Posts Tagged ‘complications due to prematurity’

The last weeks of pregnancy are important

Friday, March 23rd, 2018

In the last weeks of pregnancy, lots of important things happen to your baby. These changes help your baby have a healthy start. If your pregnancy is healthy, it is best to stay pregnant for at least 39 weeks, and wait for labor to begin on its own. If you choose to induce labor, talk to your provider about waiting until you’re at least 39 weeks pregnant. Inducing labor or scheduling a c-section should only be for medical reason.

In the last week of pregnancy:

  • Your baby’s brain is still growing and developing. At 35 weeks, your baby’s brain weighs just two-thirds of what it does at 39 weeks.
  • Important organs like the lungs and liver need this time to develop and function properly. Babies born too early may have breathing problems and jaundice after birth.
  • Your baby is gaining weight. Babies born at a healthy weight have an easier time staying warm than babies born too small.
  • Your baby is still learning how to suck and swallow. Learning these skills will help your baby feed better and avoid certain feeding problems.
  • Your baby’s eyes and ears are going through important changes. Babies born too early are more likely to have vision and hearing problems.

Your due date may not be correct

It’s hard to know exactly how many weeks of pregnancy you are. An ultrasound can help estimate your due date, but it can still be off by as much as 2 weeks. This means you may not be as far along in your pregnancy as you might have thought. This is why, if your pregnancy is healthy, it’s best if your baby is born at least at 39 weeks. This gives your baby the time he needs to grow.

However, in some instances, you may not have a choice about when to have your baby. If there are problems with your pregnancy or your baby’s health, you may need to have your baby early. If this happens, here are some questions you can you ask your provider about scheduling your baby’s birth before 39 weeks?

  • Is there a problem with my health or the health of my baby that may make me need to have my baby early?
  • Can I wait to have my baby until I’m closer to 39 weeks?

About inducing you labor:

  • Why do you need to induce labor?
  • How will you induce my labor?
  • Will inducing labor increase the chance that I’ll need to have a c-section?

About c-section:

 

The A’s and B’s of the NICU

Wednesday, March 9th, 2016

help-breathingApnea (A) and bradycardia (B) are two conditions that are monitored in the NICU. Apnea refers to an interruption in your baby’s breathing, while bradycardia is the slowing of your baby’s heart rate.

Babies in the NICU are constantly monitored for these “A’s and B’s.”

Premature babies often have breathing problems because they were born before their lungs were fully developed. As many as 80 percent of babies born before 30 weeks of pregnancy have apnea. Full-term babies may have breathing problems due to birth defects, infections or complications from labor and delivery.

When is irregular breathing considered apnea?

Often, preemies do not breathe regularly. Your baby may take a long breath, a short one, and then pause for 5-10 seconds before breathing regularly. This is not considered harmful and your baby should outgrow it. But, if a preemie or sick baby stops breathing for 15 – 20 seconds or longer, or if the pause in breathing happens along with a slower heart rate (bradycardia) or a change in your baby’s color, then it is called apnea.

A premature baby’s heart beats much than faster yours. Bradycardia is defined as “the slowing of a baby’s heart rate from its usual range of 120 to 160 beats per minute to a rate of fewer than 100 beats per minute” according to the authors of the Preemies book.

The sensors on your baby’s chest are connected to a machine which will start beeping if your baby stops breathing. The nurse will check your baby and determine if she needs to be stimulated to help her start breathing again. To resume breathing, the nurse may gently touch your baby.

If necessary, your baby’s neonatologist may give your baby medication or place her on a C-PAP machine to help deliver air to your baby’s lungs. In C-PAP (continuous positive airway pressure), air is delivered to your baby’s lungs either through small tubes in her nose or through a tube that has been inserted into her windpipe. The tubes are attached to a machine, which helps your baby breathe. With C-PAP, your baby breathes on her own, but the steady flow of air coming in through the tubes keeps enough pressure in her lungs to prevent the air sacs from collapsing after each breath. It’s a little extra support to help her lungs work better.

Machines can be scary

Seeing your baby hooked up to machines can be scary, and when those machines start to beep, it can be nerve wracking. But, the way your baby looks is a very important indicator of how she is doing. For example, some experts recommend that when machines start beeping, take a look at your baby, not at the machine. Is your baby pink? Is her chest moving in and out? Are her nostrils slightly widening with each breath? If so, she is breathing and getting oxygen.

In addition, the machines are set up to start beeping with plenty of time for the nurse to attend to your baby, before your baby is in distress.

If your baby’s apnea is not resolving, the medical team will consider whether there is something else going on, such as an infection or other problem. As difficult as it is to see your baby struggle with breathing, it may be very comforting to know that apnea usually resolves without any problems.

 

The survival rates of extremely premature babies are improving

Friday, September 11th, 2015

NICU preemieAdvances in treatment options may be helping to increase survival rates and reduce the number of complications for extremely premature babies, according to a new study published in the Journal of the American Medical Association.

The study looked at 34,636 infants born between 22-28 weeks over 20 years (1993-2012). The researchers found that the overall rate of survival for premature babies born between 22-28 weeks increased from 70% in 1993 to 79% in 2012.

According to the researchers, “Survival rates remained unchanged from1993 through 2008. After 2008, trends in survival varied by gestational age.”

  • For babies born at 23-weeks, the survival rate rose from 27% in 2009 to 33% in 2012.
  • For babies born at 24-weeks, the survival rate rose from 63% in 2009 to 65% in 2012.
  • There were smaller increases for babies born at 25 weeks and 27 weeks.
  • There was, however, no change reported for babies born at 22, 26, and 28 weeks.

The researchers also looked at how many babies survived extreme premature birth without developing major neonatal health problems. They found that the rate of survival without major complications increased approximately 2% per year for babies born between 25-28 weeks.  However, there was no change in survival without major complications for babies born between 22 to 24 weeks.

The authors of the study also observed changes in maternal and infant care which may have contributed to the increased survival rates. For instance, the use of corticosteroids prior to birth rose to 87% in 2012 (vs. 24% in 1993). Corticosteroids help to speed up your baby’s lung development. While most babies were put on a ventilator (a breathing machine that delivers warmed and humidified air to a baby’s lungs), continuous positive airway pressure (CPAP) without ventilation increased from 7% in 2002 to 11% in 2012. And the rate of late-onset infection decreased for all gestational ages.

“For parents of babies born very early — 22-28 weeks — these data are showing improvements in outcome. We are gratified by the progress, but there is so much more that could be done if we could understand what causes premature labor and birth,” said Dr. Edward McCabe, Chief Medical Officer for The March of Dimes.

“Our focus is on preventing premature births and we are making excellent progress,” he said. “We have saved hundreds of thousands of babies from premature birth since the rate peaked in 2006.”

You can read more about our Prematurity Campaign and our Prematurity Research Centers on our website.

Questions? Email or text us at AskUs@marchofdimes.org.

What is a Developmental Behavioral Pediatrician?

Wednesday, September 11th, 2013

doctor-and-child2Is there a difference between a Pediatrician and a Developmental Behavioral Pediatrician? In a simple word – yes.

A Pediatrician is a medical doctor (MD) who is specifically trained to care for children (from birth through teen years). If you have a baby, child, or a teenager, you have probably had her seen by a Pediatrician for her healthcare needs. This would include well-care visits as well as sick visits.

But if your child has any kind of need beyond the “typical” health issues common for her age, you might wish for her to see a pediatric specialist. A Developmental Behavioral Pediatrician (DBP) is a Pediatrician with advanced specialty training in the physical, emotional, behavioral and social development of children.

The American Academy of Pediatrics (AAP) says “Developmental-behavioral pediatricians are medical doctors who have completed
• Four years of medical school
• Three years of residency training in pediatrics
• Board certification in pediatrics
• Additional subspecialty training in developmental-behavioral pediatrics
In 2002, the American Board of Pediatrics began certifying developmental-behavioral pediatricians via a comprehensive examination process.”

When should your child see a Developmental Behavioral Pediatrician?

If you have concerns about your child’s development in any area – social, emotional, behavioral or developmental – you should ask your child’s health care provider about consulting with a DBP. Often a Developmental Behavioral Pediatrician works with a team of pediatricians or pediatric health care providers. This team approach can provide a more in-depth perspective for a parent, which will ultimately help your child be the best that she can be.

You may benefit from having your child see a DBP if your child has (or you think she may have):

• Delayed speech and/or trouble understanding language
• Delayed motor skills (crawling, walking, eating, riding a bicycle)
• Poor social skills
• Trouble sleeping (including bedwetting)
• Trouble feeding or eating
• Sensory sensitivities
• Trouble at school (paying attention; learning to read, write or do math)
• Cerebral Palsy
• Attention Deficit Hyperactivity Disorder (ADHD) or ADD (without hyperactivity)
• Learning disabilities
• Anxiety disorder
• Depression
• Tics or Tourette Syndrome
• Spina Bifida
• Autism Spectrum Disorder
• Intellectual disability
• Other chronic conditions, serious illnesses, or complications due to prematurity

A Developmental Behavioral Pediatrician may suggest additional testing or input from other pediatric specialists or therapists. Then, she will review the results and take all the different pieces of the puzzle and put them together to make a plan of action. The result is a comprehensive evaluation with treatment recommendations which will give your child the best chance at making progress.

The AAP has a great one-page sheet that describes all of the ways that a DBP can help you and your child.

How do you find a DBP?

To find a Developmental Behavioral Pediatrician near you, visit AAP’s physician locator or ask your child’s health care provider for a referral.

Bottom Line

Often a visit with a Developmental Behavioral Pediatrician will help to clarify complex issues. If your child is having difficulty in an area, it may be very beneficial to gain the insight from another pediatric specialist.

Note:

This post is part of the weekly series Delays and disabilities – how to get help for your child. It was started in January and appears every Wednesday. Go to News Moms Need and click on “Help for your child” on the menu on the right side to view all of the blog posts to date. As always, we welcome your comments and input.