Parenting Your Preemie (cont.)

  • Premature rupture of the membranes, also known as breaking your water, leading, then, to infection
  • There are some structural abnormalities in the uterus that can interfere with a growing fetus
  • Incompetent cervix, in which the opening to the uterus is weak and opens too early
  • Bleeding behind the placenta
  • Certain chronic conditions, such as diabetes, kidney disease, high blood pressure
  • Fetal distress

Mothers who have had previous premature births are at higher risk to deliver early, as are older mothers -- those over 35 -- and, very young mothers, those who are under 16 years old. Multiple births also have a much higher rate of premature birth.

But there is still so much mystery around the causes of premature birth and how to prevent it, that I think we will find out much more about it in the future and be able to avoid many early births.

How long does it take before a premature baby catches up to normal developmental milestones?

Usually parents are told to expect that it will take about two years for their child to catch up in development. For babies who were born very early, or who had multiple medical complications, it may take a little longer. But I think it is a lot more complicated than that.

There's really no reason to expect that your child should "catch up." He will never be the same age at his birthday as other full-term children are at their birthdays. He was born a number of weeks before he had finished developing. But as he grows older, the difference between his actual age, the age from his birthday, and what is called his adjusted age, which takes into account how early he was born, becomes less significant. There is a great difference between a 3-month-old and a 6-month-old, and not much between a 24-month-old and a 27-month-old. So the concept of "catching up" refers really to the fact that the differences become immeasurable.

In addition to catching up, one of the issues that makes preemie development unique is that it tends to be uneven, in that a preemie often develops quickly in terms of sensory skills, seeing, hearing, but their physical skills often lag behind. So when parents are told to adjust their expectations of their preemie's development based on how early they were born it is not a clear picture, because in one area your baby may be right on target for a particular skill, as if he or she had been born full-term, and in some cases he or she may even be ahead, and in others be lagging behind.

Many of those differences tend to smooth out by the time a child has reached the age of 2 to 2 1/2.

Is it true that ventilators can do more harm than good? I heard something about them scarring the lungs. If a child gets scarred lungs can a pediatrician see that kind of damage in her office?

First, I just want to make sure that you know I am speaking as a parent and not a physician, so you should always check with your doctor for medical information and for information on your particular child.

In general, ventilators and high oxygen levels can do damage to the lungs, and most nurseries use as low pressure as they can, and as low oxygen levels as the can, in order to avoid damaging the delicate lung tissue. Scarring in the lungs, if it occurs, can be seen on X-rays, and if your child does have scarring it's a good idea to keep a copy of the most recent X-ray that you have in case your child gets sick and has another X-ray. The doctors will then have another picture to compare it with.

As lungs grow they grow an enormous amount of new tissue. Scarring does not go away, but becomes a much smaller percentage of the overall lung tissue.

Even though many of the technologies that are used on our babies have potential risks, they also provide the support that is so necessary for their survival. So the fact that ventilators can cause scarring is a complicated issue.

"It's natural to worry during the first couple of years, but try to focus on all that you and your baby have accomplished, and enjoy all the things that he or she can now do."

Are the lungs the last thing to develop during pregnancy? Is that why the breathing is such an issue for preemies?

Yes, as I understand it, the lungs are one of the last organs to finish maturing before birth. Interestingly, when the body is threatening to deliver early it produces natural steroids that speed the development of the lungs and other organs. Doctors now mimic that natural process by giving mothers in early labor steroid shots to help the development.

My own son, who was born at 28 weeks, when his lungs should not have been anywhere near ready, only needed to be on a ventilator for one day. I had had the steroid shots and had also been in early labor for about a week before his birth. But it still seems like a miracle to me that he was able to breathe as well as he did.

Where can I buy preemie clothes?

Many stores now carry preemie-sized clothes. They are often still too big, since they are geared for 5 pounds and less, but if you go online and do a search on preemie clothing there are many online stores that sell preemie clothes today. Good luck.

Does that increased availability of preemie clothes mean preemie births are on the rise?

Yes, there are more preemie births today. There has been a general increase over the last 10 years or so. Part of that is driven by the increased use of assisted-reproduction technologies, which often result in multiple births, many of which are born early. As more older women deliver babies, more of them are also born early. Also, on the positive side, preemies are surviving and coming home healthy more than in the past. So there are more preemies that need clothes, and the market has responded.

Before we wrap up, Susan, do you have any final words for parents who are coming home with a preemie?

The important thing to realize when you bring your baby home is that the transition to home, which comes with great joy and relief, is also a stressful time. Preemies tend to be more difficult babies to care for, for a while. They need to eat small amounts often and they often don't sleep for long periods of time. Preemies often exhibit behavior that would be worrisome in a full-term baby, but is perfectly normal for a preemie.

You and your baby have already been through an exhausting ordeal. So give yourself time, let your friends help with grocery shopping or laundry, have a family member move in for a few weeks to provide an extra pair of hands, or hire extra help, if possible.

It's natural to worry during the first couple of years, but try to focus on all that you and your baby have accomplished, and enjoy all the things that he or she can now do. Serious problems usually show up within the first year and a half to two years, so if your baby is doing well at the end of that time, you probably don't need to worry about that other shoe dropping with some new totally unexpected problem.

Thanks to Susan Madden for sharing her expertise and experience with us. For more information, please read her book, The Preemie Parents' Companion .

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