Care of extremely premature babies born 25 to 28 weeks

The main problem for premature babies is that they are not developed enough to survive outside the safety of the uterus. Many will have problems feeding, breathing and regulating temperature. However, specialist neonatal care is widely available across the UK and teams of dedicated staff are on-hand to care for babies born early.

In the UK, more premature babies are surviving than ever before, including some born as early as 25 weeks. It is a delicate and serious situation when such a tiny baby is born and the medical care that will be needed will be intensive. For you, it is undeniably a difficult and tense time as you watch and hope that your baby will grow, develop and survive to go on to lead an independent life.

A 25-week baby is the earliest considered to be ‘viable’, but being born at this extremely premature stage is very likely to mean the baby is at a higher risk of having mild to moderate disabilities. It is estimated that 55% per cent of babies born at 25 weeks survive (EPIcure 2).

In recent years, medical care for extremely premature babies has continued to progress and the outcomes have improved as medical advances are made and greater knowledge is gained.

Causes of an extremely premature birth

It is not always known why a baby is born so prematurely but some common causes identified include:

• an emergency event such as placental abruption, infection, pre-eclampsia or prolapsed cord
• premature rupture of membranes – waters break early
• detected medical conditions and complications in pregnant patient or baby

If you are known to be at risk of an early premature birth

If you know that you or your baby are at risk, then you will receive specific treatment and undergo certain examinations to better manage your baby’s arrival and care. These are likely to be:

• regular examination of the neck of your womb – to check for signs of labour
• fetal fibronectin testing – to predict the likelihood of a natural delivery within two weeks
• ultrasound scan – to assess the growth, wellbeing and position of your baby
• antenatal steroids – injections to help develop the function of your baby’s immature lungs
• pre-delivery infusion of magnesium sulphate – a ‘brain protection’ for your baby to reduce risks of cerebral palsy

Delivery and labour

If your baby is at risk and premature labour is required, you will be advised to have a vaginal birth. Labour will be induced. A caesarean section is not generally advised before 26 weeks unless specific or urgent events affect your wellbeing or that of your baby.

If you have an unexpected or spontaneous delivery the appropriate care and arrangements will be put in place for you and your baby through your nearest Neonatal Intensive Care Unit (NICU).

What an extremely premature baby looks like

The moment you meet your baby you will be flooded with conflicting emotions and you will become very aware of how very small your baby is in size. Everything about them will be very tiny, delicate and vulnerable.

Some babies weigh as little as 500g (1lb 1 oz) and their bodies may only be as big as the palm of your hand. Your baby will have very thin, transparent skin which appears red due to blood underneath. He will also be covered in very fine hair called lanugo and his eyes will be fused shut but will have eyelashes and eyebrows.

Risks to your baby

An extremely premature birth between 25 and 28 weeks means that your baby will have very immature organs, particularly the lungs, which have not yet reached their full capacity or development. Your baby will be at higher risk of:

• damage to the brain – small holes or too much fluid increases the risk of cerebral palsy
• retinopathy – damage to eyes which may affect vision
• hearing problems
• respiratory problems – lung disease or asthma
• feeding problems – which may impact growth

Treatment and care for your baby

You baby will remain under constant supervision and care in a specialist ward known as a Neonatal Intensive Care Unit (NICU). A team of consultants, doctors and nurses will keep you fully involved and informed of your baby’s progress. Any decisions that you and the doctors make will be taken solely in the interest of your baby’s wellbeing.

The first week is always critical but you will be encouraged to be in the hospital with your baby. You may not be able to hold or handle your baby due to their fragile state and needs. Extremely premature babies will require long-term and intensive care and you should be prepared for your baby to remain in hospital until their original predicted due date. Initially, the medical care and attention you can expect your baby to receive will include:

• blood transfusions
• reliance on a ventilator for oxygen
• administering of steroids to help lung function
• temperature regulation – your baby will need to be kept warm and may be wrapped in bubble wrap
• being kept in an incubator to avoid infection and viruses

The medical team will be constantly monitoring your baby to keep them stable and they will adapt the care provided as your baby’s condition alters. Each hour, day and week that passes improves the chances of your baby’s survival and the overall outcome.

If your baby does not survive

Sadly, not all babies will survive. Doctors and the specialist teams will always strive to give your baby the best chance possible but there will be some instances of pre-term birth that will not have a positive outcome.

Your doctors will discuss the situation fully with you and may advise that the most suitable option is to withdraw treatment. This will be a sensitive and difficult decision and one that you will be fully supported in making.

You will also be offered counselling and support in your bereavement.

Coping and caring for your baby

Having an extremely premature baby can be very distressing. Many mums who have been through the experience describe it as a ‘rollercoaster’ of emotions and physical exhaustion.

There will be times when your baby appears to be improving and others when a sudden decline occurs. You are likely to be worried and restless but being involved in the care of your baby can help you to cope and get to know your baby.

Usually, after a week, you will be allowed to hold your baby and encouraged to hold them close to your skin. This is known as Kangaroo care and helps you and your baby to bond, as well as to regulate your baby’s temperature. Later, you will be involved in many aspects of your baby’s care and will be able to feed and wash them. Your breast milk will be expressed and fed to your baby through feeding tubes.

If you have a partner, you will both be able to care for your baby. Many parents of premature babies also find the support of other parents on the ward to be very helpful as they understand the emotions and feelings you are experiencing about your baby.

Going home

As each week passes and your baby will begin to grow, develop and become more independent. All being well, near to the time of your baby’s original due date, you will be able to leave the hospital and become the main carer of your baby – at home.