What is extreme prematurity? 

A birth that occurs any time prior to 37 weeks of pregnancy is considered premature. Sometimes that baby is referred to as preterm, near-term or a preemie.

Most premature babies are born just a few weeks early. And while these babies will be likely underweight, their organs are usually fully developed. Their survival rate is high, and the risk of developmental problems and respiratory difficulties, although higher than in term infants, is relatively low.

Babies born earlier have more problems. They are more likely to be seriously underweight and need intensive support in their initial days of life, including ventilator support and blood pressure support. And their risk of medical complications and long-term developmental problems increases the earlier they are born.

The most extreme issues occur in babies born at less than 28 weeks. These are cases of extreme prematurity. They often weigh less than two pounds at birth. Critical organs – such as the heart, lungs, the digestive organs, and even the brain – may not be developed enough to keep the baby alive without intensive medical care.

What causes extreme prematurity?

Often, the specific cause of extreme prematurity can’t be identified. There are, however, known factors that can increase the risk of a premature birth. These include:

  • A previous preterm labor or birth
  • Carrying multiple babies at one time
  • Having an abnormal cervix or uterus
  • Being younger than 20 or older than 35
  • Having long-term health problems such as heart disease or kidney disease
  • Smoking
  • Using illegal drugs, such as cocaine

For reasons we still can’t explain, African-American women seem to be more likely to experience premature births than women of other races. But a premature birth can happen to anyone, including women with no known risk factors.

In addition, there are conditions during pregnancy that have been found to increase the likelihood of a premature birth. These include:

  • Infections
  • High blood pressure
  • Diabetes
  • Blood clotting problems
  • Problems with the placenta
  • Vaginal bleeding
  • A short time between pregnancies

How is it diagnosed? 

A baby born before 28 weeks is considered extremely premature. Once moved to the Newborn Intensive Care Unit (NICU), an extremely premature baby may undergo a number of diagnostic and monitoring tests, including:

  • Breathing and heart rate monitor
  • Fluid input and output
  • Blood tests
  • Echocardiogram (ultrasound of the heart)
  • Ultrasound scan of the brain and abdominal organs
  • Eye exam

Complications may require other specialized tests.

How is it treated?

For any premature newborn, treatment will depend on the baby’s symptoms and general health. Specialized supportive care may include:

  • Being placed in an incubator (to maintain normal body temperature)
  • Monitoring vital signs
  • Using a feeding tube
  • Replenishing fluids
  • Spending time under bilirubin lights (to treat infant jaundice)
  • Receiving a blood transfusion

In addition, medication may be used to promote to stimulate normal functioning of the lungs, heart and circulation. In some cases, surgery may also be required.

Can it be prevented?

Advances in neonatal care have steadily increased the survival rate of extremely premature babies. But the best strategy is to do everything possible during pregnancy to prevent extreme preterm births.

Of course, good prenatal care is important. Your baby’s prenatal development will depend in large part on your good health and healthy lifestyle. Some ways to help prevent prematurity include:

  • Stop smoking, even before you become pregnant
  • Avoid alcohol consumption
  • Find out if you are at risk for preterm labor
  • Learn the symptoms of preterm labor
  • Get treated for preterm labor

The hormone progesterone may be recommended by your healthcare provider if you are at high risk for preterm birth.