319g Baby Survives And Thrives

Article from: The Daily Telegraph

A MELBOURNE miracle has been billed Australia’s tiniest tot.

Little Elora was the length of a pen and weighed less than a juicy orange when she was born, almost five months prematurely, at the Royal Women’s Hospital.

Today, the tot is thriving on Mum Adele’s milk, fed though a nasal tube.

From a red, scrawny scrap of near-life she has thrived to develop into a chunkier cherub.

Now, at eight-and-a-half months, she is 4.7kg – still half the average weight of four-week-olds who join her at weekly mother’s group meetings.

Elora is believed to be the smallest baby ever born to survive her desperate start in life.

Mum Adele De Bondi, a nurse, had known the likely consequences when major problems were diagonosed just over four months into her first pregnancy.

Anxious return trips to hospital over a fortnight did nothing to allay her fears.

“She was too small, too premature, to be viable, and I expected the worst,” Ms De Bondi said.

“But at the same time, my gut instinct was that this child would be a fighter and if she was allowed to be born, she would take it from there.”

Delivery was by caesarean section. Adele did not see her daughter until the next day when she was pushed in a wheelchair to gaze at the tiny tot struggling for life in a humidicrib.

“Her head was the same size as my thumbnail, but I bonded with her the split second I saw her fighting for life,” Ms De Bondi said.

“I was amazed and ecstatic and overawed she had survived the night, and I knew instantly and instinctively that she would survive.”

Born at just 319g, little Elora weighed less than a can of caviar or a tin of tuna, and lighter than a naval orange munched for a mid-morning snack.

“She was too critically ill for them to measure her, but my mother photographed her alongside a pen and they were roughly the same length,” Ms De Bondi said.

Elora has spent months in the Royal Women’s Hospital, fighting to survive and slowly winning.

“She rallied as she faced multiple problems, including two collapsed lungs and multiple pulmonary bleeds.

“Slowly but surely she started to gain strength, gain weight, and actually started growing.”

Today, at home in Balwyn with her single mum, the battler bub is showing her true colours.

“She sleeps soundly by night and is alert and inquisitive by day.

“She eats to make up for what she has missed out on and is going ahead in leaps and bounds.”

Ms De Bondi told of Elora’s fight for survival in the hope of attracting donations to the Royal Women’s Hospital neonatal and intensive care unit. Call the RWH Foundation on 9344 2006.

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Help on hand for families with premature babies

A NATIONAL organisation to support families with babies born prematurely was launched last weeks thanks to a dedicated and computer savvy-mum.

Julia Toivonen, 28, of Wantirna, worked solely on the National Premmie Foundation website – www.prembaby.org.au – and finished it last Thursday. The foundation was formed by six groups, including Melbourne’s Lifes Little Treaures, which Mrs Toivonen represents.

She also created the LLT website – www.lifeslittletreasures.org.au - and is in charge of maintaining the sites. She said the NPF would provide valuable support to families across Australia. “NPF will help people form their own support groups, provide information and interesting articles for parents to read, and raise funds for important research.”

Mrs Toivonen said many families caring for children with special needs were not aware that help was available. She knows only too well the difficulties a family faces after her son, Ronan, was born prematurely 18 months ago. He spent 100 days in hospital and had many complications, including chronic lung disease.

Crawling and walking are milestones in a child’s life, but for Ronan each one has proved a challenge. “He can crawl, but he can’t walk without something to hold onto”. The young battler has just started being able to sit comfortably after regular physiotherapy sessions.

Throughout her son’s development, she became motivated to help people in a similar situation and started a group called L’il Aussie Prems eight months ago. She also created a website dedicated to Ronan with pictures and updates on his progress.

He might not be able to walk unaided until he is two, but Mrs Toivonen has learnt to be patient.

Written by Will Wright – The Knox Journal

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Premmies On The Net

Something is wrong i said to my husband Mark, 29 as searing pain ripped through me. “I think the baby is coming”. It was mid March 2006 and i was pregnant with my first child, but at only 27 weeks along we weren’t expecting our bundle of joy just yet. But it didn’t really matter if we were ready or not because the very next morning our son, Ronan, was born prematurely.

Nothing could have prepared us for this sudden arrival… or the length hospital stay that ensued. Poor Ronan spent the next 110 days at Monash Medical Centre in Melbourne with chronic lung disease and other complications. It was a very difficult time for Mark and I. As my family lived in Sydney, I found a lot of our time was taken up calling relatives to keep them updated on Ronan’s progress. I’m going to start a web journal, i said to Mark. That way our family and friends can log on at any time to see how Ronan is doing. I got started and found the process quite therapeutic. www.totsites.com/tot/ronantoivonen

I was a long-time user of the internet. In fact that was how Mark and i met and we’d been together for eight years and married for three. As well as recording Ronan’s day-to-day progress, i began gathering information about premature births. I was shocked to discover there was very little information available for Aussie parents of premmie babies. There were plenty of overseas websites, but the majority of information and links were of no use to Australian parents.

`There’s not enough support for Aussie parents of prems’ i said to Mark after Ronan left hospital. `So i’m going to start a website just for them’. Several months later and i’d created my website, L’il Aussie Prems, at www.lilaussieprems.com.au. I loaded it up with all the information that i’d been searching for when dealing with Ronan’s premature birth. And i must have hit a chord, because it’s become a huge success. The forum has been particularly popular as it allows parents and family members to discuss issues and ask questions. I’ve been working extremely hard to get the word out and i’m so proud that Australian parents of premmie bubs now have a website that’s got all the information they need.

Article from issue #41 – That’s Life Magazine.

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Rethink on breastfeeding, allergy link

TONY EASTELY: Australian researchers say if mothers exclusively breastfeed their babies and there is a family history of allergies, it may actually increase the babies’ chances of developing allergies in later life. The study authors say while breastfeeding has many other benefits, it will not protect children against asthma and allergies in the long-term. But some experts aren’t so convinced and they say the results of the study are inconclusive. Barbara Miller reports.

BARBARA MILLER: The current recommendation is that babies should be exclusively breastfed for six months. One of the most-cited benefits of the breast is best policy is that breastmilk helps protect against allergies.

But researchers from the University of Melbourne, who’ve carried out a longitudinal study on 8,500 people, say that’s not necessarily the case for babies where there’s a family history of allergies. Dr Melanie Matheson from the University’s School of Population Health.

MELANIE MATHESON: We found that breastfeeding in the first three months of life protected against asthma and allergic disease before the age of seven but it no longer protected against those conditions after the age of seven. Our study followed our cohort up until the age of 44 and we found that the risk of asthma and allergic disease continued to increase right up into middle age.

BARBARA MILLER: The researchers say the increased risk is small, but they say their work does call into question the current guidelines on breastfeeding. But some experts say the work is inconclusive. David Thomas is Chair of the Child Youth Health Committee at the Australian Medical Association.

DAVID THOMAS: Their study really needs to examine whether they’ve looked at all other external variables. Allergies later in life can be predisposed to by a number of other environmental impacts which are quite independent of breastfeeding. So, if they’ve found an association, they really need to look at all the other factors ’cause it may or may not be related to breastfeeding.

BARBARA MILLER: That’s a view shared by Dr Andrew Pesce, Clinical Director of Women’s Health at Westmead Hospital in Sydney.

ANDREW PESCE: Children who are exclusively breastfed are often being looked after in the home by their mother. They may have a lower incidence of going to childcare early in life and being exposed to various infections in life. Those infections may challenge the immune system and have effects, both harmful and beneficial possibly, that we don’t fully understand. Hygiene is another thing.

So, you know, there are a whole lot of potential compounding factors which make it really difficult to know what aspect of the breastfeeding and the link to allergies story is breastfeeding alone.

BARBARA MILLER: Do you think that women should change their behaviour based on the results of this study?

ANDREW PESCE: Look no. I think that, you know, this is an incremental addition to the understanding that the researching scientists are giving us and there’s nothing in this information which would make a woman have to think that she has to, you know, change what she’s been doing so far.

TONY EASTELY: Dr Andrew Pesce, Clinical Director of Women’s Health at Westmead Hospital. That report by Barbara Miller.

Transcript from ABC AM radio 

Jane Hansen – Every parent’s nightmare

AT 12.10pm, on December 13, 2003, I lay under an enormous operating light. Through tears welling in my eyes, I counted 12 people fussing. Nurses, anaesthetists, neonatal staff, obstetric team. Two teams: one for me, one for my baby.
When I looked at the intensive care cot being readied in the corner, I shook with fear. It just didn’t feel right. It’s too soon, the words kept going around in my head. It’s too soon. Dr Brieger took my hand and squeezed it.

“How many 26-weekers have you delivered?” I asked through tears.

“Heaps,” he said reassuringly.

“How many have survived?” I asked.

“All of them,” he said, and I knew he was lying, telling me what I wanted to hear.

Jackson Nelson Fisher was born in Sydney’s Royal Prince Alfred Hospital at 1.20pm. He weighed just 958g, two pounds on the old scale. They wheeled me to my room and Andrew bounded in like an excited labrador puppy. “Oh Jane, he’s beautiful,” he said, so terribly excited and as proud as any father could be. Andrew had always been a naturally optimistic person, a Tigger to my Eeyore.

All I could think was that Jackson only had an 80 per cent chance of survival. While 80 per cent may be good in any other setting, if your child has a one-in-five chance of dying, that’s just too bloody high odds.

I was pushed along in my bed to the neonatal unit. It was like a futuristic cloning lab, with eight humidicribs dotted around the brightly fluorescent-lit room. Inside each makeshift plastic womb were tiny, tiny babies clinging to life. The air carried the distinct smell of antibacterial handwash, the hiss and hum of the ventilators punctuated regularly with the pinging of various alarms. They pulled my bed alongside Jackson’s humidicrib. I strained to see through the plastic sides, which were opaque with condensation. Jackson’s skin, still transparent, just wasn’t ready for the outside world yet. They had painted him with medical-grade lanolin to keep his body heat in. The nurse wiped the inside of the plastic so I could see my son better. Through the pills of moisture I saw my baby boy – my tiny, tiny, tiny boy. His head and body together were the size of my hand with skinny little legs flayed out to the side, but he was just beautiful with long fingers and a head of dark hair. There were so many wires and tubes hooked up to him; I could barely see his face. I put my hand through the porthole to touch him. His tiny fingers grasped my index finger and hung on for dear life. I fell hopelessly in love.

December 15. Two days old. You have EEG pads attached to your head, monitoring for any brain bleeds. A ventilator tube down your nose, and tubes coming out of what’s left of your umbilical cord. You’re wiggling around like no-one’s business and you keep kicking away your tiny nappy. I have only held your hand but I wish I could cuddle you with all my heart. Your nurse says you’re quite a fighter and strong-willed. You keep pulling the electrodes off your head! By early evening you wouldn’t settle. The nurse suggested I put my hands in and lay them across your legs and your arms and chest, to hold you “in”. It seems to work; you visibly relax.

Most premature babies die in the first week of life. For the first time in my life, I felt real fear; knee-shaking, breath-quivering fear as I tried to comprehend the minefield that was laid out before this little baby, no bigger than a Coke can. First there was the risk of brain haemorrhage. Were there to be a bleed, he might end up with cerebral palsy, or it might kill him. His lungs were bad. Before 28 weeks, the millions of tiny sacs that make up lung tissue are not yet formed and collapse on each other, causing “respiratory distress syndrome”. And for every life-saving treatment or drug, there was a downside. The ventilator can damage the fragile, half-formed lung tissue; getting off it quickly is important. The extra oxygen used to compensate for bad lungs can cause eye damage, even blindness. It might be necessary to use steroids to help his lungs but they can affect brain development. There was a valve open in his heart that was supposed to be shut, and this was making his lungs worse. He would need drugs to close the valve and, if that didn’t work, surgery might be necessary. And hospitals are full of bugs, humidicribs a prime breeding ground. Almost all premature babies get an infection. They’re sitting ducks.

December 16. Three days old. I’m feeling very sad today that my body let you down and you found yourself out in the world far too soon . . . all I can do is hope you find the strength to battle, which is a very big ask for such a little boy. If you can get through this you can get through anything, my little one. I love you so much. It’s amazing how nothing else matters anymore. I haven’t even read a newspaper yet. Saddam was caught – on your birthday! Big deal! You’re the most important thing now. I watch your chest rise up and down and pray with each breath you get stronger and bigger. We have wonderful things planned for you.

Jackson’s lungs were the major issue. We agreed to start steroids on day eight to help him off the ventilator. His breathing improved, but then he became anaemic. He needed a blood transfusion; it felt like one step forward, two steps back. Finally he got off the ventilator and on to a contraption known as CPAP – continuous positive air pressure. He hated it – it must have been like hanging your head out of a car at 100km/h. If Jackson didn’t like something, the fight was quite extraordinary. Thrashing around, crying and pushing hands away. But as distressing as it was to watch, it was the fight in him that gave me the most hope.

On Christmas Eve, 11 days after his birth, I finally got to cuddle my baby. The nurses juggled all the wires and tubes and placed him in my arms. He was so light, so tiny and I couldn’t stop the tears, they dripped all over his little head and then he just went to sleep in my arms.

He grew gram by gram. Day after day, week after week I sat with him, willing him to grow bigger, reading him chapters of Winnie the Pooh so he would get to know my voice. After six weeks, on his last day in intensive care, my parents came down from Queensland. When Mum saw him, still a tiny 1700g, tears sprang from her eyes. She had never seen such a small baby. He was moved to the next level of care that day, a step down, and the mood was immediately lighter.

Jackson needed oxygen piped through nasal prongs to help him along and it meant he had no chance of getting home until he was at least 100 days old. Life had become a routine of waking up at 2am and 6am, expressing milk, ferrying it to the hospital, spending all day with Jackson, Andrew popping in after work and then me coming home late at night. The nights were hard. More than once I woke up in a sweat, heart banging in my chest, frantically looking for my baby.

March 23, 2004. 100 days old. When I walked in this morning you had a banner above your bed: “Happy 100th day Jackson”, complete with balloons. The lovely nurses did that for you. I brought in a chocolate mudcake and we all sang Happy Birthday to you – I cried. I can’t believe what you’ve been through and I can’t believe you made it.

April 9, Good Friday. You’re home! We walked in the door and put you in your pram and both cried. I feel relieved, scared, frayed, and altered by the whole experience. You’re home now, my darling, bless you and this house and I thank God for answering all my prayers. Your discharge weight: 2.49kg – five pounds.

Autumn in Sydney is spectacular. I hooked up the portable oxygen tank and went for a walk along the harbour foreshore each morning, taking in the sunshine. It had always been my favourite time of year and now it was just perfect. I was so excited about showing Jackson the world: the green grass, the trees, the blue harbour, the boats. But he loved his walks so much that as soon as I got him out the front door he’d shut his eyes and snooze for the duration.

May 10. You smiled at me today for the first time. You looked up at me, smiled and cooed. I got a tear in my eye. Very, very rewarding and oh, what a smile.

A few weeks after my 40th birthday, Jackson slowed down again. It took an hour to feed him a bottle of expressed breast milk one morning. The next day in hospital he threw up his milk and appeared to be choking. The fear and panic in his eyes rocked me to the core. He went into respiratory failure. Dr Osborne, the neonatal paediatrician on call that weekend, said we would have to ventilate him. From the corridor outside the neonatal intensive care unit, I heard my son scream like never before and then there was quiet. I collapsed into Andrew’s arms; fear had taken my breath away.

Jackson stayed on the ventilator for ten days. Doctors theorised he had had his first cold. He was now five months old, or “two months corrected”. We had to stay in hospital until he fully recovered and during this time he entered that wonderful phase of gurgles and giggles. He had a smile for all his favourite nurses. I passed the long hours drawing him pictures to stick on the plastic sides of his cot. I drew elaborate snails and ladybirds. He’d open his eyes and see his new picture and a big smile would spread over his gorgeous little face.

After five long weeks, we were told it was time to go home again. As soon as we got home, though, I could see fear in his eyes again. He was having what looked like panic attacks. He wouldn’t take his evening feed. Something wasn’t right.

As I wheeled Jackson back into his old ward, I looked down at him and he was looking up at me, smiling a strange, knowing smile. Cheeky monkey! Tests showed he was on the brink of another respiratory failure. Plans were made to transfer us to Westmead Children’s Hospital as soon as possible.

June 28. The head of ICU says you’re on a knife-edge, a cliff, lots of analogies, but perilous is the best word to describe this dreadful combination of chronic lung disease and pulmonary hypertension. I’ve spent all day trying to keep you calm when my own knees were knocking under the cot. I have faith in you to pull through this, you’ve shown me many times you desperately want to be here. My job is to help you do so. Now, hurry up and get well, little man.

On June 30 they found Jackson had acquired septicaemia; the dreaded superbug golden staph had entered his bloodstream. It is a killer infection and he was already on his knees. I only had one page left of the journal I had been keeping ever since I fell pregnant. It simply couldn’t end there. Jackson remained in a drug-induced coma for weeks, hanging on precariously. My arms ached from not being able to hold him.

July 2. I spend my days here with you, humming songs, laying my hand on your head and just letting you know I’m here. I keep telling you I’m here and that soon we’ll go to the beach with a bucket and spade and have a nice time. There are wonderful gifts to be had in life. I fear all these drugs, etc, may have an effect on you. It won’t stop me loving you, but I hope you never suffer any cruelty.

July 19. In seven months, you’ve had just six weeks at home. It’s so depressing when I think about it, so it’s a good idea not to think about it. You’ve been ventilated now for 25 days.

The next morning, the specialist walked into Jackson’s room accompanied by palliative care expert and intensive care specialist Dr Jonathan Gillis. “There’s no real improvement,” the specialist said softly. “We’re going to keep treating him, but I think he’ll probably die.” Dr Gillis sat there, shaking his head.

“What?” I couldn’t believe my ears.

“I think he will probably die,” he repeated, again softly, but there was nothing soft about those words.

July 20. I don’t want to commit to writing what the doctor said today, but it wasn’t good. You discovered sticking your tongue out and in and it’s fun. I think you even smiled this evening. I was sticking my tongue out and you were sticking yours out and you found it funny. Precious boy. These moments are so special. Your dad and I have to reaffirm our faith in you. Your dad says if anyone can make it, Jackson can.

Jackson got another serious infection, and again he was put into a drug-induced coma for his own survival. Days turned into more weeks. Andrew took time off. We moved into a family room in the hostel and we split the 24-hour bedside vigil.

Paediatric intensive care wards are scary places. The children are too sick to cry. The only cries you hear are from desperate parents facing their worst nightmare. I mastered the silent scream in that toilet down the hall to let the madness out.

On August 9, we got “the talk” from Dr Gillis. He spoke in the hushed tones we had grown to hate. “Look, this isn’t working. He’s in 100 per cent oxygen, his pressures are high, he has five chest drains in, he is in a coma. He can’t climb out of this,” he said. We knew we were being asked to consider what no parent should ever, ever have to think about: turn off the life support on our own child. No, no, no, no, no. Never . . . I just have to get him out of here. He’s only eight months old.

“This is not acceptable,” I said with hushed outrage, my fists clenched.

“Of course it’s not acceptable,” he replied, like that somehow made sense.

August 24. I climb into bed with you each morning and attempt to give you a cuddle as best I can. I hold your hand with one hand and put my other hand under your right leg and buttock and I put my lips to your head and dream that we’re at home and you’re in bed with me having a morning cuddle. As I write this I feel so ripped off. Why? I’m so angry at the world, I want to absolutely pull my hair out and yell and scream and kick. Why. Why, why?

On August 29, Jackson’s temperature was high and despite the multitude of painkillers, he was crying – hard. He hadn’t really cried at all for the whole 9½ weeks out at Westmead, his personality bombed out on diazepam, morphine, clonidine and more. Now, he was crashing fast. He would probably have a cardiac arrest within the day. Jackson quieted for a moment and looked up at me, a long, long look with his beautiful grey eyes. I instinctively knew he was saying goodbye. Tears welled in my eyes.

Andrew did the night shift and went to bed at 6am. I woke him at 10am. We went to a little room down the corridor from Jackson’s room. There we made the only loving decision we thought we could – to sedate him, hold him, love him and let him go peacefully.

I held Jackson’s hand. Andrew found the doctor he liked the most. “We can’t do this to him anymore,” he stammered. The doctors and nurses moved quickly. They closed the curtains with the cartoons all over them. It was a sign we had seen many times in that ward, a sign that all had failed. They placed my precious baby in my arms. It had been such a long time since I held him. I sang to him. Andrew, sitting next to me, broke down. I told him not to cry yet. I tried to hold it together so Jackson would not know.

I don’t remember how long we sat there. The world stopped. Jackson’s world. Our world. I felt him leave, though, and he had the life force of a giant. He so wanted to live. Then the tears finally came.

It grew dark, and it was raining outside. The window reflected the image of me holding my own baby. I was rocking, the way a mother instinctively does. The image that stared back at me, it was so inconceivable. I could see the horror in my own eyes.

That Christmas, I had my first Jackson dream. I went sleepwalking, looking for him. When I couldn’t find the bassinette, I went to Andrew’s side of the bed, frantic, and woke him. “I can’t find Jackson,” I said with panic. “I know,” he said sadly. I woke up at that point and remembered he was dead.

A few days later, I discovered I was pregnant. I felt pure terror, but also a fragile glimmer of hope. Maybe there could be a life worth living after all. It had only been four months since we lost Jackson. Plenty of people said it was too soon. But I was grateful. I knew I would grieve Jackson for the rest of my life – nothing would change that.

August 29, 2005. My darling Jackson, a year has passed since I held you in my arms that dreadful afternoon. I would have thought the passage of a year would lessen the pain. It has not. I miss you, long for you. Your loss created a beast I had to learn to live with – grief. I fell pregnant shortly after losing you – too soon no doubt, but Andrew and I told each other you had something to do with it. On 20 July your baby brother was born. He has everything I failed to give you: his health from being born full-term. Samuel makes me smile, but he is not a replacement for you. I love him very much and I’m so glad I faced this day with him in my arms. The hope he has given me is so, so important.

I’m so tired now, little man, emotionally drained by the events of the past year. I don’t know if I’ll ever be whole again – all I know is that I miss you terribly. It scares me sometimes that I’m starting to forget little bits; I try hard to keep memories alive. It’s such a double-edged sword – the pain is alleviated with some memory loss, but memory is all I have left. n

Edited extract from Three Seasons by Jane Hansen (Macmillan), published September 25.

Article from: Courier Mail

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Premature Birth

Premature birth
From MayoClinic.com
Article from CNN

Most babies are born about 40 weeks after the first day of their mother’s last menstrual period. But about one in eight babies arrives sooner, according to the March of Dimes. A birth that takes place more than three weeks before the due date is considered a premature birth.

A premature birth gives a baby less time to develop and mature in the womb. The result is an increased risk of medical and developmental problems, including underdeveloped lungs. If you go into labour too early, your doctor may try to delay your baby’s birth. Even a few extra days in the womb can promote significant development.

The rate of premature birth has grown by more than 30 percent in the last 20 years, according to the Institute of Medicine. Thankfully, a healthy lifestyle can go a long way toward preventing preterm labour and birth.
Signs and symptoms

Prompt recognition of preterm labour may help you prevent premature birth. Even months before your due date, be on the lookout for:

  • Regular contractions of your uterus (You’ll feel a tightening sensation in your lower abdomen, often reminiscent of menstrual cramps.)
  • Low, dull backache
  • A sensation of pelvic pressure
  • A tightening sensation in the thigh
  • Vaginal spotting or bleeding
  • Watery vaginal discharge (This may be amniotic fluid, which surrounds your baby in the womb. A leakage may indicate that the membranes around your baby have ruptured.)

If you suspect you’re in preterm labour but haven’t had a watery discharge, stop what you’re doing and rest. Pay attention to what you’re feeling. If you have regular contractions 10 minutes apart or less, contact your doctor or go to the hospital. If you’re having contractions but they’re irregular or more than 10 minutes apart, drink two or three glasses of water and lie down on your left side. This helps improve circulation to your uterus and may stop contractions.
Causes

Some women who go into preterm labour do so for unknown reasons. Other women may have a medical condition that contributes to early labour, such as:

  • Ruptured amniotic sac. Normally, the fluid-filled sac that surrounds your baby in the womb ruptures during labour or just before labour begins. But sometimes the sac may rupture for no apparent reason weeks or even months before your due date. In that case, there’s a high risk that labour will begin within a few days. A ruptured amniotic sac also increases the risk of infection for both you and your baby.
  • Certain infections. Infections of the cervix or urinary tract are associated with preterm rupture of the membranes and preterm labour.
  • Weak cervix. In a normal pregnancy, the cervix softens late in pregnancy and opens (dilates) in response to uterine contractions. But for some women, the cervix opens earlier — perhaps due to the weight of the baby and amniotic fluid. This problem can be associated with previous surgery involving the cervix, such as a dilation and curettage (D and C) or a cone biopsy. It’s somewhat more likely to occur when you’re pregnant with twins or other multiples.
  • Certain chronic diseases. Diseases such as high blood pressure, diabetes, kidney disease and lupus may increase the risk of preterm labour. If complications arise, labour may need to be induced early.
  • Uterine abnormalities. An abnormally shaped uterus may increase the risk of preterm labour.
  • A previous premature delivery. Women who’ve had a premature delivery are at higher risk of preterm labour. For many women, though, early labour happens only once.
  • Substance abuse. These include smoking, drinking alcohol or using illicit drugs.
  • Malnutrition. Women who are undernourished or anemic are more likely to give birth prematurely.
  • Excess amniotic fluid. Too much amniotic fluid can contribute to early labour.

When to seek medical advice

Good prenatal care includes regular visits to your doctor throughout your pregnancy to check on both your health and your baby’s health. If you’re at risk of preterm labour, your doctor may recommend more frequent visits.

If you develop any signs or symptoms of early labour — such as bleeding with cramps and pain, a watery vaginal discharge or regular contractions 10 minutes apart or less — call your doctor or hospital right away. It’s a good idea to keep these phone numbers handy so that you can find them quickly.
Screening and diagnosis

If preterm labour seems likely, your doctor will check to see if your cervix has begun to dilate and whether the fetal membranes have ruptured. The duration and spacing of your contractions may be closely monitored. In some cases, your doctor may use ultrasound to monitor the length of your cervix. A swab from the cervical canal may be tested for the presence of fetal fibronectin, a glue-like tissue lost during labor.

If you’re in preterm labor, you and your doctor will discuss the risks and benefits of trying to stop your labor.
Complications

Preterm labor and birth may have various complications.

For mothers
Preterm labor doesn’t pose greater physical risks than later labor, unless it’s the result of another problem — such as a uterine infection. But all treatments used to delay delivery carry some risks.

Medications that halt uterine contractions may cause fluid to collect in your lungs, which can make it difficult to breathe. Other side effects depend on the medication used to stop labor. Some medications can lead to fatigue and muscle weakness. Others may cause a rapid heart beat, blood sugar abnormalities or stomach ulcers.

You and your doctor will need to consider your own potential risks from medications used to stop labor, as well as possible risks to your baby if he or she is born too soon.

For babies
If your baby is premature, how well he or she will thrive depends largely on gestational age at birth. Risks are greatest for the youngest babies.

Survival is possible for babies born as early as 23 to 26 weeks, but these preemies may face a lifetime of health problems — including cerebral palsy, fluid accumulation in the brain (hydrocephalus), seizures, lasting neurological problems or developmental delays. Others will have less serious chronic problems, such as vision problems or mild developmental delays.

Premature babies are also at risk of other conditions:

  • Bleeding in the brain (intracranial hemorrhage). If this occurs, it’s usually in the first week to 10 days of life. The more severe the bleeding, the greater the likelihood that the child will develop serious problems, including developmental delays, seizures, learning disabilities and fluid accumulation in the brain.
  • Retinal problems. Another complication seen in the youngest and most vulnerable premature babies is retinopathy of prematurity (ROP), an abnormal growth of blood vessels in the retina — the light-sensitive inner lining of the eye. ROP probably occurs because the vascular system in the baby’s eye hasn’t fully developed. Many cases of ROP improve on their own, but the condition can lead to scarring or some degree of vision impairment. The most serious cases may be treated with laser surgery to help prevent retinal detachment.
  • Intestinal problems. Preemies also have an increased risk of a potentially severe intestinal problem known as necrotizing enterocolitis (NEC). In the most serious cases, this condition can be life-threatening. Infants who have NEC need to be fed intravenously and given antibiotics.
  • Sudden infant death syndrome (SIDS). Premature babies have a higher risk of SIDS, the sudden and unexplained death of an infant during sleep.

For some premature babies, difficulties may not appear until later in childhood. Not performing well in school is often a prime concern.

But not all preemies have medical or developmental problems. By 28 to 30 weeks, the risk of serious complications is much lower. And for babies born between 32 and 35 weeks, most medical problems are short-term.
Treatment

Treatment may focus on women in preterm labor, on babies still in the womb or on newborns in hospital neonatal (newborn) intensive care units (NICUs).

For mothers
If you’re experiencing preterm labor, treatment depends on your stage of pregnancy and how far labor has progressed. Sometimes bed rest and extra fluids are enough to stop premature contractions.

If you have a weak cervix early in pregnancy, a surgical procedure known as cervical cerclage may help prevent preterm labor. Using strong sutures, your doctor stitches the cervix closed. The sutures are removed in the last month of pregnancy.

In other cases, your doctor may recommend medication. These may include terbutaline (Brethine), a medication that relaxes smooth muscles — including those of the uterus — or the muscle relaxant magnesium sulfate. Sometimes medications that block the calcium channels in muscle cells can stop contractions. So can drugs that block the production of substances that stimulate uterine contractions (prostaglandins), such as ibuprofen (Advil, Motrin, others) or indomethacin (Indocin).

Medications often stop labor only briefly, however — perhaps long enough to accomplish other goals, such as transferring you to a facility better equipped to care for a premature baby or allowing use of other medications that have a beneficial effect on the baby.

For babies in the womb
If preterm delivery is likely, you may be given medications to help prepare your baby for birth. Corticosteroids such as betamethasone and dexamethasone can help speed your baby’s lung maturity in as little as 24 to 48 hours. After week 34, steroids aren’t typically needed because lung development is more advanced.

For newborns
Hospital NICUs are designed to provide care for premature babies and full-term babies who develop serious problems after birth. In the NICU, babies receive round-the-clock intensive care from doctors, nurses and respiratory therapists specially trained to care for newborns with medical problems.

In the NICU, your baby will probably be kept in an incubator — an enclosed plastic bassinet that’s kept warm to help your baby maintain normal body temperature. Because preemies have immature skin and very little body fat, they often need such care to stay warm.

Sensors may be taped to your baby’s body to monitor blood pressure, heart rate, breathing and temperature. Caregivers may also use ventilators to help your baby breathe. This high-tech equipment may seem overwhelming at first, but it’s all designed to help your baby.

At first your baby may receive fluids and nutrients through an intravenous tube. Milk feedings may be given later through a tube passed through your baby’s nose and into his or her stomach. When your baby is strong enough to suck, breast-feeding or bottle-feeding is often possible. The antibodies in breast milk are especially important for premature infants.

Your baby’s caregivers will help you learn how to touch and eventually hold and feed your baby. Talking or singing softly to your baby, or just providing quiet company, can give great support and comfort.

Taking your baby home
Premature babies are ready to go home when they no longer require continuous hospital care, when their body temperature is stable at room temperature and when they feed well enough to gain weight. Your baby need not reach a specific weight or age before going home.

Your baby’s doctor will provide guidelines on how to care for your baby at home. Keep in mind that preemies are more susceptible than are other newborns to serious infections, and their illnesses tend to progress more quickly. Schedule frequent checkups for your baby. Routine checkups are a great time to ask questions about caring for your baby.
Prevention

A healthy lifestyle can go a long way toward preventing preterm labor and birth.

  • Seek regular prenatal care. Mention any signs or symptoms that concern you, even if they seem unimportant.
  • Eat healthy foods. During pregnancy, you’ll need more folic acid, calcium, iron, protein and other essential nutrients. A daily prenatal vitamin — ideally starting before conception — can help fill any gaps.
  • Manage chronic conditions. Remember, uncontrolled diseases such as diabetes and high blood pressure increase the risk of preterm labor. Work with your doctor to keep any chronic conditions under control.
  • Limit stress. Set reasonable limits — and stick to them. Set aside some quiet time every day. Ask for help when you need it.
  • Follow your doctor’s guidelines for activity. If there are problems with your pregnancy, your doctor may suggest working fewer hours or spending less time on your feet. Sometimes it makes sense to scale back other physical activities, too.
  • Ask your doctor about sex. Sex may be off limits if you have certain complications — such as vaginal bleeding or problems with your cervix or placenta.
  • Avoid risky substances. Smoking may trigger preterm labor. Alcohol and recreational drugs are off limits, too. Even over-the-counter supplements and medications deserve caution. Get your doctor’s OK before taking any medications or supplements.

Some research suggests that the hormone progesterone may prevent preterm labor in women at high risk. If you’re a candidate for this treatment, your doctor may recommend weekly progesterone injections. Although promising, the effectiveness of progesterone treatments in preventing preterm labor isn’t yet clear.

It’s also important to take care of your teeth. Although a 2006 study found that treating gum disease by cleaning the teeth above and below the gums doesn’t reduce the risk of premature birth — negating the recent association between gum disease and premature birth — good dental hygiene remains an important part of proper prenatal care.

Coping skills

Caring for a premature infant can be a great challenge. You may be anxious about your baby’s health and the long-term effects of premature birth. You may also feel angry or guilty. Sudden hormonal changes after pregnancy may trigger anxiety or postpartum depression.

You may find it hard to establish milk production if your baby is too small or requires too much support to breast-feed at first, and you may need more time to recover physically than you expected. Fatigue is inevitable. Long hours in the hospital with your baby are exhausting, and caring for a preemie at home may leave you little time to rest.

Some of these suggestions may help during this difficult time:

  • Learn everything you can about your baby’s condition. In addition to talking to your baby’s doctor and other caregivers, read books on premature birth and look for information on the Internet.
  • Take care of yourself. Get as much rest as you can and eat healthy foods. You’ll feel stronger and better able to care for your baby.
  • Establish your milk supply. Use a breast pump until your baby is able to breast-feed. Ask the hospital staff for help, if needed.
  • Seek good listeners for support. Talk to your partner or spouse, friends, family or your baby’s caregivers. If you’re interested, your baby’s caregivers may be able to suggest a support group in your area. Many parents find it particularly helpful to talk to other parents who are caring for a preemie.
  • Accept help from others. Allow friends and family to help you. They can care for your other children, prepare food, clean the house or run errands. This helps you save your energy for your baby.
  • Keep a journal. Record the details of your baby’s progress as well as your own thoughts and feelings. Include pictures of your baby so that you can see how much he or she changes from week to week.