Is this topic for you?
This topic is for people
who want to know what to expect when a baby is born early. For information
about early labor, its causes, and its treatment, see the topic
What is premature birth?
Pregnancy normally lasts
about 40 weeks. A baby born 3 or more weeks early is premature. Babies who are born closer to
their due dates tend to have fewer problems than babies born earlier. But even those who are born late preterm (closer to 37 weeks) are at risk for problems.
Doctors and nurses often
call premature babies "preemies."
premature baby may be stressful and scary. To get through it, you and your
partner must take good care of yourselves and each other. It may help to talk
to a spiritual advisor, counselor, or
social worker. You may be able to find a support group
of other parents who are going through the same thing.
Why is premature birth a problem?
When a baby is born too early, his or her
major organs are not fully formed. This can cause health problems.
- Babies who are born closer to 32 weeks (just over 7 months) may not be
able to eat, breathe, or stay warm on their own. But after these babies have
had time to grow, most of them can leave the hospital.
- Babies born
earlier than 26 weeks (just under 6 months) are the most likely to have serious
problems. If your baby was born very small or sick, you may face hard decisions about treatment.
What causes premature birth?
Premature birth can
be caused by a problem with the
fetus, the mother, or both. Often the cause is never
known. The most common causes include:
- Problems with the
- Pregnancy with twins or more.
- Infection in the mother.
- Problems with the
- Drug or alcohol use during
What kind of treatments might a premature infant need?
Premature babies who are moved to the neonatal intensive care unit (NICU)
are watched closely for infections and changes in breathing and heart rate.
Until they can maintain their body heat, they are kept warm in special beds
They are usually
tube-fed or fed through a vein (intravenously),
depending on their condition. Tube-feeding lasts until a baby is able
to breathe, suck, and swallow and can take all feedings by breast or
Sick and very premature infants need special treatment,
depending on what medical problems they have. Those who need help breathing are
aided by an oxygen tube or a machine, called a ventilator, that moves air in
and out of the lungs. Some babies need medicine. A few need surgery.
Breast milk gives your
baby extra protection from infection. You can pump breast milk and bring it to the hospital for your baby.
NICU (say "NIK-yoo") nurses can teach you things you'll need to do at home to help your baby.
Does premature birth cause long-term problems?
Before the birth, it is hard to predict how healthy a premature baby will
be. Most premature babies don't develop serious disabilities.
But the earlier a baby is born, the higher the chances of problems. Work together with your doctor and other health providers to closely watch your baby's development and try to catch any problems early on.
- Most premature babies who are born between 32
and 37 weeks do well after birth. If your baby does well after birth, his or
her risk of disability is low.
- Babies most likely to have
long-term disability are those who are born before 26 weeks or who are very
small, 2.2 lb (1000 g) or
less. Long-term problems may include
problems with thinking and learning or
What can you expect when you take your baby home?
When you're at home, don't be surprised if your baby sleeps for shorter
periods of time than you expect. Premature babies are not often awake for more
than brief periods. But they wake up more often than other babies. Because your
baby is awake for only short periods, it may seem like a long time before he or
she responds to you.
Premature babies get sick more easily than
full-term infants. So it's important to keep your baby away from sick family
members and friends. Make sure your baby gets regular checkups and shots to
protect against serious illness. Be current on your immunizations and ask other people who will
be near your baby to be immunized too.
Sudden infant death syndrome (SIDS) is more common among premature babies. So make sure your
baby goes to sleep on his or her back. This lowers the chance of SIDS.
Health Tools help you make wise health decisions or take action to improve your health.
Actionsets are designed to help people take an active role in managing a health condition.
- Depression: Managing Postpartum Depression
Learning about prematurity:
- What is premature birth?
- What can I expect before and after delivery?
- Why is a premature infant so fragile?
- What kinds of health problems can a premature infant have?
- How can I cope with my feelings about my fragile baby?
- What can I expect in the NICU?
- What can I expect if I have a very premature infant?
- How can I best prepare for my baby's homecoming?
- What should I expect during my baby's first few weeks at home?
- Will my premature infant grow and develop normally?
delivery may happen suddenly or after days or weeks of waiting and worrying. If
you know you may deliver early, you, your partner, and your doctor can prepare
for a premature birth.
The premature delivery
You and your
premature infant (preemie) are considered high-risk
during preterm labor. This means that you will have less freedom, both to make
birth-related decisions and to move about freely. You can expect the
- You may need to adjust your birth plan and birthing choices during this birth. You can refuse medicines such as painkillers
during preterm labor. But other treatments such as
antibiotics or corticosteroids can be important to
ensure your infant's chances of good health after birth. Be sure to ask as many
questions as you can think of about your medical care. The more you understand
about your doctor's decisions, the less anxious you will feel.
- You will
be on constant
fetal heart monitoring. You also will be
checked regularly for changes in heart rate, body temperature, and uterine
- You will probably deliver vaginally, rather than by
cesarean section (C-section), as long as you and your
fetus show no signs of distress.
After the premature birth: The infant
As soon as
umbilical cord is cut, the neonatal staff will
watch over and stabilize your infant. If your infant is less than 36 weeks'
gestation at birth, they may move him or her to the neonatal
intensive care unit (NICU) for observation and specialized care. If you deliver in a hospital that has no NICU, your infant may need to be taken to another hospital.
During the first hours and
days, your infant will adjust to living outside of the maternal "life-support
system." This is a time when birth defects and complications of prematurity
often become apparent.
If your infant is
born between 22 and 25 completed weeks of pregnancy (extreme prematurity), you
likely will be faced with some
difficult decisions during the first month
after the birth. These
personal stories may help you make your decision.
After the premature birth: The mom
neonatal staff attends to your infant, the obstetric staff will care for you.
Depending on your condition, this will take
at least a few hours. Meanwhile, your birth partner may want to go with your
infant to the NICU.
Before your breast milk comes in (3 or 4 days
after childbirth), you will be asked to decide whether you plan
to breast-feed or bottle-feed your premature infant. Formula does not give your infant added
protection from early infection, so strongly consider pumping
milk for your infant for at least the first weeks of life. If
you decide to breast-feed, expect at first to pump milk for feedings until your
infant is mature enough to feed orally.
- Breast milk contains
antibodies that help protect your vulnerable infant
against early, serious infections, including
necrotizing enterocolitis, as well as ear and upper
respiratory infections during early childhood.
- The benefits of
breast milk over formula include better nutrient absorption, digestive
functioning, and nervous system development.
- Both specialized
formula and breast milk can offer your infant excellent
- Pumping and breast-feeding can
be one of the most beneficial and rewarding things you do for your premature
infant. But it may also be hard and exhausting. If you cannot breast-feed,
decide not to breast-feed, or find that you have to discontinue doing so,
formula feeding will meet your infant's nutritional needs.
lactation consultant can be very helpful with pumping
and breast-feeding questions and problems, both before and after the birth.
For more information, see:
- Preterm Labor.
premature infant is moved to the neonatal intensive
care unit (NICU), you may become overwhelmed with new emotions and information.
You and your loved ones may handle issues and feelings differently, and it may
create a strain on your relationships.
Thinking of yourself and your relationships may
not be easy when you are under a lot of stress. But your child or children
depend on you to be physically and emotionally able to care for them.
Take a quiet moment and focus on yourself. Ask yourself, "How am I doing?
What do I need right now?" Try to take time to get enough rest, food,
exercise, and fresh air and sunlight. Do you have someone you can talk to: a
partner, friend, parent, spiritual advisor, or counselor? If any of these basic
needs aren't being met, make them a top priority.
- Arrange for and accept as much help from
friends and family as you can.
- Keep a journal of your thoughts and
- Visit with a friend, spiritual advisor,
social worker. It helps to talk about how you feel.
- If your hospital has a
support group for NICU parents, try it out. Sometimes
the best possible support comes from people who are going through the same
issues that you are.
- See a mental health professional or go to the
emergency room right away if you are having thoughts of hurting
yourself or another person. Such thoughts can sometimes arise due to
postpartum depression, severe stress, or both.
- Depression: Managing Postpartum Depression
- Watch for signs of depression, anxiety, or post-traumatic stress disorder. Seek help if you have symptoms.
A premature infant's health at
birth is influenced by many things, including:
- Gestational age at
- Weight at birth.
- Maternal illness and medical
treatment during pregnancy.
- Congenital birth defects.
Most infants born at 36 and 37 weeks' gestation are mature
enough to be discharged from the hospital with the mother. But many premature
infants need care in the neonatal
intensive care unit (NICU). Hospital care will be needed for:
- Underdeveloped lungs.
- Inability to breathe continuously (apnea of prematurity).
- Inability to maintain body heat.
- Inability to feed orally.
While in the NICU or at home, many premature
infants also need treatment for
jaundice, infection, and anemia.
premature infants are resilient and surprise everyone
by overcoming great odds. Expect that
your infant can progress for several days but may then have a medical setback.
Premature infants are more likely than others to get an infection. And organs that have not had time to mature can cause a number of problems.
The more premature a newborn is, the greater is the baby's risk of having medical problems.
Infants born at 23 to 26 weeks' gestation are extremely
underdeveloped and have a much higher risk of death or disability.
Parents of these infants are likely to be faced with difficult
medical decisions. Infants who have reached their 32nd week of
development before birth are less at risk than
those who are born earlier.
Babies born at 34 to almost 37 weeks' gestation are called late preterm infants. Although they are not as likely to have as many problems as infants who are born earlier, they are at risk for breathing problems, high blood pressure in the lungs, and other short-term and long-term problems.
premature infant (preemie) is admitted to the neonatal
intensive care unit (NICU) after birth, you will find out about new
technologies, new medical words, and new rules and procedures.
depend on the NICU staff members, including
nurses, to know how to care for your infant and to be
your teachers. With their help, you can quickly learn about your infant's needs and what you can do for your infant. Throughout your
infant's stay in the NICU, you will want to
keep open communication with the staff.
First you'll learn to scrub up
before visiting your infant's bedside. When you're there, you may be surprised by the number of
machines and instruments surrounding your child. Remember that because of these machines your premature infant has a much greater chance of doing
well than ever before.
At a minimum, your infant will be warmed and watched over with equipment that includes:
- An isolette or overhead
- A temperature probe, to keep track of
- A heart monitor, to keep track of
breathing and heart rate.
- A pulse oximeter
to keep track of how much oxygen is in the blood.
If your infant has additional medical needs, other tests
and equipment also may be used, including:
- A transcutaneous oxygen and/or carbon dioxide monitor, to constantly measure these levels in the blood without using a
- An intravenous (IV) site, for giving
medicine, fluids, and feedings.
- An umbilical catheter, for giving medicine, fluids, and feedings, and for drawing
- A ventilator, for help with breathing.
- Continuous positive airway pressure (CPAP), for help
with breathing. (This is usually for mild to moderate
apnea of prematurity and mild lung problems or for weaning from a ventilator.
- A cranial ultrasound, to check for brain bleeding or
damage, usually between days 3 and 7 after birth.
- A chest X-ray, to check for lung damage. It may also be used to check the
positioning of an
endotracheal tube if one is used to assist with
- An abdominal X-ray. This is to check the
necrotizing enterocolitis and to check the position of
the umbilical catheter.
- An echocardiogram, to check the heart for
congenital heart defects or
patent ductus arteriosus.
- Phototherapy, to help treat jaundice.
Your role in your infant's care
At first sight,
you may question whether and even how to touch your tiny infant. Unless your
newborn is very sick or immature, you will be allowed to touch and possibly
hold him or her. But your infant's nurse or doctor will first need to show you
how to work around the technology and to alert you to your infant's special
needs. When visiting with your premature newborn, remember that:
- A premature infant has limited energy for
recovering and growing. Try not to wake your infant from sleep.
- A premature newborn's brain isn't quite ready for
the world. Be alert to
signs that your infant is being overstimulated, such as a change in heart rate or a need to turn away from you. This can be triggered by your gaze, voice, or touch,
or by sound and light in the room.
- A stable, more mature preemie
will thrive on periods of cuddling (kangaroo care), infant massage, and
If you're not able to hold or
help your infant, you can give him or her an immunity boost by providing breast
milk. Regardless of whether you plan to
breast-feed or bottle-feed later on, pumped breast
milk for tube-feeding reduces your infant's risk of infection.
As your infant grows stronger, you will be able to take on
more caregiving tasks. These range from holding and feeding to changing diapers and
bathing. You can count on the NICU nurses to teach you and answer your
questions. If you are breast-feeding, you may be asked to spend the night with
your infant to find out if he or she is strong enough to nurse around the
premature infant is considered ready to go home when
he or she is able to:
- Take all feedings by nipple and continue to
- Maintain body heat in an open infant
- Breathe well. (An infant whose lungs have suffered damage may
be sent home with portable oxygen.)
- Have normal breathing and a
normal heart rate for a week. (An infant who is otherwise mature enough yet
still stops breathing sometimes or has lung disease or other breathing problems
may be sent home with a device to monitor his or her breathing.)
Some infants are ready to go home as early as 5 weeks
due date. Other infants, usually those who have had
medical problems, may be sent home later.
Preparing to go home
As your infant's discharge from the hospital approaches,
you may feel excitement, impatience, and a new kind of anxiety. Responsibility
for your infant's care, which has so recently required lots of technology and
medical training, is now being transferred to you. You can best prepare
yourself by learning:
- Infant cardiopulmonary resuscitation (CPR), as taught
by a certified instructor.
- How to
safely transport your infant in the
- Basic infant care skills.
- How to handle the medicine or medical equipment, if any, that will be needed at home.
You will also want to:
- Discuss your questions and concerns with the
neonatal intensive care unit (NICU) staff, your baby's
doctor, and a discharge planner. A discharge planner can help make sure that your baby will get the right care after leaving the hospital.
- Make an appointment with your baby's doctor for a few days after your
infant's homecoming. Weekly medical checks after discharge are especially
important for a premature infant, as well as reassuring for you.
- Be current on your immunizations, and ask other people who will
be near your baby to be immunized too. It's okay to get routine immunizations while you are breast-feeding. They do not harm your baby.
If home-based health care and support are
available to you, take advantage of them. Home-based services spare you and
your infant the physical and emotional stress of traveling to numerous
As you and your premature infant
adjust to being at home, you will gradually establish a routine together. During the first weeks at home, consider these
- Sleeping and wakefulness. Because their brains aren't as fully developed at
birth as full-term newborns, premature infants:
- Sleep more than
full-term infants do but for shorter periods of time. Expect that you may be
awakened frequently at night until 6 months after your
- Are seldom awake for more than
brief periods until about 2 months after their due date. It may seem like a
long time before your infant responds to your presence.
- Fussiness and hypersensitivity. It's normal for full-term infants to
cry for up to 3 hours a day by 6 weeks after their due
date. Most premature infants will do the same and then some. Your premature
infant may be easily disturbed by too much light, sound, touch, or
movement or by too much quiet after living in the noisy NICU. If so, gradually
create a more calming environment, swaddle your infant in a blanket, and hold
him or her as much as possible. When you swaddle your baby, keep the blanket loose around the hips and legs. If the legs are wrapped tightly or straight, hip problems may develop.
- Sleeping position. Laying your infant on his or her back reduces the risk of
sudden infant death syndrome (SIDS), which is more
common among premature infants than full-term infants.
Your infant probably will come home on a hospital feeding schedule, which will
tell you how often to nurse or bottle-feed at home. To avoid infant
dehydration, never go longer than 4 hours between
feedings. Small feedings may help reduce spitting up. If you see signs of
reflux during or after feedings, such as spitting up a lot, talk to your infant's
- Nutrition. Your infant's doctor may
recommend adding iron, vitamins, or supplemental formula to a breast-fed diet.
Adding iron is typical treatment for all premature infants (preemies),
because they lack the iron stores that full-term infants have at birth. Some
preemies simply need extra energy and vitamins from formula (given in addition to breast milk) to
keep up their growth.
- Exposure to diseases and smoke. Your premature infant needs more protection than a
full-term infant, particularly due to immature lungs at birth.
- Keep your infant away from sick family
members and friends as well as from enclosed public places during his or her
first two winter seasons.
- Don't allow tobacco smoke near your
- Protection from serious illness (immunizations and RSV antibody). With the exception of
hepatitis B vaccine, the preemie's schedule for
childhood immunizations is the same as for a full-term infant, figured from the
date of birth (chronological age). In addition, the doctor may suggest that your baby get injections of RSV antibody in the winter, to help reduce the risk of problems from respiratory syncytial virus (RSV) infection.
- Child care. You may need to find child care for times when you need a break or for when you return to work or other tasks. Avoid group child care if your baby is at high risk for infection, especially in the fall and winter when viral illnesses tend to spread. You'll likely need to keep your baby out of group child care until he or she is on a routine schedule. For more information about child care options, see the topic Choosing Child Care.
- Hearing and vision screening. Premature infants are at greater
risk of hearing loss. Those born at or before 30 weeks or weighing less than
1500 g (3.3 lb) are more likely
to develop a vision problem called
retinopathy of prematurity.
- Your infant's hearing will have been assessed in the NICU.
But be alert to new or increased hearing problems during your child's first 5
years of life.
- Vision screening is recommended for infants born at
or before 30 weeks, whose birth weight was below
1500 g (3.3 lb), or who have
serious medical conditions. The first screening is recommended between 4 and 7
weeks after birth.1
Your infant's "age"
Age is both a measure of time
and a marker of development. Unlike with a full-term infant, a premature
infant's age and development can be defined in different ways. This can be
confusing. When following your premature infant's growth and
development, it can be helpful to know the difference between the following
- Gestational age is the
same as the length
of your pregnancy. If your baby was born at 32 weeks, that is his or her gestational age. This is sometimes called the baby's postconceptual age.
- Chronological age is measured from the day of birth. Your
child's birthdays are celebrations of his or her chronological
- Corrected age is your child's chronological age minus the amount of weeks or months he or she was
born early. For example, if your 1-year-old was born 3 months early, you can
expect him or her to look and act like a 9-month-old (corrected age). You may
find this figure to be most reassuring when following your child's growth and
development for the first 2 years after birth.
Your infant's development
child's first 2 years of life, he or she will appear to be developmentally
behind full-term children of the same age. But you can expect your infant and
young child to achieve the same sequence of developmental milestones as any
For more information about infant and child developmental
- Growth and Development, Newborn.
- Growth and Development, Ages 1 to 12 Months.
- Growth and Development, Ages 12 to 24 Months.
Expect that your premature infant's "lag" in development will catch up at
about age 2. As your child grows into the preschool
years, a 2- to 4-month difference in age or development blends right in among a
group of preschoolers. For more information about preschoolers, see
Growth and Development, Ages 2 to 5 Years.
As your child begins formal schooling, be alert for signs of learning
problems. Learning, reading, and math disabilities due to prematurity may first
become apparent during the early school years.
American Academy of Family
Physicians: FamilyDoctor.org www.familydoctor.org
- Chronic Lung Disease in Infants
- Crying, Age 3 and Younger
- Dealing With Emergencies
- Growth and Development, Newborn
- Hospital Discharge Planning
- Jaundice in Newborns (Hyperbilirubinemia)
- Medical Specialists
- Music Therapy
- Preterm Labor
- Respiratory Syncytial Virus (RSV) Infection
- Sensory Processing Disorder
- Support Groups and Social Support
American Academy of Pediatrics Section on
Ophthalmology, et al. (2006). Screening examination of premature infants for
retinopathy of prematurity. Pediatrics, 117(2): 572–576.
[Errata in Pediatrics, 117(4): 1468 and Pediatrics,
Other Works Consulted
American College of Obstetricians and Gynecologists
(2008, reaffirmed 2010). Late-preterm infants. ACOG Committee Opinion No. 404. Obstetrics and Gynecology, 111(4): 1029–1032.
Brazelton TB (2006). Prematurity. In Touchpoints, Birth to Three: Your Child's Emotional and Behavioral Development, 2nd ed., pp. 351–356. Cambridge, MA: Da Capo
Committee on Fetus and Newborn, American Academy of
Pediatrics (2007, reaffirmed 2010). Noninitiation or withdrawal of intensive care for high-risk
newborns. Pediatrics, 119(2): 401–403. Also available
Cunningham FG, et al. (2010). Diseases and injuries of the fetus and newborn. In Williams Obstetrics, 23rd ed., pp. 605–643. New York: McGraw-Hill.
Engle WA, et al. (2007, reaffirmed 2010). "Late-preterm" infants: A
population at risk. Pediatrics, 120(6):
Gaude AB, Martin RJ (2012). Control of breathing. In CA Gleason, SU Devaskar, eds., Avery's Diseases of the Newborn, 9th ed., pp. 584–597. Philadelphia: Saunders.
Mohan SS, Jain L (2012). Care of the late preterm infant. In CA Gleason, SU Devaskar, eds., Avery's Diseases of the Newborn, 9th ed., pp. 405–416. Philadelphia: Saunders.
Pignotti MS, Donzelli G (2008). Perinatal care at the
threshold of viability: An international comparison of practical guidelines for
the treatment of extremely preterm births. Pediatrics,