51. Prematurity – Dr. Seth Langston, MD

Imagine you’re 30 weeks pregnant and your water breaks. You call your doctor and are instructed to go to the hospital as you may be in preterm labor. Perhaps you’re at 25 weeks gestation and your blood pressure is too high, a concern for the pregnancy-related disorder pre-eclampsia. Again, your doctor insists you go to the hospital for inpatient monitoring. Despite multiple medications to lower your blood pressure it remains elevated, and you are told the next best option for both mother and baby is to deliver. These scenarios occur regularly. Nobody expects to have a preterm baby and to say it’s an overwhelming experience is an understatement. However, with modern day health care and the neonatal intensive care unit (NICU), a preterm baby can have an exceptional life characterized by bravery and resiliency.

Approximately 15 million preterm babies are born annually worldwide. The causes for preterm

delivery are vast and are generally considered to be from either maternal (the mother) or fetal (the baby) causes. Preterm babies are those born before 37 weeks gestation with the youngest known to have survived being 22 weeks. When born at the earliest of ages and smallest of sizes, preterm babies have some of the largest hurdles to overcome. This includes babies born at the edge of viability, known as periviable, and encompasses those born between 22- and 24-weeks gestation. Prematurity at these extremes requires thoughtful and serious conversations, but these babies can go on to survive and thrive. On the opposite end of the spectrum are late-preterm infants, which are born between 34 weeks and 36 weeks and 6 days. These babies are expected to do quite well but have their own set of challenges. In best case scenarios, a 35 or 36-week baby may not require admission to the NICU, while those born at 34 weeks generally require some assistance and monitoring in the NICU.

When faced with preterm delivery, expectant parents generally meet the NICU team before the delivery in the form of a prenatal consult. This consultation allows the NICU care team to discuss the NICU’s role at the time of delivery, commonly encountered problems preterm babies face, and the risks and general outcomes expected at the anticipated gestational age. The level of detail provided can be entirely dependent on what the family wants to know. Some families rely on statistics and numbers to feel more informed whereas other families seek generalizations to feel at ease. However, most families share similar concerns:

“Will my baby survive? Will my baby be okay?”

“What are the risks of delivering this early?”

“What will my baby’s future development be like? How will they be affected?”

“How long will my baby be in the NICU? Can I visit?”

“How will I breastfeed? Will I be able to do skin-to-skin?”

The answers to some of these questions are dependent on co-existing pregnancy complications, the gestational age of the baby, and estimated weight at time of delivery. Preterm infants require care in the NICU because of developmental immaturity. This can cause issues with breathing and feeding, unstable blood sugars, inability to maintain body temperature, jaundice, and even infections. Answers regarding outcomes such as survival and development are provided from local, national, and even global outcomes observed in preterm babies. Although we have a lot of information at our hands, it’s important to keep in mind that so much of what ultimately affects a preterm baby’s outcome is how they do following delivery and while in the NICU.

It can feel disempowering to have a preterm baby. Your birth plan and expectations suddenly change and necessary decisions you never thought about are suddenly at the doorstep. A team of medical professionals cares for your baby instead of you. There are tubes and wires you never thought you’d see attached to your baby. It’s an adjustment and may not be an easy one. However, families are supported every step of the way in the NICU and encouraged to be actively involved in their child’s care. Resources include social workers and family support groups that consist of previous patients’ families. Parents are encouraged to participate in daily care of their baby, including temperature checks and diaper changes. When medically feasible, skin-to-skin is highly encouraged, allowing for a bit of the normalcy expected after having a baby. Although the doctors and nurses know the medical side, parents know their babies and have as important a voice and opinion in the care their baby receives.

Having a preterm baby can be a rollercoaster ride: There are good days in the NICU and there are bad days; sometimes it feels like your baby takes two steps forward and three steps back. This is normal and something most preterm babies must deal with. Know they are doing their best and just need a little support to cross that finish line of going home. We celebrate the small victories and achievement of various milestones. For the staff, watching preterm babies meet the milestones needed to be discharged from the NICU is a privilege. After weeks to months of managing the challenges of prematurity in the NICU, having a baby graduate is a victory for everyone, but especially the family. Once home, they’ll generally follow-up in a clinic for NICU graduates to closely watch growth and development. The relationships and connections families form with the staff and other families lasts beyond the NICU, providing a lifelong network and support system. Although having a preterm baby may be frightening, there is a dedicated team to help guide you and your family through the process and deliver the highest quality of care. There is a reason preterm babies are referred to as warriors and heroes. Their uphill climb is tough and filled with obstacles, but they can persevere and show they’re able to thrive.

Seth Langston is a board-certified neonatologist currently working in Los Angeles, CA. Originally from Houston, TX he moved to Southern California for medical training and couldn’t seem to leave. His scholarly pursuits include teaching medical students and residents, as well as studying and minimizing health disparities within neonatology. In his free time, you will find him exploring good eats in Los Angeles, learning Italian, or working in the garden.