Common Problems of Premature or Sick Infants

Many premature babies have breathing problems. This is because their lungs are not as fully developed as a full-term baby’s. Many babies in the NICU and SCN will need to be put on a ventilator, a machine that helps with breathing.

• Respiratory distress syndrome (RDS). This is a breathing disorder in premature babies that is most often caused by their inability to produce surfactant [ser-FAK-tuh nt]. Surfactant is the fatty substance that coats the tiny sacs in the lungs to keep them from collapsing. Other causes of respiratory distress can be infection or breathing meconium [mi-KOH-nee-uh m] or fluid into the lungs.
• Apnea, bradycardia, and desaturation. Sometimes, a premature baby stops breathing for short periods of time. This is known as apnea [AP-nee-uh]. Apnea is often accompanied by a slower-than-normal heart rate called bradycardia [brad-i-KAHR-dee-uh]. Apnea and bradycardia may be associated with desaturation [dee-sat-yuh-REY-shuh n], which means a low level of oxygen in the blood.
• Pneumothorax. When a baby has trouble breathing, one possible complication is a pneumothorax [noo-muh-THOWR-aks]. A pneumothorax results when air leaks from the lungs and is trapped between the lungs and the chest wall. If the air collection is large, it may need to be drained with a needle or a tube. Sometimes a special ventilator will be used. In other cases, your baby can just be watched until her body reabsorbs the air and repairs the ruptures in her lungs.
• Meconium aspiration. Sometimes babies have breathing problems caused by aspirating (inhaling) meconium during labor or delivery. (Meconium is the dark green material in a baby’s intestines before and just after birth — the baby’s first stool.) Mild meconium aspiration usually resolves with few complications. In other cases, extensive treatment is required to address complications such as lung infection, low oxygen levels, or lung damage.
• Pulmonary hypertension. Pulmonary [PUHL-muh-ner-ee] hypertension [hahy-per-TEN-shuh n] is when the blood vessels in the lungs don’t open up normally after birth. It causes poor circulation in the lungs and limits the oxygen entering the baby’s bloodstream.
• Pulmonary interstitial emphysema (PIE). Pressure from a ventilator may cause air to leak from the lungs, creating tiny air bubbles that become trapped between layers of lung tissue. This condition is called pulmonary interstitial [in-ter-STISH-uh l] emphysema [em-fuh-SEE-muh] (PIE). It usually gets better as your baby’s lungs improve and the ventilator pressure to the lungs is reduced.

Babies born prematurely, as well as babies born with breathing or nerve problems, are more prone to certain eye problems. Although the eyes are one of the first organs in the body to begin developing, they are not completely developed until several weeks after birth, even in a baby born at full term.

It is important for your newborn to have a complete eye exam by an ophthalmologist [off-thuhl-MOL-uh-jist], who is a medical doctor trained in diseases of the eye, as recommended by your pediatrician or neonatologist. Two common conditions are:

• Retinopathy of prematurity (ROP). Premature babies are at particular risk for problems with blood circulation to a part of the eye called the retina. The retina of the eye records what we see and sends images to the brain. When immature blood vessels to the retina develop abnormally, the condition is called retinopathy [ret-n-OP-uh-thee] of prematurity (ROP). ROP is often mild and requires no treatment. However, more serious cases can lead to scarring or detachment of the retina and may require treatment. Most cases will not lead to blindness. A specialist will discuss this problem with you in more detail if your child develops ROP.
• Alignment problems. Children who are born prematurely are more prone to alignment problems of the eye, one of which is called lazy eye or amblyopia [am-blee-OH-pee-uh]. Often misalignments are not evident until the child is several months of age.

Gastrointestinal (GI) problems occur in the stomach or intestines. This section discusses two conditions that are most commonly seen in the NICU and SCN.

• Reflux. If the muscle at the entrance of your baby’s stomach isn’t fully developed, it may allow food to move back up into the esophagus [ih-SOF-uh-guhs], which is the passage leading from the mouth to the stomach). This condition is called reflux [REE-fluhks] and can lead to choking and increased apnea and bradycardia. Management of mild cases of reflux usually involves experimenting with feeding position, increasing feeding time, and giving smaller amounts of food. If the condition is severe, treatment may include medicine.
• Necrotizing enterocolitis (NEC). One of the most common gastrointestinal emergencies treated in the NICU and SCN is necrotizing [NEK-ruh-tahz-ing] enterocolitis [en-tuh-roh-koh-LAHY-tis] or NEC. It’s an inflammatory bowel disease that affects premature infants but is also seen in full-term infants. With NEC, the lining of the intestinal wall dies, and the tissue sloughs off. In serious cases, the bowel wall can perforate (rupture) and lead to abdominal swelling, abnormal stools, and increased apnea and bradycardia. Treatment varies according to the severity and extent of bowel damage. It also depends on your baby’s age, health, and medical history. For some serious cases of NEC, surgery may be necessary.

A blood vessel located just outside of the heart, called the ductus [duc-tus] arteriosus [ahr-TEER-ee-oh-suh s], allows blood to bypass the lungs while your baby is still being carried in the womb. After birth, the ductus arteriosus should close, redirecting your baby’s blood flow through the lungs. If the ductus arteriosus does not close, we say it is patent [PAT-nt], or open. A patent ductus arteriosus (PDA) can place stress on your baby’s heart and lungs, and it may need to be closed with medicine.

If your baby has a PDA, your doctors and nurses will discuss this with you in more detail and provide you with additional information.

Premature or sick newborns don’t fight infections well. That’s why hospital staff do everything they can to prevent your baby from being exposed to germs. However, even with all the precautions that are taken, many premature or sick babies may develop 1 or more serious infections while they’re in the hospital.

When an infection is suspected, a baby may need tests to help identify the infection. Also, a baby will usually be started on one or more antibiotics. The staff will discuss any suspected or identified infections with you in as much detail as you wish.

You Can Help Prevent Infections

All newborns are vulnerable to germs — and babies in the NICU and SCN are especially vulnerable. Protect your baby by doing the following:

• Be aware that your NICU or SCN may limit visitors or have special rules about sibling visits. Be sure to follow these rules. They help protect babies from illness.
• Ask friends and family not to visit the NICU or SCN if they're ill. Even parents should not visit when ill.
• Wash your hands often, carefully, and thoroughly — from fingertips to elbows. Also sanitize your hands with an alcohol-based hand rub. Every NICU and SCN has multiple dispensers.
• Keep your cell phone and other personal electronic devices in your pocket. Don't touch them while you're holding your baby. Your cell phone and other electronic devices are covered in germs that could make your baby sick.
• Don’t allow anyone wearing rings, watches, bracelets, or artificial nails to touch your baby unless they’re wearing gloves.
• Once you go home, continue to practice prevention. Wash and sanitize your hands, and ask others to do the same. Continue to protect your baby from people who are ill.
• Make sure that people who come into contact with your baby are all up to date on their vaccines. (Note that people who've had the flu mist should wait seven days before seeing the baby.)

Jaundice [JAWN-dis] is a common problem in newborn babies, especially those who are premature. Jaundice causes the skin, and sometimes the whites of the eyes, to turn a yellowish color. Jaundice is usually caused by too much bilirubin [BIL-uh-roo-bin] in the blood.

Bilirubin comes from red blood cells that have been broken down. Normally, the liver removes bilirubin from the body, but the liver of the premature infant is not mature enough to do its job completely. Jaundice usually occurs during the first seven days of life. During this time, your baby’s blood will be checked, and the bilirubin level will be closely monitored.