Early challenges for your premature baby

Do premature babies have a lot of health problems?

Because premature babies have not had as much time to develop in the uterus (womb), they often do have extra health problems. Each baby is different. It's not possible to predict exactly how a baby's first weeks or even later years will go.

Many babies born too soon grow up strong and healthy. Generally, babies born closer to full-term (between 37 weeks and 40 weeks) face fewer challenges than babies born much earlier.

If your baby has arrived early, it's bound to be a worrying time for you. But it might help if you know some basic facts about the health problems that premature babies can have. Be assured that the nurses and doctors are specialists who have a lot of experience in treating these conditions.

How can a premature baby's lungs be affected?

Breathing problems are common for premature babies, because their lungs have not had time to mature in the uterus. For this reason, mums are often given steroids if they are in premature labour, to help protect their baby’s lungs (Bliss 2007).

After the birth, premature babies may receive another treatment called surfactant. This is a natural substance produced by the lungs, which makes breathing easier. Premature babies are not always born with enough. It is passed gently through a tube in a baby’s windpipe, and then into his lungs (Bliss 2007).

Some common lung problems babies may face include:
  • Respiratory distress syndrome (RDS). This is a serious situation where a baby's lungs can’t absorb enough oxygen. Surfactant helps to prevent RDS in many cases but a baby with RDS is likely to need a breathing machine for a while (NIH 2011a).
  • Apnoea of prematurity. This happens when a baby’s breathing is irregular. Apnoea can be picked up by a monitor. It might be treated with medicine, such as caffeine, or with temporary help from a breathing machine (Kopelman 2009).
  • Chronic lung disease (CLD). This condition is also called bronchopulmonary dysplasia (BPD). It can happen when a baby is born very early, or when their lungs become a bit stiff from being on a ventilator over time. A baby with this condition may need oxygen for a while after going home and must be protected against chest infections (Bliss 2007).
Many premature babies need some help with breathing for a while. You can learn more about ventilators and other breathing machines in our article about the neonatal unit.

Can heart problems affect premature babies?

A common heart problem for premature babies is patent ductus arteriosis (PDA). In the uterus, babies have a blood vessel that allows the circulation of oxygen-rich blood to make a detour around the lungs. This blood vessel normally closes up soon after birth, when the lungs take over the job of breathing and oxygenating a baby's blood.

When PDA happens, the blood vessel that should close stays open, affecting the blood circulation between the heart and lungs (Beerman 2009, Hamrick 2010, NHLBI 2009a).

If the blood vessel has mostly closed, and only a small opening remains, it may not cause many problems. A larger opening can make a baby easily tired, or slow down feeding and weight gain. The baby’s heart can be strained by overwork, and there can be problems with breathing and the way the lungs work (Beerman 2009, Hamrick 2010, NHLBI 2009b, 2009c).

Sometimes a smaller opening can be left to close on its own. While this natural healing is under way, doctors can treat a baby with a non-steroidal anti-inflammatory drug, such as indomethacin or ibuprofen. Some babies need to have an operation to close the vessel (Beerman 2009, Hamrick 2010).

Can a baby’s brain be affected by premature birth?

In premature babies, the blood vessels in the brain are tiny and fragile. One of the risks they face is bleeding in the brain. This is called intraventricular haemorrhage (IVH). If bleeding is going to happen, it usually does so within the first few days or weeks after birth. The chances of a bleed is greater for babies born very early (McCrea 2008).

If it's a small area of bleeding, there may be no long-term harm. But more severe bleeding can cause damage to the brain (NIH 2011a).

Doctors routinely monitor premature babies with ultrasound scans to check for IVH. There is not a specific treatment to stop the bleeding. Occasionally, doctors may give a baby blood transfusions and extra help with breathing (NIH 2011b).

Serious bleeds can cause problems such as cerebral palsy or learning disabilities (McCrea 2008). In the longer term, these babies will be followed up by the neonatal team. Any resulting problem can be spotted, and support given to them and their families, as needed.

What eye conditions can premature babies have?

Inside the back of the eye, there is a thin lining of tissue called the retina. The retina acts like the film in a non-digital camera, to produce an image for the brain.

If a baby is born too soon, the blood vessels in the retina can mature incorrectly (Fleck 2008). This causes bleeding. Scar tissue can form, causing some damage to vision (RNIB 2011).

This is called retinopathy of prematurity (ROP). The risk is higher for smaller babies and those born the earliest (RNIB 2011).

The exact cause of ROP is unknown, although exposure to concentrated oxygen might be part of the problem. This is one reason why the level of oxygen given to babies in the neonatal care unit is carefully controlled (Fleck 2008, RNIB 2011).

An eye specialist (ophthalmologist) will check the eyes of babies thought to have a chance of developing ROP (RCPCH 2008). Mild cases of ROP might not interfere much with a baby’s sight. Otherwise, a baby's damaged eye tissue can be treated by freezing (cryotherapy) or with a laser (RCPCH 2008, RNIB 2011).

Are gut problems a risk for premature babies?

Premature babies can develop a very serious gut disorder called necrotising enterocolitis (NEC). When this happens, tissue in the gut (intestine) dies off. The full cause is not known but bacterial infection could play a role (NIH 2011b, AlFaleh 2011).

Some symptoms of NEC include a swollen tummy, diarrhoea, vomiting, and not wanting to feed (NIH 2011b).

If a baby has NEC, doctors will stop giving him feeds into his tummy. Instead, a baby will receive nutrition through a drip. This will give his gut a rest. The baby is also treated with antibiotics. A baby with NEC might need an operation to remove the damaged part of the gut (GOSH 2008).

Babies fed with breastmilk have a lower risk of developing NEC (Boyd 2007, Renfrew 2009). There is also evidence that giving babies probiotics (gut-friendly yeast or bacteria) could help to prevent NEC, although some experts say more research is needed (AlFaleh 2011).

Do premature babies need blood transfusions?

Babies rarely need transfusions. Anaemia of prematurity is common. But doctors will only consider a blood transfusion for this if a baby is very anaemic.

Anaemia happens when there is a shortage of red blood cells, which carry oxygen around the body. This can happen for many reasons. Premature babies may not produce enough red blood cells, or the cells may die off too quickly. Tiny babies are also more affected by the amount of blood nurses have to take from them for laboratory tests (Potter 2011).

Doctors are still debating about when to give blood transfusions for anaemia, because the evidence about its benefits is mixed (Bell 2008).

Premature babies with severe jaundice may also need a blood transfusion (see next section).

Is jaundice a problem for premature babies?

Jaundice is common in both full-term and premature babies. Jaundice is caused by a by-product from the breakdown of red blood cells, called bilirubin. The liver processes the bilirubin and it should pass out of the body in the baby's poo.

Jaundice happens when the liver can’t keep up with the rate of bilirubin build-up. Very high levels of bilirubin can be harmful to a baby's brain (NICE 2010a, NICE 2010b).

An obvious sign of jaundice is when a baby's skin, and sometimes the whites of his eyes, appear yellow. But nurses will take a blood sample to check for bilirubin levels, which will confirm a jaundice diagnosis.

Jaundice can be treated by putting the baby under a special light, which helps to break down the bilirubin. This is called phototherapy (NICE 2010a, 2010b).

If the levels of bilirubin are dangerously high, a baby may need an exchange transfusion. This is a complete changeover of the baby’s blood (NICE 2010a, 2010b).

Last reviewed: January 2012


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Beerman L. 2010. Patent ductus arteriosis. In: Porter R & Kaplan J. Eds. The Merck manual of diagnosis and therapy. [Accessed January 2012]

Bell E. 2008. When to transfuse preterm babies. Archives of Disease in Childhood - Fetal and Neonatal Edition 93: F469-F473

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Fleck BW, McIntosh N. 2008. Pathogenesis of retinopathy of prematurity and possible preventive strategies. Early Human Development 84: 83-88

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NHLBI. 2009b. How the heart works – effects of patent ductus arteriosis. National Heart Lung and Blood Institute. [Accessed January 2012]

NHLBI 2009c. What are the signs and symptoms of patent ductus asrteriosis? National Heart Lung and Blood Institute. [Accessed January 2012]

NICE 2010a. Neonatal jaundice: Understanding NICE guidance. National Institute for Health and Clinical Excellence. [pdf file, accessed January 2012]

NICE 2010b. Neonatal jaundice: NICE guideline. National Institute for Health and Clinical Excellence. [pdf file, accessed January 2012]

NIH. 2011a. Medline encyclopaedia: Neonatal respiratory distress syndrome. National Institutes of Health. [Accessed January 2012]

NIH. 2011b. Medline encyclopaedia: Intraventricular hemorrhage of the newborn. National Institutes of Health. [Accessed January 2012]

NIH. 2011c. Medline encyclopaedia: Necrotizing enterocolitis. National Institutes of Health. [Accessed January 2012]

Potter CF. 2011. Anemia of prematurity. In: Rosenkrantz T. ed. Medscape reference: Drugs, diseases and procedures. [Accessed January 2012]


Royal College of Paediatrics and Child Health, Royal College of Ophthalmologists, British Association of Perinatal Medicine
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RNIB. 2011. Retinopathy of prematurity. Royal National Institute for Blind People. [Accessed January 2012]

Whyte R, Kirpalani H, Asztalos E et al. 2009. Neurodevelopmental outcome of extremely low birth weight infants randomly assigned to
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Hello,my baby rehab is premature born in 34 weeks,i am quite warried about his health,who bhoat slowly waight gain kar rahi hai aur us ko bhoat zada pate mai dard hota hai becoz of gas prob.plz give me some saggestion about hr good health

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