Born between weeks 34 and 36: main problems faced by late premature babies

In Spain, nine out of 100 newborns are premature, one of the highest rates in the surrounding countries. The good news is that scientific advances and medical care are making possible a survival rate of up to 65% in those born before week 28, and 95% in those born after.

However, these little fighters need to stay in the neonatology units of the hospitals, and once they are discharged, the medical follow-up protocol they must have is very different from that followed by full-term children. Today we tell you what are the health recommendations and follow-up of late prematauros, according to a report prepared by the Spanish Society of Neonatology and the Spanish Association of Primary Care Pediatrics.

What is understood by late premature?

Of the 9% of premature babies born in Spain, between 70-74% are the so-called late premature babies who are those born between the 34th and 36th week of gestation. The term "late premature" is relatively recent, since it was defined in 2005 replacing the concept of "almost full-term newborn" that had been used until then.

But it is important to note that late premature infants are not babies who only need routine neonatal care, but that the risks associated with their immaturity involve personalized follow-up and care. In Babies and more Born prematurely, an arrival in the world ahead of time for which no one is prepared

And it is that after several studies it has been seen that these children have a different development from the term newborns, so they are not exempt from presenting long-term sequels that must be closely reviewed.

Therefore, once they are discharged, their follow-up should be done between the hospital, the primary care consultations and the specific pediatric specialties that correspond according to each case.

Between the Causes of late premature births They are, among others:

  • Mother's older age

  • Maternal overweight and health problems derived from it during pregnancy, such as gestational diabetes and high blood pressure

  • Twin pregnancies

Main health problems they present

Contrary to what we can popularly think, the Complications presented by late premature infants are not limited exclusively to their neonatal period, but they can spread throughout your childhood.

This translates into higher hospitalization rates and greater use of emergency services with respect to the rest of children, because they are more at risk of getting infections, respiratory problems and neurodevelopmental disorders.

The work and Follow-up by primary care pediatricians is essential, since they not only deal with the health problems that may arise, but they must also inform families about the possible health risks of premature babies, educate them on preventive measures and on rapid detection of symptoms.

The complications of the first weeks

In the first 15 days of life, late premature babies have three times the risk of being admitted to the hospital than those born at term, due to frequent complications such as jaundice, feeding difficulties, poor weight gain, dehydration and apnea.

Respiratory infections

According to the Spanish Society of Neonatology (SENeo) late premature infants frequently have respiratory problems both short and medium and long term. This is due to the lung immaturity they presented at the time of their birth.

At week 34, the lungs are still developing and their volume is 47% compared to that of a full-term newborn

Some of the problems that usually present are translated into:

  • Three times more risk of respiratory infections than term infants, which implies a higher number of hospital admissions during their first year of life

  • Increased risk of getting RSV bronchiolitis

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Other infections

After respiratory infections, gastrointestinal infections are the ones that cause the highest income and medical consultations in cases of late premature babies.

Neurological development deficit

According to studies, late premature infants They are twice as likely to have delayed neurodevelopment than those born at term, as well as more likely to manifest deficits in motor skills and in the acquisition of executive, cognitive and behavioral skills.

This is because between 34 and 40 weeks of gestation the most critical period in the maturation of neuronal structures occurs, which in the case of premature babies must be reached outside the uterus.

Therefore, and up to two years of age, during their routine visits to the pediatrician or in the specific hospital follow-up, simple tests of neurological development as well as other specific tests will be carried out, in order to identify any problem early.

Late preterm school age

This possible delay in neurological development should be taken into account at the time of beginning the school stage, and in case of any suspicion, offering families easy and quick access to Early Care to evaluate possible disorders.

Although according to the studies, in the preschool age the differences that have been found between late preterm infants and those born at term are very subtle, they are indicative of the difficulties they may manifest in their academic and socio-emotional development in later stages.

Therefore, before starting primary school, late premature infants with suspected neurodevelopmental disorders they should be evaluated by the guidance team of their schools, in order to offer specialized help so that it does not affect their school performance.

According to studies, the main problems that late premature infants usually present in the school stage are:

  • Increased risk of psychomotor deficit: at four years of age it has been observed that 16.6% of late premature infants have psychomotor deficit, compared with 4.5% of those born at term

  • Major problems in language development, especially in the expressive language that manifests between 18 and 36 months

  • Greater possibilities of repeat course during the Primary Education stage

  • At six years of age they usually present worse results in the areas of comprehensive reading and math

  • In addition, prematurity has been associated with a higher incidence of learning and attention problems, being the most frequent attention deficit hyperactivity disorder

Special needs of late premature babies

Once they are discharged, late premature infants present a series of special needs that must be taken into account by families, and of which pediatricians and neonatologists will report as the baby is completing stages.

Kangaroo method

During the hospital stay, health personnel will inform the importance of making skin with skin with the premature baby, since it is shown that caressing, hugging and talking to him helps improve his physical and neuronal development.

But once you are discharged it is essential that parents continue practicing the kangaroo method at home, as long as possible.

Breastfeeding

As with the kangaroo method, the Breastfeeding is very important and beneficial for the baby, regardless of the gestational age in which he was born. But if in addition, the baby is premature, breastfeeding acquires an even more relevant role if possible.

However, in these cases the baby may have little force when sucking, as well as drowsiness that makes breastfeeding difficult, so it is essential that the nursing mother receives indications, advice and professional support, in order to detect any possible problem in the feeding of your baby.

Supplementary feeding

The onset of complementary feeding in premature babies should be studied by the pediatrician of individualized form, considering its gestational age, general nutritional status and gross motor development.

In addition, it is important that breastfeeding continue at least until the first year of life, and preferably beyond the first year.

Vaccines per day

Vaccines save lives, and in the case of premature children, rigorously complying with the vaccine schedule is more important and necessary if possible

Pediatricians will inform parents of the importance of not delaying vaccines, in order to achieve sufficient levels of protective antibodies early in the first months of life, which are the most at risk.

Thus, premature babies should follow the same vaccination schedule as the rest of the children, and their first vaccines will be given two months after birth, regardless of gestational age or birth weight. In addition, it is especially recommended to protect them against rotavirus and influenza, because they are a population at risk.

With these recommendations for monitoring the late premature period, the Spanish Society of Neonatology and the Spanish Association of Primary Care Pediatrics intend that Pediatricians and neonatologists are sensitized to the main risks that premature babies can present born between week 34 and 36.

In this way, not only will it be possible to detect in time possible complications of health, feeding, development and / or learning, but to offer families all the support they need in the raising and care of their baby.

  • Photos or iStock

  • Via Guide follow-up recommendations for late premature

  • In Babies and More Premature Babies