Lois & Clark Forums Forums Fan Fiction Fanfic Related FFQ: Premature Babies and other such questions

Okay, here's my question. If a baby is born at eight months, can he or she be totally healthy or do they always have to have some sort of treatment? And if so, what kind of treatment?

And what kind of problems would the doctors be on the lookout for?

Related to that, if a woman goes into the hospital at seven and a half months, would the doctors try to prevent her from having the baby until she was further along? And if so, how might they do this?

And could a baby born at eight months seem healthy at first and then have problems? And if so, what kind of problems and when might they manifest themselves?

I tried researching this on the internet, but I ended up finding so much stuff that it was really hard to narrow it down to what I was looking for. So your help would be appreciated.

Thanks,

ML

My son was three weeks early and, other than being a couple of pounds underweight, he turned out fine.

My sister-in-law's water broke when she was eight weeks away from delivery. For the next month she was stuck in a hospital bed with a fetal monitor attached to her.

When my nephew was born, it was terrifying. They had to do an emergency C-section when things turned nasty in a hurry. He was in NICU for about three weeks, on constant oxygen and under bili lights. He spent the first six months of his life with an oxygen tank because his lungs were touch and go (due to the loss of fluid when he was still "baking", his lungs had stuck together. They gave him Sufectin (sp?) when he was born to infuse them). To look at him today, though, you would never know it. He's now four years old and just the most active and healthy child.

If you have specific questions, let me know and I can ask my sis-in-law.

When my daughter was having her son she showed signs of premature labor. Apparently a possible problem if you have asthma. They put her on something that she had to take every 6? hours. So her and her husband started the lack of sleep bit several weeks early. IIRC she was on it for a month which is as long as they will use it. They also gave her something that speeds up lung development which is the biggest problem in premies usually. Has him almost a month early and he was fine, went right home.

My twins were born four and a half weeks early, so I guess that qualifies as eight month babies.

Mark was 6 pounds 2oz and never had any sign of problems. Steven was 5 pounds 4 oz. He didn't really have any problems but the pediatrician considered him borderline premature, and when he went home they told me to bring him back three days later so they could check him for jaundice because he was showing signs of it.

Many moms would worry about this but I have cared for a lot of babies and I know even full term babies often show signs of jaundice. It is caused by the fact that a new baby's liver is busy clearing out a lot of extra red blood cells right after birth. The bilirubin from the cells builds up in the tissues and too heavy a concentration can cause brain damage. In the nursery we put them under a bili light. Being exposed to sunlight seems to help with the processing of the extra blood cells and helps the body cope with the jaundice. In my case, I made sure Steven was in the sunlight from the window as much as I could and when I took him back a few days later he was given a clean bill of health.

Babies born early can and often do have problems, of course, but they are usually born earlier than eight months. In the last month, most of what is going on is that the baby is putting on fat so that you get the traditional round, fat baby. A baby born a few weeks early is generally fully developed, but tends to be skinnier than a full term one, and thereby has somewhat less fuel in reserve, which isn't usually a problem in the modern world. If you're looking for problems you want about seven months or so. Then you can look at immature lungs, immature organs in general, and the danger of cerebral palsy, of course.

Of course *any* baby, even a full term one, can seem healthy at first and develop problems later. They don't have to be premature, so if you're looking to have a baby develop problems in a story, you don't have to use prematurity for a reason, although you could.

Nan

DS was 30 days early [35weeks, 5 days]. Part of the problem [according to my OB] is that they don't have the reserves a more full term baby does. Even though labor was just under 5 hours, by the time they broke my water, 30 minutes before he was born, he'd already used all of his energy reserves and couldn't hold his heart rate during contractions. It was down in the 60s and 70s during contractions for about 10 minutes before he was born. They gave him oxygen for about 30 seconds or so after he was born.

He also had trouble keeping his temp up for about 24 hours - completely normal problem to have - they kept him in a warmer for part of that time and we kept him wrapped up well when he was with us. He was a little jaundiced at his 5 day check but was fine at 12 days. DD2 had the same problem with her temp when she was born and she was 3 weeks early.

They did tell us when he was born that even though he was breathing fine then, that he could have problems later [as in the next couple of hours] since he didn't have those energy reserves etc.

He was 6lbs, 6oz and 21 inches long - so he's got little bird legs. Long and skinny - like his grandpa [my dad is 6'3" and wasn't over about 220 ever until a few years ago in his late 50s].

As far as problems that might occur... you might think about RSV. Babies born before 36 weeks are much more susceptible [okay did I spell that right?] to RSV which can easily require hospitalization etc. For older babies, later gestational age I mean, it would be a cold is my understanding, but with preemies, it can turn into something worse. There is a 'vaccine' [not a true vaccine but rather antibodies introduced into the baby's system] that is given once a month during cold and flu season but is VERY expensive [about $2000/shot IIRC, and not always covered by insurance] that is supposed to help prevent but doesn't always. A friend with a 31.5 weeker did the shots but she got RSV anyway. To go along with that, we're supposed to be very careful about having him in the 'general population'. We can take him to Sunday school with us [about 30 people] but have to be careful passing him around and CANNOT put him in the nursery and they really don't want us to take him to 'big church'.

Here's some links to RSV if that might be what you're looking for:
CDC
RSV info center
Kid\'s Health
Wiki

I just google'd RSV and tons of stuff came up.

HTH
Carol

Both of my children were preemies. My 12 year old son was born at 25 3/7 weeks (6 1/2 months) and weighed 1# 10oz (743g). He spent 4 months in the hospital. He was born October 13th but wasn't due until February 2nd. The rule of thumb is that they go home around their due date. My daughter was born at 28 weeks (7 months)and weighed 1107g (2# 8oz). She stayed in the NICN 3 months. She was born May 17th and went home August 12th when she was due.

My daughter was born by emergency C-section so I'm sure that the urgency of her birth didn't help matters. But it had to be done.

They were both on the ventilator for a long time because the lungs in a preemie are the last thing to fully develop. My son did get some cosmetic nose damage from the vent but has had plastic surgery to fix it.

They are prone to brain bleeds, ie developmental deficits ultimately resulting in Cerebral Palsy. The earlier they are the higher the odds of CP. However, my son had NO bleed and is perfectly normal. My daughter did have a bleed (intraventricular hemorrhage). She had a very minimal bleed which statistically leaves minimal to no "obvious" residual but she unfortunately does have Cerebral Palsey. And by the grace of God, it is very minimal and it only affects some of her gross motor skill.

She does take ballet and after some surgery she can now run. She's in 2nd grade and one of the smartest in her class. So Cerebral Palsy can have a wide range. She also developed some ROP-retinopathy of prematurity from long time oxygen exposure. It's when oxygen interferes with the growth of blood vessels in the eyse and can ultimately cause blindness. It was mild and at this point she doesn't even need glasses. She does however wear bilateral "pink" hearing aids. She has a 20% hearing deficit I'm aasuming from ototoxic antibiotics (antibiotics that kill hearing). I assume that because her hearing loss is equal. But I didn't discover it until she had her hearing screened for school. She never acted like she can't hear well and she doesn't talk like someone who has lost their hearing.

I breast fed so neither of then got the inflammation of the gut that lost of preemies get (NEC-necrotizing enterocolitis). They are very prone to infections that is normal flora for us. Again Christina got multiple infections and Colin didn't get any. They have problems with apnea & bradycardia (stop breathing and heart rate drops). They essentially forget to breathe because that auto breathing center is not fully functional.

Many preemies have lung problems essentially from prolonged mechanical ventilation (on the ventilator for a long time) but neither of mine do. They often have seizures from brain injury (bleeds) but again neither of mine do. They are prone to RSV which exhibit to the normal person as a common cold but can ultimately kill preemies, but we escaped that also. I could go on for days about potential risks.

Fortunately I was a nurse and my husband a Medical Technologist in both instances and understood a lot of what was going on but sometimes I think that ignorance would have been a lot more blissful.

Feel free to ask any specific questions that you may have. None of this is sacred and I'll give you the best answer that I can.

~Sheila

Usually, here in the US, if you are 34 weeks, they will NOT stop your labour. They just load you with steroid to try and speed up lung development in the baby.

I used to be an L&D nurse for 7 years also, so I have some medical insight on this as well and not just a mother's insight.

I don't understand people having their babies in birthing centers or hospitals without NICN's. A perfectly normal halthy pregnancy can go bad in seconds and require all resources. I've seen situations of lifelong bad outcomes when it could have been avoided because people want to do the "in-yuppie thing" and have their baby at the beautiful private hospital/birthing center, which minimal emergency resources. Once those infant brain cells are damaged, they don't recover.

Most NICN's are at major trauma centers which tends to be the place for the indigent crowds and those hospitals have a negative stigma attached. I've heard people say that their friends may think that they are on "medicaid" if they go to that hospital. Well, what's more important? What your friends think or the best outcome for you and your baby? Did I mention that I coded (had to be resuscitated) during my C-section. Had I been a the local yuppie hospital I probably would have died and my baby died or been worse off.

Sorry...my passion.

~Sheila

Sheila, you wouldn't have been birth center eliglible under the conditions you described. Birth centers and home births are a safe option for many women. My mother helped to create one of the first birth centers in the United States, wrote the national exam that all nurse midwives take to get their license, has been both a practitioner and professor, and has done extensive research around the world on safe birthing practices. The majority of women around the world don't even have the option of the kind of care you describe. My mother has been a tragic witness to babies dying in her arms in third world countries due to factors that wouldn't even be an issue in the western world. Birthing with a skilled birth attendant is the standard of care for most women world-wide, not just a "yuppie" choice. Research demonstrates the favorable results of matenal and neonatal outcomes that come from planned home births under circumstances that replicate elements of "first-level" care. I invite you to read an article written by my mother (I'm third author on the paper) that is based on a meta-analysis of 30 years worth of research on the subject.
[Judith T. Fullerton, Ana M. Navarro, Susan H. Young. Outcomes of Planned Home Birth: An Integrative Review. Journal of Midwifery & Women's Health; Volume 52, Issue 4(July 2007-August 2007), pages 323-333]
I understand the passion you have for your beliefs based on your personal experiences and do not believe that your comments were intended to disrespect women with other beliefs or experiences. Please understand my mother's lifelong passion for helping women give birth under different circumstances and give equal respect to the choices they make. The most important factors involved are the favorable maternal and neonatal outcomes that come from a positive birthing experience.
Susan

I don't have kids myself, so I can't talk from a mom perspective. But as a pediatrician with several months of neonatal intensive care experience, I'll throw myself into the deluge of information.

I could probably just agree with Sheila and be done with.

We standardly date babies by weeks (months are kind of hard to interpret for us wacky medical people). A normal pregnancy is 40 weeks, but once you reach 37 weeks we give you a gold star and call you term anyway. Anything less than that is considered premature. So, preemie babies range from 24 weekers to 36 weekers and vary HUGELY depending on where they fall in that range. * you may hear things about the occasional baby that they save at less than 24 weeks, but exceedingly uncommon - we don't even usually go to deliveries that are less than 24 weeks because there's pretty much NO chance for the baby.

At 34-35 weeks, they usually will not stop the labor, before that they would give moms medications to help stop the contractions - doesn't always work and sometimes we make the babies angry and they develop problems that lead to emergent C-sections. Most preemie babies, they will try to give mom doses of steroids 24-48 hours before the babies come to help the babies lung become more mature.

So, main problems with preemie babies...
Lungs!!!! The lungs don't usually mature until about 34 weeks gestation - there are varying levels of how bad the lungs are prior to that. We try to get them steroids before they come out. Once they're out, they may be intubated to help them breathe - depends on how poorly they're doing on their own. Where I am, we try to avoid intubating if we can because of airway problems later on if they do get intubated. So we'll use CPAP or high-flow air into their nose, with or without oxygen (as little as we can use - for other reasons). Usually takes the tiny babies a while to successfully breathe on their own without us giving any help - and some do still go home on oxygen. We will also sometimes intubate them, give them Surfactant (medicine to help keep the lungs from collapsing) and then try to get them extubated.

Feeding/gut problems- These babies are BAD at eating on their own and usually get fed with an NG tube into the stomach for a while until they are big enough and learn to suck on bottles or breastfeed. They are also at a higher risk for a bad baby problem with the intestines called NEC (necrotizing enterocolitis), which has scared the crap out of me several times in the past.
They also tend to have trouble keeping their blood sugars up after delivery - they don't have much in the way of fat stores, so we usually have to give them IV fluids with sugar in it.

Neuro- They're at higher risk for bleeds into their brain (intraventricular hemorrhages) - the earlier you are, the more likely the bleed (and the worse it's likely to be). These bleeds can lead to developmental problems (cerebral palsy among other things) later on and also problems with seizures. Their nervous system is also not mature - preemie tend to have trouble controlling their heart rate - so they drop down low in response to stress or really just about anything. They also forget to breathe...we give them caffeine to help remind them to do that! These apnea/bradycardia spells (As and Bs) can continue to happen until the babies reach corrected ages of 35-36 week gestations.

Temperature- They have trouble keeping their temperatures up, will usually need to be under warmers for a while (or incubators if they're really early).

Jaundice- Preemies are at higher risk for jaundice than term babies. All babies have some trouble breaking down and getting rid of dead red blood cells initially - their livers aren't quite up to the task yet. But preemies baby have more trouble, so tend to end up under bili lights for a few days.

Infection- Huge, big, scary problem for preemies. They are a much higher risk in the newborn period to get serious infections - bacteria in the blood, urine, spinal fluid, etc.... A lot of times, we just automatically start them on antibiotics for 48 hour rule-outs. We have to worry about whether mom was infected and if that's why they came early. Their immune systems suck! And when they get sick, they don't have a lot of reserve. The preemie babies (especially with lung problems) are also at higher risk for RSV and other viral infections of the lungs over the 1st winter or 2 of life. We will give them monthly shots of Synagis to protect from RSV, but there's lots of other viruses we can't protect against.

Plenty of other problems that happen to babies before, during and after labor...and yet amazingly most of them make it through unscathed. I'm always amazed.

I'm also happy to help with any particular questions you might have. I love these boards - so many crazy people willing to share their expertise!

Jill

Thanks, guys, for all the info. That's really helpful.

So... for my story... I really want this baby to be healthy. Problem was that I only had a space of eight months to work with (without stretching the show's timeline). So I'm glad that the doctors aren't going to try to stop labor and that the baby can be born without any problems or special medical treatment

That's not to say that when I get to that point in the story, I won't be back begging for more information.


ML

Ooooh, I saw this question too late!

I think I was about a month or three weeks early, and aside from my mom saying I looked like a rubber chicken (thanks, Mom...) I think I turned out rather healthy. Physically anyhoo And it didn't seem to take me long to catch up. Even if I was a wee bit early, I was always one of the tallest kids in the class... (When I was about four, people thought I was six and would ask my mom why I couldn't speak very well yet, and were quite rude about it! Traumatized poor widdle me...)