Premature birth poses many risks for a baby. When a baby is born prematurely, the lungs and other organ systems aren’t fully developed, which significantly increases the risk of infection, respiratory distress, and hypoxic-ischemic encephalopathy (HIE), among many other issues (1). These birth injuries can lead to permanent disabilities such as cerebral palsy, seizure disorders, and developmental delays.
The best way to prevent problems associated with premature birth is to prevent the baby from being born preterm. Other methods can be used to mature a baby’s lungs before and after birth and protect the baby’s brain.
In-utero steroid administration
When a baby is less than 34 weeks gestation and the physician suspects preterm birth is imminent, corticosteroids (such as betamethasone) should be given to the mother to reduce the incidence and severity of respiratory distress syndrome (RDS), intraventricular hemorrhages (brain bleeds), sepsis, and periventricular leukomalacia (PVL) in the baby (2). When appropriately given to the mother, corticosteroids help the baby’s lungs and other tissues mature before the baby is delivered. If the baby isn’t born as soon as the medical team had expected, corticosteroid therapy may be repeated under certain guidelines. Corticosteroids can provide enormous long-term benefits when given to the baby in the womb, although there are also certain risks associated with this treatment which must be taken into consideration by the physician.
Post-birth surfactant therapy and lung development
After delivery, medical staff should provide premature babies with surfactant. Surfactant is a lipoprotein that helps the lungs become more pliant and able to easily expand and retract. Mature lungs have millions of alveoli (airways). Surfactant allows these airways to remain open so that gas exchange occurs easily. If a baby has insufficient surfactant, the lungs will be stiff and these alveoli can collapse, leading to breathing trouble (even if the baby is on a ventilator). Surfactant helps prevent the alveoli from collapsing at the end of exhalation and helps open collapsed airways.
The administration of surfactant to a newborn is called surfactant therapy (3). If the baby is born before 35 weeks – and especially if the baby is born before 30 weeks – it is highly likely that surfactant replacement therapy will be needed. The first dose of surfactant is typically given right after birth, or shortly after breathing problems are revealed. Three doses of surfactant are usually given within a 72 hour period.
A baby with stiff lungs on a ventilator can become seriously injured. Babies with stiff lungs and respiratory distress are prone to lung infections and pneumonia. These conditions can cause the baby to be oxygen deprived, which in turn can cause hypoxic-ischemic encephalopathy (HIE), periventricular leukomalacia (PVL), and cerebral palsy.
Magnesium sulfate in-utero
Magnesium sulfate can also be given to the mother to protect the unborn baby’s brain, and to decrease the chance that the baby will develop cerebral palsy.
Magnesium sulfate protects the baby’s brain in numerous ways (4):
- It increases cerebral (brain) blood flow
- It has antioxidant effects
- It reduces the level of damaging molecules (cytokines) released in the presence of inflammation
- It reduces neuronal excitability (excitotoxicity), which is damaging to the brain and occurs when the brain experiences trauma, restricted blood flow, and oxygen deprivation
- It stabilizes brain membranes
- It prevents large blood pressure fluctuations
When a physician suspects that a mother is going to give birth to a premature baby within 24 hours, they should start to administer magnesium sulfate. The medication is typically administered when the baby is between 24 and 32 weeks of gestation. Magnesium sulfate should be administered to women with preterm premature rupture of membranes (PPROM), preterm labor with intact membranes, or indicated preterm delivery.
Antibiotics can prevent preterm premature rupture of the membranes (PPROM) and infection
Approximately 3% of all premature births are due to preterm premature rupture of the membranes (PPROM), which can be caused by infections such as chorioamnionitis (5). PPROM can also cause an infection in the baby; when the membranes rupture (when a mother’s ‘water breaks’), infection in the mother can travel to the baby. These infections can be life-threatening and place the baby at risk for sepsis, septic shock, meningitis, and cerebral palsy.
Infections in pregnant women must be promptly recognized and treated with antibiotics in order to prevent (a) infection from traveling to the baby and (b) premature birth. If PPROM occurs, medical staff must promptly provide antibiotics. The longer the time between the rupture of the membranes and delivery of the baby, the more likely infection is to occur. The risk significantly increases if labor does not occur within 12 hours of the membrane rupture.
As with any premature birth or suspected premature delivery, standards of care should be followed for administration of corticosteroids, magnesium sulfate, and surfactant.
The key to understanding PPROM is that a premature baby with an infection is much more worrisome than a premature baby without an infection. This is difficult to predict, so close monitoring is critical, and signs of infection or changes in the baby’s tests (even subtle ones) should be relied on.
Birth injury lawyers helping premature babies
If your baby was born prematurely and has a condition such as hypoxic-ischemic encephalopathy (HIE), cerebral palsy, a seizure disorder, or periventricular leukomalacia (PVL), contact the award-winning birth injury attorneys at ABC Law Centers (Reiter & Walsh, P.C.). We have helped children throughout the country obtain compensation for lifelong treatment, therapy, and a secure future. Our firm has numerous multi-million dollar verdicts and settlements that attest to our success, and no fees are ever paid to our firm unless we win your case.
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- PROM and Premature Birth
- Preventing Premature Birth
- Risks of Premature Birth
- Progesterone to Prevent Birth Injury
- Betamethasone to Prevent Birth Injury
- Michigan Cerebral Palsy and Premature Birth Lawyers. www.abclawcenters.com/practice-areas/prenatal-birth-injuries/premature-birth-and-prevention/.
- Betamethasone (In-Utero Steroids for Premature Babies). www.abclawcenters.com/practice-areas/neonatal-birth-injuries/neonatal-intensive-care-unit-nicu/premature-birth-treatment/betamethasone-steroids/.
- “Respiratory Distress Syndrome in Premature Babies.” AboutKidsHealth, www.aboutkidshealth.ca/article?contentid=1764.
- Magnesium Sulfate in Pregnancy: Birth Injury Prevention. www.abclawcenters.com/practice-areas/treatments-and-therapies-for-birth-injuries/magnesium-sulfate-for-protection-against-cerebral-palsy-and-motor-dysfunction/.
- “Premature Rupture of Membranes (PROM): Birth Injury.” Michigan Birth Injury & HIE Attorneys, www.abclawcenters.com/practice-areas/prenatal-birth-injuries/maternal-medical-conditions/premature-rupture-of-membranes/.