What Every Expectant Parent Needs to Know About Premature Birth

A Conversation with Eduardo Bancalari, M.D.

Every year in the United States, about 1 in 10 babies is born prematurely before they complete 37 weeks of pregnancy, according to the Centers for Disease Control and Prevention. Due to their early birth, they miss out on critical growth and development that usually happens within the womb.

Luckily, advances in neonatal medicine enable neonatologists to help babies overcome the challenges of an early birth. This means more babies are not only surviving preterm birth but thriving with great outcomes that allow them to lead healthy, fulfilling lives into adulthood.

November is Prematurity Awareness Month, and doctors like Eduardo Bancalari M.D., Chief of Newborn Service at Holtz Children's Hospital, are raising awareness about the consequences of preterm birth. He took some time to answer questions about known causes for premature birth, advances in the field, and what all expecting parents should consider when choosing a hospital for their delivery.

What are some of the most common causes of preterm birth?

A large percentage of premature births happen without any clear reason, and that makes this issue important for everyone to pay attention to but also more challenging for us to tackle. Not knowing what causes premature labor and birth makes it much harder to develop strategies to prevent it.

Having said that, there are clearly some things that can trigger or are associated with higher rates of preterm birth. For example, a mother who has had one preterm birth is at a higher risk of delivering early again during future pregnancies. There is some evidence that babies born prematurely also have a higher risk of delivering a child prematurely. At Jackson, we have treated babies in our neonatal intensive care unit (NICU) decades ago and later have that woman with a premature infant in our NICU.

There can be some environmental, genetic, and other factors that seem to contribute to premature births, but we just do not fully understand all the factors and how they play a role yet. For example, those living in poverty tend to have a higher rate of premature birth.

When it comes to clearly associated maternal diseases that can lead to premature birth, one of the most common is preeclampsia. Hypertension is more common among Blacks and Hispanics, which can explain why certain ethnic groups have a higher rate of premature birth.

Other known causes of premature birth include infections - both maternal and fetal infection - and an incompetent cervix, or weak cervical tissue that leads to an early birth.

What is the experience like for mom and baby when a baby is born prematurely?

The gestation of the baby or how far along they are in the pregnancy when they are born will play a big role in the number of complications the baby may face.

For example, a baby born at 24 weeks will face significantly more challenges than a baby born at 34 weeks, who had more time to grow and develop.

When a baby is born prematurely, there are many complications or risks we need to watch out for.

When dealing with a baby born before 28 weeks gestation, they have incomplete development of the lungs and respiratory system and frequently need respiratory support. Other organ systems like the gastrointestinal may also not be fully functional, so we commonly need to supply nutrition intravenously.

Many premature babies also have a hard time maintaining their body temperature, which can lead to hypothermia. This is why we place them immediately in an incubator.

Babies born early also have a compromised immune system that puts them at a higher risk of infection, and because they are ill and often require lines in their veins, they have an increased risk of infection. Therefore, we have very strict protocols and special precautions in the NICU with handwashing, limited visitors, the use of gowns, etc. We do everything possible to minimize the risk of infections - which can both be much more common for these infants and also much more devastating.

How long do babies born prematurely generally stay in the NICU?

Generally, we tell parents that if all goes well and there are no or minimal complications, a baby will require as many weeks in the hospital as they are missing from their gestation. For example, a baby born at 28 weeks will be in the hospital for about 9-12 weeks, or until the time they were expected to be born.

Since every woman has a risk of experiencing premature labor, what do you encourage every expecting mom to do to ensure the best possible outcome for their infant?

In all states where perinatal care is more developed, mothers should deliver at a hospital that has a Level 3 or 4 NICU because these centers can deliver the highest level of care.

Many excellent studies have found that not only the possibility for survival but the quality of the survivor improved tremendously when premature babies are born in a hospital with a Level 3 or 4 NICU. This is critical because being born in a hospital with that level of care allows the infant to get all of the support and care from the first minutes of life, which is not possible if a baby has to be transferred to another center after delivery.

Delivering in a hospital with a high level of perinatal care also means that the baby starts getting care through maternal care. There are some medications and interventions that can be provided before and during delivery to help minimize risks when a baby is being born prematurely.

What are some of the misconceptions about the care of premature babies?

I think a lot of people do not realize how far we have come in the field of neonatology. Many people still believe that a baby born prematurely will always have long-term health and/or neurological issues. While it is true the risk is higher for a premature baby to have more complications compared to a full-term infant, a vast majority of these babies survive - even when born at very early gestation, and they go on to live perfectly happy and normal lives.

There have been many studies now that have evaluated the perceptions that ex premature infants have about themselves later in life. Their responses are consistently much more positive than what physicians were expecting.

Overall, the view today is much more optimistic than it used to be. Every year, we welcome new discoveries that allow us to further improve our care and the outcomes for premature infants.

Eduardo Bancalari, M.D. is chief of the Division of Neonatology and Newborn Service at Holtz Children's Hospital. He is also an Emeritus Professor of Pediatrics at the University of Miami Leonard M. Miller School of Medicine.

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