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Preterm Baby


What is a preterm baby?

A preterm baby is born before 37 weeks of pregnancy. A preterm baby is also known as a preemie or premature baby. Premature babies are at risk for several health problems because they are not ready to leave the womb. These problems may be short-term or long-term.

What short-term health problems is my baby at risk for?

Short-term problems usually get better on their own or with treatment before the baby leaves the hospital. Some short-term problems may develop into long-term problems. Your baby may have any of the following.

  • Breathing problems may happen. Preterm babies may be born before their lungs have started making surfactant. Surfactant is the liquid that helps your baby's lungs stay expanded when he takes a deep breath. He may not be strong enough to breathe on his own and may need help to breathe. Your baby may have periods of apnea, or no breathing. This is normal in a preemie. It usually gets better as the baby gets older.
  • Heart problems may happen. Your baby may have a patent ductus arteriosus. The ductus arteriosus is a blood vessel that brings oxygen and blood to your baby during pregnancy. After he is born, it is should close, and your baby should get oxygen by breathing. A ductus arteriosus that stays open after birth may cause heart failure in your baby. Babies with apnea may also have episodes of a low heart rate. It may be treated with medicine.
  • Feeding problems are common in preterm babies. A preemie may have a hard time sucking and swallowing. He may need to be fed through a tube that is inserted into his stomach or intestines. Some preemies cannot be fed through their stomach or intestines. This happens because their digestive system is not developed, or they are too sick. These babies may be fed through an IV until they are well enough to get nutrition into their stomach. Your baby may also have reflux, or the movement of fluid backwards from his stomach and into his esophagus. This is very common in preemies, and usually does not need treatment.
  • Digestive problems may happen. Your baby's intestines may become injured or swollen. This may lead to an infection or a hole in your baby's intestines. Your baby may need surgery to fix the hole.
  • Eye and hearing problems may happen. Most eye problems get better on their own. Your baby may have a decrease in his vision or hearing.
  • Jaundice happens when bilirubin builds up in your baby's blood. Bilirubin is a yellow liquid that gets into the blood when red blood cells get broken down. The liver usually helps the body get rid of bilirubin. A preemie's liver has trouble getting rid of bilirubin. This may cause your baby's eyes and skin to look yellow.
  • Low red blood cell counts , also known as anemia, may happen. A preemie cannot make red blood cells quickly. Red blood cells carry oxygen to organs and tissues. If your baby is anemic, he may also have trouble with his oxygen levels.
  • Control of body temperature is difficult for a premature baby. He may have problems staying warm because he does not have enough fat tissue.
  • Infection is a greater risk for a preterm baby. His immune system is not fully developed and he cannot fight germs. His blood may also lack antibodies that help prevent infections. He may develop infections anywhere in his body.

How will my baby be cared for after birth?

Your baby may be cared for in the neonatal intensive care unit (NICU) after he is born. He will be closely monitored, and treated, for problems. He may need any of the following:

  • An incubator or special lights will help your baby stay warm and get rid of jaundice.
  • A monitor will record your baby's heart rate and oxygen levels. Your baby's blood pressure will also be monitored. You may see wires connected to your baby's chest and a wire attached to a sticker on his hand or foot. Healthcare providers will always be near your baby. If his monitor alarms they may gently tap him. This may make him breathe better and increase his heart rate.
  • An IV may be used to give your baby fluids, medicine, or nutrition.
  • Oxygen or a ventilator may be needed to help your baby breathe and increase the oxygen levels in his blood. Your baby may get oxygen through a mask placed over his nose and mouth or through small tubes placed in his nostrils. If he cannot breathe well on his own, pressure will be given through the tubes in his nose to help keep his airways open. If he needs more help to breathe, an endotracheal tube may be inserted through his mouth and into his lungs. It will be attached to a ventilator, or a machine that will breathe for him until he can breathe on his own.
  • A feeding tube or IV nutrition will help your baby grow stronger. You may be able to pump your milk and give it to healthcare providers. They can add protein, calcium, and other nutrients to your breast milk and give it to your baby through his feeding tube. If you cannot produce enough milk, your baby can be given formula or breast milk from a donor bank.
  • Blood tests and glucose checks may be needed to check for infection and monitor blood sugar levels. These tests may also give information about your baby's overall health. Blood tests will help healthcare providers decide what care your baby needs.
  • Blood transfusions may be needed to increase the number of your baby's red blood cells. More red blood cells may help increase your baby's oxygen levels and get him off a ventilator or oxygen. A blood transfusion may also increase his blood pressure and the blood flow to his organs.
  • Medicines may be given to treat heart or lung problems. Your baby may need medicine to increase his blood pressure, or to help him breathe more regularly. Medicine may also be given to help treat an infection or other problems. Premature babies may be given extra vitamins and iron.
  • Surgery may be needed to fix any problems that do not get better on their own or with other treatments.

How can I care for my baby at home?

Your baby may leave the hospital when he can breathe on his own, stay warm without extra heat, and is gaining weight steadily. Spend time with your baby in the hospital as much as possible before he goes home. Learn about equipment, medicines, and how to feed your baby. Healthcare providers will teach you how to care for your baby before you take him home. Do the following to keep your baby safe and healthy at home:

  • Prevent infection by keeping your home clean. Your baby will need several immunizations to decrease his risk for infections and diseases. Ask your healthcare provider how often your baby needs immunizations. Wash your hands before you touch your baby or anything your baby comes in contact with. Ask anyone who visits your baby to wash their hands. Do not take your baby to crowded places and keep him away from people who are sick. Do not let anyone smoke near your baby. Breastfeed or give your baby your milk in a bottle as much as possible. Your milk will help protect your baby from infections and other illnesses.
  • Feed your baby as directed. Only give your baby breast milk or formula with iron for the first 6 months of his life.
    • You may need to feed your baby through his feeding tube. Ask your healthcare provider how often to feed your baby through his tube. You may be able to pump your milk and give it to your baby through his feeding tube.
    • Feed your baby at least every 3 hours throughout the day and night. Instead you may need to give your baby formula. Ask your healthcare provider how to prepare your baby's formula. Wash all bottles and nipples with hot water and soap. Let them air dry.
    • Your baby may spit up after he eats. This is normal. Tell your healthcare provider if your baby spits up large amounts or continues to spit up throughout the day.
    • Your baby should have 6 to 8 wet diapers per day. This means that he is getting enough liquids.
  • Give your baby medicine as directed. You should know when to give your baby medicine, how to give it, and what the dose is. You should also understand what the medicine is for, and what side effects to look for. Ask your healthcare provider how to give your baby medicine if he has a feeding tube. Your baby may need vitamins, iron, or other medicines to help him grow and stay healthy.
  • Always place your baby to sleep on his back to prevent sudden infant death syndrome (SIDS). Clear your baby's crib of toys and loose bedding. Put your baby to sleep on a hard or firm surface. Allow your baby tummy-time as directed. Watch your baby at all times when he is on his tummy.
  • Use medical equipment as directed. Most babies do not need medical equipment at home. Your baby may need any of the following:
    • Oxygen increases your baby's oxygen levels. Care for your baby's skin around the oxygen tubing as directed. Make sure the oxygen tank is full. Keep the oxygen tank away from open flames. Do not let anyone smoke near your baby.
    • An apnea monitor monitors your baby's heart rate and breathing. Your healthcare provider will show you what to do if the monitor alarms. You may need to gently tap your baby if he stops breathing. This will make him breath and increase his heart rate. You should learn infant CPR before your baby leaves the hospital.
    • A feeding tube and a syringe may be needed to feed your baby. A feeding tube may be needed if your baby cannot get enough food by bottle or breast feeding. Care for the feeding tube as directed. Use a syringe to give him breast milk or formula through his feeding tube. Clean your baby's skin around his feeding tube as directed. Wash all feeding supplies with hot water and soap. Let them air dry.
  • Watch for your baby's progress so that you know that your baby is growing and developing as he should. Your baby will reach certain milestones such as crawling, smiling, holding up his head, and speaking, at different ages. Preemie babies may take longer to reach milestones than babies born on time. Ask your healthcare provider when your baby should reach certain milestones.

Call 911 for any of the following:

  • Your baby stops breathing or you cannot feel his pulse.
  • Your baby cannot be woken.
  • Your baby's skin looks blue.

When should I seek immediate care?

  • Your baby vomits more than 3 times in a day, or has trouble eating.
  • Your baby is wheezing, breathing faster than normal, or grunting during feeding.
  • Your baby's skin or eyes look yellow.
  • Your baby has less than 4 wet diapers per day, or his head looks sunken in.
  • Your baby's abdomen looks larger than usual and feels hard.
  • Your baby cries more than usual or seems like he is in pain.

When should I contact my baby's healthcare provider?

  • Your baby has a fever higher than 100.4°F (38°C).
  • Your baby has a rash.
  • Your baby has white patches on his tongue or gums.
  • You see a bulge or swelling around your baby;s belly button or any part of his abdomen.
  • Your baby's skin around his feeding tube or oxygen becomes red, swollen, or drains pus.
  • You have questions or concerns about your baby's condition or care.

Care Agreement

You have the right to help plan your baby's care. Learn about your baby's health condition and how it may be treated. Discuss treatment options with your baby's caregivers to decide what care you want for your baby. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2016 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.