Other Health Problems

Anaemia

Premature babies often have a lack of red blood cells (anaemia) for several reasons:

• a baby's red blood cells have a shorter life span than an adult's red blood cells
• babies do not make many new red blood cells in the first few weeks after birth
• many blood samples are taken from premature babies to be used in essential laboratory tests

Treatment may include a blood transfusion or medication to increase red blood cell production. The baby may also need to take iron drops after discharge.

Infections in the Blood

Premature babies are at a greater risk of having a serious blood infection because their immune systems are not fully developed at birth. Newborn sepsis caused by group B streptococci (GBS) bacteria is nearly always passed from the mother around the time of delivery. However many preterm infants develop further infections during the first weeks of life and may require one or more courses of antibiotic treatment. Hand hygiene is particularly important to reduce the risk of infection.

Any baby who is suspected of having an infection will have a blood culture taken. A sample of the baby's blood will be taken using sterile procedures. This sample is then sent to the laboratory to see if any organisms grow. It can take a number of days for some organisms to grow and be identified. As it is sometimes difficult to determine whether a baby is infected and because babies who are infected often become quite ill, treatment may be started before the culture results are known. Babies are usually treated with two different antibiotics.

Intaventricular haemorrhage (IVH)

In the fetus and premature baby, the blood vessels in the brain are immature and quite fragile. After birth the premature baby's brain is exposed to changes in blood flow and oxygen levels. These changes may cause these blood vessels to break and bleeding to occur.
IVH is abnormal bleeding into the ventricles, or chambers, surrounding the brain. A haemorrhage is most likely to occur during the first days after birth but can also occur before birth and up to 2 weeks after birth. Many premature babies undergo a head ultrasound, usually within a week after birth, in order to detect IVH and other problems.

Minor degrees of bleeding usually do not cause long-term problem as the body reabsorbs the blood over 2 to 3 weeks.

Major bleeding can result in increased pressure in the ventricles, which can develop into hydrocephalus. Babies at risk of this condition have frequent ultrasounds to monitor the size of the ventricles.

Periventricular Leukomalacia (PVL) and parenchymal brain damage

These conditions are thankfully uncommon. There is damage to the tissue of the brain which is detected by formation of cysts or fluid filled spaces in the brain tissue. They can be caused by lack of oxygen, or haemorrhage or inflammation in the brain tissue. They usually only occur in premature infants.

Problems before delivery such as prolonged rupture of the membranes and intrauterine infection can increase the risk.

They can be detected by way of a head ultrasound. However, it may take several weeks to detect changes on ultrasound from PVL.

These conditions can cause long-term problems with muscle movement and coordination, vision, or intellectual development.

Low Blood Sugar

The amount of sugar in the blood may be too high or, more frequently, too low in premature babies. In most cases, blood sugar levels are easily corrected by increasing or decreasing the sugar concentration of the baby's IV fluids.

Blood sugar problems at this stage do not mean that your child will develop diabetes later.

Jaundice

Many babies develop jaundice, or yellow skin, in the first few days after birth. This is caused by high levels of bilirubin, which is produced when red blood cells are broken down.

Bilirubin is normally processed by the liver for elimination, but sometimes premature babies are not able to process it quickly enough. In any event, jaundice can be treated with phototherapy, a process using special lights to help break down bilirubin. In very premature babies phototherapy may be started soon after birth to prevent bilirubin concentrations from reaching excessively high levels.

Low Blood Pressure

Premature babies often develop low blood pressure just after birth. This can be caused by blood loss during delivery, fluid loss after birth, infection, or medications given to the mother before delivery.

Treatments include the provision of extra fluid to the baby, medication to increase blood pressure, or blood transfusion.

Necrotizing Enterocolitis (NEC)

Some premature babies have swelling in part of the bowel, causing the tissue to die in that area. Symptoms of necrotizing enterocolitis (NEC) include:

• general signs of being unwell
• green vomit after feeding
• increased stomach size
• red or abnormally coloured stomach
• blood in the faeces (bowel movement)

NEC can be a very serious condition. Doctors will immediately stop regular feeding and start feeding intravenously if this illness is suspected. The baby will also need X-rays, medication and frequent blood tests. Most babies with NEC recover and do not have any further difficulties, but some need surgery and may have future bowel problems.

Patent Ductus Arteriosus (PDA)

The blood vessel which connects the pulmonary artery (the main blood vessel in the lungs) to the heart, before birth, is known as the ductus arteriosus. This opening is necessary before birth, and usually closes up in the first few hours or days after delivery.

When it doesn't close by itself, the condition is called patent ductus arteriosus (PDA). If this happens, the doctor will prescribe medication to close it. If this is not successful, a simple operation will be needed. This may sound alarming but do not worry- PDA in premature babies is easily corrected.

Retinopathy of Prematurity (ROP)

Overgrowth of blood vessels in the eye, called retinopathy of prematurity (ROP), sometimes occurs in premature babies, especially in those born more than 10 weeks early.

An eye test is used to check for ROP. Doctors will decide whether the ROP will go away by itself or if treatment is needed. Severe ROP can lead to vision problems and even blindness. Treatment may involve laser therapy to destroy the overgrowth of blood vessels.

Temperature Regulation Problems

It is not unusual for a premature baby to be unable to maintain a regular body temperature for several days or weeks. During this time, extra care and attention are required to help control the baby's temperature, and during this time infants are usually nursed in incubators.