What Are the Long-term Problems for Premature Babies?
Author: Dr. Anna Kaplan
Getting through the weeks to months after a premature delivery is difficult for both the parents and the baby. The care of preemies is so good in high level Neonatal Intensive Care Units (NICUs) that at least 90% of babies born at 28 weeks survive. In order to do so, babies need sophisticated medical care. A very-early preterm baby may be obviously sick, needing breathing support and tube feeding, and may sustain brain and lung damage. An older preemie may have much less in the way of visible problems. However, many premature babies have at least some behavior or learning difficulties as they get older.
Preterm babies need to be cared for in a NICU. Very-early preterm babies should be in high level NICUs, and are often transferred to hospitals prepared to care for them properly.
There are a number of specific medical problems that can be caused by being born prematurely. These usually occur during the hospital stay, but there may be residual illness or damage. Babies born before 32 weeks are the most at risk for later health problems.
Acute medical problems can lead to other problems when the children are older. Some of the more serious conditions related to prematurity include:
- Respiratory Distress Syndrome (RDS). Preemies less than 34 weeks of gestational age usually have RDS, which occurs because the baby's lungs have not had time to develop. It is treated with a medicine called surfactant, oxygen, and sometimes a ventilator.
- Apnea. Apnea means that the baby stops breathing for 20 seconds or more. Preemies are monitored, and an alarm goes off, telling the nurse to stimulate the baby to breathe.
- Intraventricular hemorrhage (IVH). IVH is bleeding into the brain. Preemies born before 32 weeks are the most at risk. The bleeding resolves most of the time. However, some kinds of bleeding can damage the substance of the brain. This can lead to cerebral palsy, mental retardation, learning and behavior problems.
- Patent ductus arteriosus (PDA). The ductus arteriosus is how blood bypasses the lungs of the baby in the womb. It closes after birth so that the blood can go to the lungs to get oxygen. Failure of the ductus to close can lead to heart failure. PDA is usually treated with medicines to help close it. Occasionally surgery is necessary.
- Necrotizing enterocolitis: Necrotizing enterocolitis, which is a very serious infection of the intestine, usually comes on later, 2 to 3 weeks after birth. Treatment includes antibiotics and intravenous feeding to let the bowel heal. If it doesn't, surgery is needed to remove the affected part of the bowel.
- Retinopathy of prematurity (ROP). ROP is an abnormal growth of blood vessels in the back of the eyes, usually in babies born before 32 weeks. Sometimes this resolves by itself. It can be treated using a laser or cryotherapy (freezing).
- Bronchopulmonary dysplasia. BPD is a chronic lung disease of preemies who needed a lot of extra oxygen as the result of RDS. Babies who still need supplemental oxygen at 36 weeks (the total of weeks in the womb plus the weeks after birth) can wind up with lung damage. BPD can be treated with medications. If it is severe, the baby may need a ventilator. BPD usually improves over the first 2 years, but some children have a persistent disease resembling asthma.
A study of all premature babies born in Norway between 1967 and 1983 revealed a lot of information about their long-term prospects. These children were followed from 20 to 36 years. Data was gathered from over 900,000 premature infants, looking at their situation in adulthood. This table displays percent of those affected, by age at birth.
| Weeks at birth | cerebral palsy | mental retardation | schizophrenia | autism spectrum | psych. disorders | Other major disabilities |
| 23 to <28 | 9.1% | 4.4% | 0.6% | 0.6% | 2.5% | 4.1% |
| 28 to <31 | 6.0% | 1.8% | 0.1% | 0.4% | 0.7% | 2.2% |
| 31 to <34 | 1.9% | 1.0% | 0.2% | 0.05% | 0.3% | 0.5% |
| 34 to <37 | 0.3% | 0.7% | 0.2% | 0.03% | 0.3% | 0.3% |
| 37 weeks or more | 0.1% | 0.4% | 0.1% | 0.05% | 0.2% | 0.2% |
The other major disabilities include blindness or decreased visual acuity, hearing loss, and epilepsy. The psychological disorders include problems with development, behavior and emotional control.
In addition, 10.6% of the earliest preterm infants grew up to have a medical disability that severely affected their ability to work. This declined to 2.4% in the infants born at 34 to <37 weeks, with the others in between.
Despite whatever disabilities the children had to deal with, 67.7% of the youngest preterm infants grew up and finished high school. 25.1% finished college, and 4.6% received a postgraduate degree (compared with 7% of those born at 37 weeks or greater).
Clearly many preterm babies grow up with few disabilities. This is mainly related to the gestational age at which they were born, as well as the care they received in the hospital and what acute complications they had at the time.
It is also clear that there are those who need help throughout their lives. Current data from the United States indicates that 50% of the preemies born at less than 28 weeks have some sort of learning and behavioral problems as they grow up. Parents and educators are taught how to help these children.
Nonetheless, this should give parents of preterm babies hope, because many of the youngest and sickest children can still go on to have a good quality of life. It should also help to get an idea of the possible range of problems a premature baby will have as he or she grows, and what parents may have to handle. Studies on children born now would be expected to show even better outcomes, because the care of preterm infants has improved greatly since 1967.
