What to Know About Premature Babies
One thing I know for a fact, having worked as a doula for nearly a decade, is that babies never bother to look at the calendar. Due dates don’t mean much to babies, but normally they still arrive fairly close to that guess date and all is well. But for 1 in 10 babies born in the United States, their arrival date will be more cause for concern. This is the number, according to the March of Dimes, of babies born premature, meaning they were born at 36 weeks gestation or earlier. So what exactly does this mean, for both parents and baby? Since November is Prematurity Awareness Month, let’s talk about what you need to know when it comes to premature babies.
Defining Prematurity - Various Stages
A pregnancy is considered full term once the person reaches 37 weeks gestation, so a baby born any time after 37 weeks would not be classified as a premature baby. Babies are considered premature if they are born during the 36th week of gestation or earlier. However, the exact week of birth is important to know as this will determine the stage of prematurity for the baby.
34-36 Weeks - Late Preterm
32-34 Weeks - Moderately Preterm
26-32 Weeks - Very Preterm
Less than 26 Weeks - Extremely Preterm
As you can probably imagine, the earlier the gestational age, the more complications the premature baby is likely to have. While a baby born at 36 weeks might not need much (if any) time in the Neonatal Intensive Care Unit (NICU), a baby born at 26 weeks is going to have a very lengthy NICU stay. The gestational age will play a huge role in the baby’s development and influences how the baby can eat, breathe, and regulate their physiological states, just to name a few things.
A baby born very or extremely preterm will need assistance with eating (either being intravenously or tube fed), will need supplemental oxygen, help with regulating body temperature, and more. In contrast, depending on the individual, babies born late preterm have had the time to develop many of those behaviors and skills in utero so will need less assistance and care taking in the NICU.
Chronological Age vs Adjusted Age
Another important defition to be aware of when learning about premature babies is the difference between chronological age and adjusted age. A baby’s chronological age is based on the exact date of their birth. So if today is June 1 and the baby was born on April 1, for example, that baby’s chronological age is 2 months old.
A premature baby’s adjusted age is their age based off of their original estimated due date. So if today is June 1 and the baby was born on April 1 but their due date was May 1, then that baby’s adjusted age is 1 month old. For premature babies, their development is measured using their adjusted age. So in our examples, even though this baby is chronologically 2 months old, their developmental milestones would be tracking that of a 1 month old baby since that is their adjusted age. Things like motor skills milestones, sleep patterns and needs, developmental leaps and growth spurts will all be based off of the baby’s adjusted age.
For most premature babies, their development follows their adjusted age until they are 2 to 2.5 years old, when growth and development should begin catching up with their chronological age.
Caring for Premature Babies
Depending on the gestational age of the baby, many premature babies will spend some time in the NICU, being cared for by the very capable NICU nurses and staff. But once the baby “graduates” from the NICU and comes home, there are still a few things to keep in mind that might look different from the care provided to a baby born at term.
Because these babies follow the developmental patterns based on adjusted age, always keep that number in mind when considering how to care for the baby. A baby whose adjusted age is only 37 weeks gestation can become very easily overstimulated, considering that their term counterpart would still be in utero at this time. Loud, continuous noises, bright lights, too much handling and passing around, can all overstimulate and exhaust a premature baby. Keep in mind this baby’s need for sleep at this age and don’t be surpised if this baby spends the majority of their day and night not awake.
Premature babies can also have some challenges with feeding, either from the bottle or at the breast. Again, depending on the gestational age of the baby, their ability to suck, swallow, and breathe simultaneously may not have been fully developed at birth. For this reason, feeds should always be slow and paced. In the NICU, many premature babies are bottle-fed on their sides to make sure that the feeding session is nice and slow and to reduce any risk of the baby choking or having trouble breathing while eating. Continuing paced bottle feeds once the baby is home is very important.
Depending on the overall health of the baby at birth, some premature babies may be immuno-comprised. It is especially important when visting a family that has a preemie at home to practice good hand washing, respect the parents’ wishes when it comes to wearing a mask, and stay away if you are experiencing even the slightest symptom of an illness. What might be an uncomfortable cold for a healthy, term infant, could land a premature baby with an immune-compromised system back in the hospital if they were to contract the same virus.
Supporting the Parents
And last, but certainly not least, the parents of premature babies need support too. Parents of babies that are admitted to the NICU are at an increased risk of developing a postpartum mood or anxiety disorder, particularly postpartum depression or postpartum post traumatic stress disorder. So when visiting the family of a premature baby, keep in mind what the parents are going through as well.
Some of the best ways to support a parent with a baby in the NICU is to check in frequently on how they’re doing. Don’t offer platitiudes such as "everything will be okay” or “everything happens for a reason.” Instead offer validation that what they are going through is hard and let them know that if they need a safe space to vent their feelings, you will be that listening ear. This time can feel very lonely - being home but having your baby in the hospital - so just showing up to provide emotional support is important.
You can also offer to bring their favorite take out to alleviate the burden of meal prep and planning or gift them with a gas card - often these families are driving back and forth from the NICU once or even several times a day. If there are older siblings in the home, you could volunteer to watch them to give the parents a break or even the opportunity to visit the NICU together.