Prematurity and High-Risk Infants
Top Contributors - Robin Tacchetti, Jess Bell and Ewa Jaraczewska
Introduction
"Preterm birth is defined as birth before 37 weeks of gestation."[1]
There are an estimated 15 million preterm births every year and prematurity is considered a significant healthcare problem.[2][3] Preterm births are categorised by gestational period:[4]
- extremely preterm (< 28 weeks)
- very preterm (28–32 weeks)
- moderate to late preterm (32–36 weeks)
Risk of Preterm Birth
Preterm infants are at an increased risk for neurodevelopmental disorders and delayed growth.[5] Neurological sequelae associated with prematurity include cerebral palsy and delayed neurodevelopment.[6] The rate of neurodevelopment and growth in preterm infants can be affected by:
- gestational age
- birth weight
- length of hospitisation
- Apgar score
- cardiopulmonary resuscitation (CPR)
- ventilation
- breastfeeding[6]
Infants born at an earlier gestational age have a higher risk of complex medical conditions, recurrent hospitisations and neurodevelopmental impairments. Developmental delays and chronic diseases that result from preterm birth may persist into adulthood and, consequently, have a heavy burden on the individual, families and healthcare system.[6][7]
Complications
The third trimester of pregnancy is marked by rapid organ maturation and growth. Without proper organ development, preterm infants are at an increased risk for chronic respiratory, cardiac, renal and endocrine system disorders throughout their life.[8][2] Pravia and Benny[8] detail the risks and management of a preterm birth on each body system.
Pulmonary
Some risks and management options of preterm birth on the pulmonary system are as follows:[8]
Risks:
- pulmonary hypertension
- obstructive disease
Management:
- evaluate previous asthma diagnosis
- avoid smoking
- maintain a healthy weight
- promote exercise
- perform baseline pulmonary function testing
- stay up-to-date with Pneumococcus and influenza vaccinations
Renal
Some risks and management options of preterm birth on the renal system are as follows:[8]
Risk:
- chronic kidney disease
Management:
- monitor blood pressure regularly
- limit salt intake
- avoid nephrotoxins
- control blood pressure
- periodic urine microalbumin screening, renal ultrasonography
Cardiovascular
Some risks and management options of preterm birth on the cardiovascular system are as follows[8]
Risks:
- hypertension
- peripheral vascular disease
- ischaemic heart disease
- congestive heart failure
Management:
- monitor blood pressure regularly
- avoid smoking
- promote exercise
- maintain a healthy weight
- baseline echocardiogram with appropriate cardiovascular risk assessment
Endocrine
Some risks and management options of preterm birth on the endocrine system are as follows:[8]
Risks:
- diabetes
- obesity
- osteoporosis
- metabolic syndrome
Management:
- monitor blood glucose
- body mass composition, lipids
- promote weight-bearing exercise
- maintain a healthy body weight and abdominal girth
- ensure appropriate vitamin D and calcium supplementation
- limit medications associated with worsening bone density, metabolic abnormalities, dyslipidemia
Central Nervous System
Some risks and management options of preterm birth on the central nervous system are as follows:[8]
Risks:
- Autism
- mood disorders
- intellectual disabilities
Management:
- be alert to the need for early evaluation and support
Prevention
Pre-term birth poses significant short- and long-term risks for both the infant and the mother, affecting the baby's central nervous, respiratory, and gastrointestinal systems, and causing psychological distress for the families.[4]
Knowing all of the potential sequelae of preterm birth, prevention where possible is key. When prevention is not possible, understanding the best ways to handle preterm birth and care for the newborn are essential to attain the best possible outcome. Below are suggestions from the Global Action Report on Preterm Birth to reduce the risk, manage and care for preterm babies.[9]
Management of Pregnant Women at Higher Risk of Preterm Birth
- Identify and treat hypertensive disease in pregnancy
- Monitor multiple pregnancies
- Administer progesterone to prolong pregnancy
- Identify and treat structural abnormalities (e.g., cervical cerclage, cervical pessary)
- Promote antenatal and skilled delivery care for all women
- Smoking cessation and reducing exposure to secondhand smoke and other pollutants
- Workplace policies to regulate working hours and strenuous working conditions
- Professional and hospital policies to regulate infertility treatments, reduce caesarean birth rates and early induction of labour[9]
Management of Women in Preterm Labour
The initial assessment for a woman with pre-term labor symptoms is crucial for management. It includes a comprehensive history, physical exam, and specific tests to establish an accurate diagnosis and prognosis, which then guides the selection of appropriate interventions.[10] These interventions include:
- Tocolytics to slow down labour
- Antenatal corticosteroids to reduce mortality in the newborn
- Antibiotics to prevent infection
- Provision of magnesium sulphate for neuro-protection of the newborn[9]
Care of the Premature Baby
Preterm infants often struggle to adapt immediately after birth due to the immaturity of their respiratory, cardiovascular, and cerebrovascular systems, which can result in long-term complications. To lessen these consequences, the use of minimally invasive therapies and parental presence during hospitalization is essential.[11]
- Essential and extra newborn care, especially feeding support
- Neonatal resuscitation
- Thermal care (maintain baby's body temperature)
- Kangaroo Mother Care (skin-to-skin contact with mother or another family member to provide stable warmth and to encourage frequent and exclusive breastfeeding)
- Chlorhexidine cord care (umbilical cord cleaning)
- Comprehensive neonatal intensive care, where capacity allows[9]
Resources
References
- ↑ Liang X, Lyu Y, Li J, Li Y, Chi C. Global, regional, and National burden of preterm birth, 1990–2021: a systematic analysis from the global burden of disease study 2021. EClinicalMedicine. 2024 Oct 1;76.
- ↑ 2.0 2.1 Kamity R, Kapavarapu PK, Chandel A. Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management. Children. 2021 Dec 8;8(12):1158.
- ↑ Pusdekar YV, Patel AB, Kurhe KG, Bhargav SR, Thorsten V, Garces A, Goldenberg RL, Goudar SS, Saleem S, Esamai F, Chomba E. Rates and risk factors for preterm birth and low birthweight in the global network sites in six low-and low middle-income countries. Reproductive Health. 2020 Dec;17(3):1-6.
- ↑ 4.0 4.1 Emms A, Pilarski N, Hodgetts-Morton V. Preterm labour and birth: prevention strategies and preparation for delivery. Obstetrics, Gynaecology & Reproductive Medicine. 2025 May 7.
- ↑ Mitha A, Chen R, Razaz N, Johansson S, Stephansson O, Altman M, Bolk J. Neurological development in children born moderately or late preterm: national cohort study. Bmj. 2024 Jan 24;384.
- ↑ 6.0 6.1 6.2 Kang SR, Cho H. Research trends of follow-up care after neonatal intensive care unit graduation for children born preterm: a scoping review. International journal of environmental research and public health. 2021 Mar 22;18(6):3268.
- ↑ Grunberg VA, Geller PA, Bonacquisti A, Patterson CA. NICU infant health severity and family outcomes: a systematic review of assessments and findings in psychosocial research. Journal of Perinatology. 2019 Feb;39(2):156-72.
- ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 Pravia CI, Benny M. Long-term consequences of prematurity. Cleveland Clinic journal of medicine. 2020 Nov 23;87(12):759-67.
- ↑ 9.0 9.1 9.2 9.3 Jawaid SA. The global action report on preterm birth. Pulse International. 2012 May 31;13(10).
- ↑ Doulaveris G, Berghella V. Management of Preterm Labor. Queenan's Management of High‐Risk Pregnancy: An Evidence‐Based Approach. 2024 Jan 2:372-80.
- ↑ Zivaljevic J, Jovandaric MZ, Babic S, Raus M. Complications of preterm birth—The importance of care for the outcome: A narrative review. Medicina. 2024 Jun 20;60(6):1014.