41% are pursuing post-secondary education.

The most promising and surprising aspect of the findings is that these young adults are less likely to engage in risk-taking behavior, use alcohol or illicit drugs, engage in sexual activities, or become pregnant. "We believe that this limited risk-taking behavior may result from increased parental monitoring of very low-birth-weight children," suggests Maureen Hack, professor of pediatrics, Case Western Reserve University.

"What is unexpected is their relative success despite such difficulties. These are children who face substantial challenges, beginning very early in their schooling, because of cognitive and behavior problems," note Marie McCormick of Harvard School of Public Health and Douglas Richardson of Beth Israel Deaconess Medical Center. "The fact that they are almost as successful as the members of the normal-birth-weight comparison group in completing school and at least as successful in avoiding risk-taking behavior speaks to a resilience in these young persons and their families that needs to be examined further."

Some women who go into premature birth do so for unknown reasons. Other women may have a medical condition that contributes to early, such as:

• Ruptured amniotic sac. Normally, the fluid-filled sac that surrounds your baby in the womb ruptures during or just before begins. But sometimes the sac may rupture for no apparent reason weeks or even months before your due date. In that case, there's a high risk that will begin within a few days. A ruptured amniotic sac also increases the risk of infection for both you and your baby.
• Certain infections. Infections of the cervix or urinary tract are associated with premature birth rupture of the membranes and premature birth.
• Weak cervix. In a normal pregnancy, the cervix softens late in pregnancy and opens (dilates) in response to uterine contractions. But for some women, the cervix opens earlier — perhaps due to the weight of the baby and amniotic fluid. This problem can be associated with previous surgery involving the cervix, such as a dilation and curettage (D and C) or a cone biopsy. It's somewhat more likely to occur when you're pregnant with twins or other multiples.
• Certain chronic diseases. Diseases such as high blood pressure, diabetes, kidney disease and lupus may increase the risk of premature birth. If complications arise, may need to be induced early.
• Uterine abnormalities. An abnormally shaped uterus may increase the risk of premature birth.
• A previous premature delivery. Women who've had a premature delivery are at higher risk of premature birth. For many women, though, early labor happens only once, etc.

The required care for premature infants differs greatly depending on the child's gestational age, birth weight, and overall maturity. Measures common among extremely premature infants include:

• Placing the infant in a warmer or isolette. Premature infants are easily susceptible to cold-stress or hypothermia and infection, and preventing these is a key priority.
• Infants under 32 weeks typically do not produce enough surfactant in their lungs to enable them to breathe on their own. In these cases, surfactant will be administered to assist them.
• A breathing tube may be inserted in the infant's trachea, and a ventilator and supplemental oxygen may be used.
• Adequate nutrition, via a feeding tube or, in extremely premature infants, intravenously. If a feeding tube is used, expressed breast milk from the mother or a breastmilk bank can be used, which lowers the risk of infections such as necrotizing enterocolitis.

In a 2007 study, the heart drug nitroglycerin showed promise in stopping premature birth and reducing newborn illness. Nitroglycerin, which can be absorbed through the skin, is thought to prolong pregnancy by relaxing the smooth muscles of the uterus. Researchers suspect that it might improve blood flow to the uterus and placenta as well. It's important to note that other drugs to stop labor have had similar early findings, only to be disappointing in practice (Lisa McDermott-Perez, 2007). Additional studies are needed before nitroglycerin becomes a routine way to manage premature birth. However effective any medications might seem at first, they often stop labor only briefly perhaps long enough to accomplish other goals, such as transferring you to a facility better equipped to care for a premature baby or allowing use of other medications that have a beneficial effect on the baby.