This topic is for people who want to know what to expect when a baby is born early. For information about early labor, its causes, and its treatment, see the topic Preterm Labor.
Pregnancy normally lasts about 40 weeks. A baby born 3 or more weeks early is premature. Babies who are born closer to their due dates tend to have fewer problems than babies born earlier. But even those who are born late preterm (closer to 37 weeks) are at risk for problems.
Doctors and nurses often call premature babies "preemies."
Having a premature baby may be stressful and scary. To get through it, you and your partner must take good care of yourselves and each other. It may help to talk to a spiritual advisor, counselor, or social worker. You may be able to find a support group of other parents who are going through the same thing.
When a baby is born too early, his or her major organs are not fully formed. This can cause health problems.
Premature birth can be caused by a problem with the fetus, the mother, or both. Often the cause is never known. The most common causes include:
Premature babies who are moved to the neonatal intensive care unit (NICU) are watched closely for infections and changes in breathing and heart rate. Until they can maintain their body heat, they are kept warm in special beds called isolettes.
They are usually tube-fed or fed through a vein (intravenously), depending on their condition. Tube-feeding lasts until a baby is able to breathe, suck, and swallow and can take all feedings by breast or bottle.
Sick and very premature infants need special treatment, depending on what medical problems they have. Those who need help breathing are aided by an oxygen tube or a machine, called a ventilator, that moves air in and out of the lungs. Some babies need medicine. A few need surgery.
Breast milk gives your baby extra protection from infection. You can pump breast milk and bring it to the hospital for your baby.
NICU (say "NIK-yoo") nurses can teach you things you'll need to do at home to help your baby.
Before the birth, it is hard to predict how healthy a premature baby will be. Most premature babies don't develop serious disabilities. But the earlier a baby is born, the higher the chances of problems. Work together with your doctor and other health providers to closely watch your baby's development and try to catch any problems early on.
When you're at home, don't be surprised if your baby sleeps for shorter periods of time than you expect. Premature babies are not often awake for more than brief periods. But they wake up more often than other babies. Because your baby is awake for only short periods, it may seem like a long time before he or she responds to you.
Premature babies get sick more easily than full-term infants. So it's important to keep your baby away from sick family members and friends. Make sure your baby gets regular checkups and shots to protect against serious illness. Be current on your immunizations and ask other people who will be near your baby to be immunized too.
Sudden infant death syndrome (SIDS) is more common among premature babies. So make sure your baby goes to sleep on his or her back. This lowers the chance of SIDS.
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A premature delivery may happen suddenly or after days or weeks of waiting and worrying. If you know you may deliver early, you, your partner, and your doctor can prepare for a premature birth.
You and your premature infant (preemie) are considered high-risk during preterm labor. This means that you will have less freedom, both to make birth-related decisions and to move about freely. You can expect the following:
As soon as the umbilical cord is cut, the neonatal staff will watch over and stabilize your infant. If your infant is less than 36 weeks' gestation at birth, they may move him or her to the neonatal intensive care unit (NICU) for observation and specialized care. If you deliver in a hospital that has no NICU, your infant may need to be taken to another hospital.
During the first hours and days, your infant will adjust to living outside of the maternal "life-support system." This is a time when birth defects and complications of prematurity often become apparent.
If your infant is born between 22 and 25 completed weeks of pregnancy (extreme prematurity), you likely will be faced with some difficult decisions during the first month after the birth. These personal stories may help you make your decision.
While the neonatal staff attends to your infant, the obstetric staff will care for you. Depending on your condition, this will take at least a few hours. Meanwhile, your birth partner may want to go with your infant to the NICU.
Before your breast milk comes in (3 or 4 days after childbirth), you will be asked to decide whether you plan to breastfeed or bottle-feed your premature infant. Formula does not give your infant added protection from early infection, so strongly consider pumping milk for your infant for at least the first weeks of life. If you decide to breastfeed, expect at first to pump milk for feedings until your infant is mature enough to feed orally.
Your hospital's lactation consultant can be very helpful with pumping and breastfeeding questions and problems, both before and after the birth.
If your premature infant is moved to the neonatal intensive care unit (NICU), you may become overwhelmed with new emotions and information. You and your loved ones may handle issues and feelings differently, and it may create a strain on your relationships.
Thinking of yourself and your relationships may not be easy when you are under a lot of stress. But your child or children depend on you to be physically and emotionally able to care for them.
Take a quiet moment and focus on yourself. Ask yourself, "How am I doing? What do I need right now?" Try to take time to get enough rest, food, exercise, and fresh air and sunlight. Do you have someone you can talk to: a partner, friend, parent, spiritual advisor, or counselor? If any of these basic needs aren't being met, make them a top priority.
A premature infant's health at birth is influenced by many things, including:
Most infants born at 36 and 37 weeks' gestation are mature enough to be discharged from the hospital with the mother. But many premature infants need care in the neonatal intensive care unit (NICU). Hospital care will be needed for:
Many premature infants are resilient and surprise everyone by overcoming great odds. Expect that your infant can progress for several days but may then have a medical setback.
Premature infants are more likely than others to get an infection. And organs that have not had time to mature can cause a number of problems.
The more premature a newborn is, the greater is the baby's risk of having medical problems.
Infants born at 23 to 26 weeks' gestation are extremely underdeveloped and have a much higher risk of death or disability. Parents of these infants are likely to be faced with difficult medical decisions. Infants who have reached their 32nd week of development before birth are less at risk than those who are born earlier.
Babies born at 34 to almost 37 weeks' gestation are called late preterm infants. Although they are not as likely to have as many problems as infants who are born earlier, they are at risk for breathing problems, high blood pressure in the lungs, and other short-term and long-term problems.
If your premature infant (preemie) is admitted to the neonatal intensive care unit (NICU) after birth, you will find out about new technologies, new medical words, and new rules and procedures.
You will depend on the NICU staff members, including neonatologists and nurses, to know how to care for your infant and to be your teachers. With their help, you can quickly learn about your infant's needs and what you can do for your infant. Throughout your infant's stay in the NICU, you will want to keep open communication with the staff.
First you'll learn to scrub up before visiting your infant's bedside. When you're there, you may be surprised by the number of machines and instruments surrounding your child. Remember that because of these machines your premature infant has a much greater chance of doing well than ever before.
At a minimum, your infant will be warmed and watched over with equipment that includes:
If your infant has additional medical needs, other tests and equipment also may be used, including:
At first sight, you may question whether and even how to touch your tiny infant. Unless your newborn is very sick or immature, you will be allowed to touch and possibly hold him or her. But your infant's nurse or doctor will first need to show you how to work around the technology and to alert you to your infant's special needs. When visiting with your premature newborn, remember that:
If you're not able to hold or help your infant, you can give him or her an immunity boost by providing breast milk. Regardless of whether you plan to breastfeed or bottle-feed later on, pumped breast milk for tube-feeding reduces your infant's risk of infection.
As your infant grows stronger, you will be able to take on more caregiving tasks. These range from holding and feeding to changing diapers and bathing. You can count on the NICU nurses to teach you and answer your questions. If you are breastfeeding, you may be asked to spend the night with your infant to find out if he or she is strong enough to nurse around the clock.
Your premature infant is considered ready to go home when he or she is able to:
Some infants are ready to go home as early as 5 weeks before their due date. Other infants, usually those who have had medical problems, may be sent home later.
As your infant's discharge from the hospital approaches, you may feel excitement, impatience, and a new kind of anxiety. Responsibility for your infant's care, which has so recently required lots of technology and medical training, is now being transferred to you. You can best prepare yourself by learning:
You will also want to:
If home-based health care and support are available to you, take advantage of them. Home-based services spare you and your infant the physical and emotional stress of traveling to numerous appointments.
As you and your premature infant adjust to being at home, you will gradually establish a routine together. During the first weeks at home, consider these important points:
Age is both a measure of time and a marker of development. Unlike with a full-term infant, a premature infant's age and development can be defined in different ways. This can be confusing. When following your premature infant's growth and development, it can be helpful to know the difference between the following "ages":
During your child's first 2 years of life, he or she will appear to be developmentally behind full-term children of the same age. But you can expect your infant and young child to achieve the same sequence of developmental milestones as any other child.
Expect that your premature infant's "lag" in development will catch up at about age 2. As your child grows into the preschool years, a 2- to 4-month difference in age or development blends right in among a group of preschoolers. For more information about preschoolers, see the topic Growth and Development, Ages 2 to 5 Years.
As your child begins formal schooling, be alert for signs of learning problems. Learning, reading, and math disabilities due to prematurity may first become apparent during the early school years.
- Fierson WM, et al. (2018). Screening examination of premature infants for retinopathy of prematurity. Pediatrics, 142(6): e20183061. DOI: 10.1542/peds.2018-3061. Accessed January 4, 2019.
Other Works Consulted
- American College of Obstetricians and Gynecologists (2008, reaffirmed 2010). Late-preterm infants. ACOG Committee Opinion No. 404. Obstetrics and Gynecology, 111(4): 1029–1032.
- Brazelton TB (2006). Prematurity. In Touchpoints, Birth to Three: Your Child's Emotional and Behavioral Development, 2nd ed., pp. 351–356. Cambridge, MA: Da Capo Press.
- Committee on Fetus and Newborn, American Academy of Pediatrics (2007, reaffirmed 2010). Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics, 119(2): 401–403. Also available online: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;119/2/401.pdf.
- Cunningham FG, et al. (2010). Diseases and injuries of the fetus and newborn. In Williams Obstetrics, 23rd ed., pp. 605–643. New York: McGraw-Hill.
- Engle WA, et al. (2007, reaffirmed 2010). "Late-preterm" infants: A population at risk. Pediatrics, 120(6): 1390–1401.
- Gaude AB, Martin RJ (2012). Control of breathing. In CA Gleason, SU Devaskar, eds., Avery's Diseases of the Newborn, 9th ed., pp. 584–597. Philadelphia: Saunders.
- Mohan SS, Jain L (2012). Care of the late preterm infant. In CA Gleason, SU Devaskar, eds., Avery's Diseases of the Newborn, 9th ed., pp. 405–416. Philadelphia: Saunders.
- Pignotti MS, Donzelli G (2008). Perinatal care at the threshold of viability: An international comparison of practical guidelines for the treatment of extremely preterm births. Pediatrics, 121(1): e193–e198.
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