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Health risks related to preterm birth
A baby born before completing 37 weeks of gestation is described as having been born preterm or prematurely. A preterm birth disrupts important developmental and growth processes which take place during the pregnancy in utero. Babies born preterm are at a greater risk for various health complications, some of which are described on this page.
Compared to term infants, preterm babies are at higher risk of developing attention-deficit/hyperactivity disorder (ADHD). The precise reasons for this are not fully clear. However the brain of a preterm infant is forced to develop outside the protective space of the uterus, and many cellular and molecular events that will determine brain connectivity are still taking place. Preterm birth can impact upon these developmental processes and alter the trajectory of brain maturation. Inflammation of the brain potentially links prematurity to brain maldevelopment and subsequent ADHD.
Necrotising enterocolitis (NEC) is an intestinal disease affecting approximately 7% of very preterm infants during their first weeks and months of life. It is the most common surgical emergency in newborn babies. NEC survivors often face life-long health challenges. For example, it is associated with a higher risk of poor neurodevelopmental outcomes.
Cerebral palsy is a term that describes a group of disorders that affect movement and posture. It is the most common physical disability in childhood. Although there is no single cause of cerebral palsy, preterm birth is a risk factor which substantially increases its occurrence. Preterm birth disturbs the process of brain development including the connections between muscles and brain and within the brain.
Further information about cerebral palsy can be found on the Cerebral Palsy Alliance website.
Did you know that babies born preterm are at higher risk of developing vision issues? One such cause of vision damage is retinopathy of prematurity (ROP) which is caused by the abnormal development of retinal blood vessels. It is most likely to occur in preterm babies born before 31 weeks of gestation as the retina develops late in pregnancy and preterm birth disrupts this phase of growth. Babies with mild ROP may not require treatment but in severe cases, it can mean lifelong vision impairment and blindness.
Further information about ROP can be found in EFCNI’s fact sheet, available in English and German.
Congenital heart defects present at birth mean that the structure of the baby’s heart is altered, disturbing blood flow to the body. The most severe congenital heart defects need to be treated with surgery or another type of procedure in the first weeks of life. Many infants require repeat surgeries in the first year of life. Congenital heart defects impact on the development of the whole body including the brain, putting infants at increased risk of cognitive impairments or neurodevelopmental disorders.
The body’s response to an infection or injury is called inflammation. Babies born preterm are at a higher risk of a damaging inflammatory response. Exposure of the foetus to inflammation is a common cause of preterm birth and brain damage in preterm-born infants. Foetal inflammatory response syndrome describes a severe inflammatory response and is a significant risk factor for brain injury and later neurodevelopmental problems.
Babies born extremely preterm miss out on an important phase of nephron development and have a lower nephron count at birth. Nephrons are involved in the filtration and purification of the blood. The nephrons we are born stay with us (and even diminish in number) over our lifetimes. Preterm birth has been linked to kidney dysfunction or chronic kidney disease due to lower nephron mass.
Research shows that babies born before 33 weeks of gestation are more likely to have asthma than those born at term. Fortunately, almost a quarter of babies born premature with childhood asthma outgrow their symptoms before they reach adulthood.
Asthma in the mother can also impact the health of the pregnancy. According to March of Dimes, asthma affects 4-8% of pregnancies. Women with asthma are at a slightly increased chance of preterm labour and delivery. When unmanaged, asthma makes breathing difficult and can reduce the amount of oxygen in the blood for the mother and the developing baby.