More and more, it seems children are being born before their due date.

Some of this increase in prematurity is due to infertility treatments, which often result in multiple births. This is common because more than one egg may be fertilized. In addition, there is a steady background rate of prematurity common in many societies.

The high survival rate of these infants and their great clinical outcomes mean that more parents and physicians have to understand how to manage these infants.

Dr. Ricki Goldstein, director of the Duke Special Infant Care Clinic, tells us how “premies are different” and how we should take care of them once they go home.

-- Dennis Clements, MD, PhD, MPH

Ricki F. Goldstein, MD

Bringing your premature baby home after several weeks or months in the hospital is very exciting -- but often overwhelming.

Premature infants (24-32 weeks gestation) are very different from full-term infants in their growth, nutritional requirements, medical needs, and behavior and development.

Often they are recovering from serious illness, and they can play catch up in growth and development for several months or years after discharge.

Premature infants develop for two to four months outside the womb. During this time, they are exposed to different types of stimuli such as light, noise, touch, and pain.

These stimuli make them very sensitive to similar types of stimulation after they go home. They benefit from being swaddled in a blanket in the early weeks and often prefer a quiet environment with dim lights to achieve a quiet alert state that is needed for feeding and staying calm.

Common Problems: Chronic Lung Disease and Acid Reflux

Premature infants can have continued medical problems after discharge. The most common problem is chronic lung disease -- sometimes called bronchopulmonary dysplasia (BPD).

BPD can occur because the infants still have some inflammation in their lungs and may require extra oxygen or medications to help them breathe comfortably.

The medications to treat this may be diuretics or water-elimination medicine to help keep fluid out of their lungs (Diuril, Aldactone, or Lasix), or medicines that they breathe which help keep their tiny airways open and decrease inflammation (Albuterol, Zopenex, or Pulmocort).

Another common problem in premature babies is excessive spitting or gastroesophageal reflux, more commonly called acid reflux.

Spitting up usually doesn’t bother full-term babies. But in premature babies, it may cause them to stop breathing or make their heart slow down. This can begin or get worse after discharge as the acid production in your baby’s stomach increases.

Reflux is often treated by thickening formula or breast milk, and with medicines that decrease acid in the stomach (Zantac or Prilosec) or that help prevent milk from coming back up (Reglan).

If your baby goes home on medicines for chronic lung disease or acid reflux, it is very important to give these medicines as directed, make sure you refill them when they are close to running out and have your pediatrician adjust the doses as your baby grows every couple of weeks for at least the first two to three months.

If your baby is sent home on a heart or breathing monitor, it is important to use it as directed.

Remember, just because the symptoms are gone that doesn’t mean the problem is better. It means the medicines are working.

These problems will resolve over time and the medicines can be stopped when your baby gets bigger and stronger.

Transitional Formula Helps Weight

Premature babies are always smaller than they should be for their age when they go home. To increase weight, they often need special transitional formulas (with higher calories) or added powdered formula if they are taking breast milk.

The most common transitional formulas are Enfacare or Neosure. If they had problems with tolerating milk protein or had a serious infection in their intestines (called necrotizing enterocolitis or NEC), they may drink a formula that is easier to digest such as Pregestimil, Neocate, or Elecare.

It is very important to mix the formula as instructed and to continue using it until your doctor says you should change.

Your premature infant should stay on infant formula until he is a year old from his expected birth date -- in other words, his age corrected for being premature. For example, if your baby was born at 28 weeks (three months early), he should continue formula until 15 months of age. This helps his bones develop properly.

Your premature baby may develop slower than a full-term baby. This is to be expected -- it may take up to two years to catch up with children who were born on their expected birth date.

Developmental delay can be more serious if your baby had bleeding in his brain or a stroke. Those born before 28 weeks gestation may not catch up until three years of age particularly with language development.

Premature babies may benefit from intervention services such as physical, occupational, speech therapy, or developmental therapy during the first couple of years.

It is important to have your child’s development followed in your hospital’s neonatal follow-up clinic.
-- Ricki F. Goldstein, MD, is director of Duke Special Infant Care Clinic (SICC), where they follow the medical and developmental progress of premature and other sick babies for the first two to three years. The SICC teaches parents what to do to help their babies develop as normally as possible and arrange for intervention services if needed. For more information call 919-681-6024.
-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics atDuke Children's Hospital.