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The Myth of the “Healthy” Preemie
By Phyllis Dennery, MD

Congratulations! You may have just welcomed a beautiful, bouncing baby into your family. If you are the parent of a preterm infant, then you and your family were most likely surprised by the momentous occasion of your child’s birth happening earlier than planned. But, if your bundle of joy has left the hospital and settled in at home, you may believe that prematurity no longer needs to be a consideration in your baby’s development. In reality, even if your baby was born only a few weeks ahead of schedule and looks just like a full-term infant, you should understand that specialized care is still required due to your little one’s early arrival.

While the term “preemie” often connotes “very preterm” (born before 32 weeks gestation) or “moderately preterm” (born between 32 and 34 weeks gestation) babies, most premature babies are actually born between 34 and 36 weeks and are considered “late preterm.” The health risks associated with these late-preterm babies are often overlooked or misunderstood by parents because their child appears to be as healthy as a full-term baby. But any preemie is still more vulnerable to complications than full-term infants, and parents should work with their doctors to ensure babies receive the special medical attention they require.

Early arrival disrupts development
All preemies experience some level of disrupted development that puts them at risk for a wide range of health and developmental problems well after they leave the hospital. This is because babies do not develop fully in the mother’s womb, making them more vulnerable overall to serious health problems and subsequent disabilities, including susceptibility to infection, chronic lung disease and neurological disorders.

Late-preterm babies more often slip under the radar than more severely premature babies do because they generally weigh between 4 ½ and 6 pounds and don’t appear much smaller than their full-term peers. Severe health complications also tend to be less frequent in infants born between 3-6 weeks early. However, late-preterm infants can have increased problems with breathing, feeding, maintaining their temperature, jaundice and other issues.

Specifically, it is estimated that at 35 weeks gestation, the weight of the brain is only around 60 percent that of full-term infants. Though late-preterm babies are unlikely to develop serious disabilities from this disrupted development, they may be at increased risk for subtle learning and behavior problems. In addition, the lungs of infants born at 32-35 weeks gestational age are still developing, and therefore children are at risk of experiencing reductions in lung function as late as six or seven years old. Infants born before 36 weeks gestational age also possess fewer maternal antibodies, putting them at greater risk for infections.

Be aware, not afraid
It’s important to know that even though your premature child is doing well at home, you will need to provide some extra TLC to ensure your little one receives the additional care that may be required. To support you, find a trusted medical care provider who understands the specialized health needs of a preemie and can spend extra time with you and your child as needed.

For example, preterm babies are more vulnerable to seasonal infections such as respiratory synctial virus (RSV), a common virus during these fall and winter months, which can be potentially serious for preemies because of their underdeveloped lungs and lack of antibodies needed to fight infections. RSV usually causes symptoms that mimic a cold, such as a runny nose or a low fever, and the symptoms generally run their course. But parents of preemies should be especially aware of potential signs of severe RSV—persistent coughing or wheezing, rapid or gasping breath, blue color on the lips, around the mouth or under the fingernails, and a temperature of 100.4 degrees—and consult their pediatrician with any concerns.

Parents, you can take extra precautions during this season by always washing your hands before touching your baby (and making sure others do, too) washing toys and bedding frequently, and shielding your baby from tobacco smoke, people with colds and unnecessary exposure to crowds. Parents of preemies should be especially diligent—regardless of how premature a baby was born.

Help protect your preemie
Your premature baby is a unique gift to your family, one that will certainly be cherished forever. Regardless of how early your child is born, empower yourself to be especially diligent in monitoring and caring for your baby. Seek the support of your medical care provider as needed to help ensure that your baby’s health needs are met. Every preterm baby needs special care, so remember:
• Be your baby’s advocate. Do research. Ask questions.
• Seek a medical setting where your questions will be answered.
• Network with other parents of preemies.
• Trust your parental instincts.
 
Phyllis Dennery, MD, is Chief of the Division of Neonatology at Children's Hospital of Philadelphia and Professor of Pediatrics at the University of Pennsylvania.