A premature baby, or preemie, is defined as one that is born before the 37th week of pregnancy. A full term pregnancy is 40 weeks. More than a half million babies are born premature each year in the United States or about 1 in every 8 births. Prematurity is the leading cause of death in newborns and preemies are at increased risks for lifelong health problems.

Premature infants may face a number of health challenges, including:

• Low birth weight
• Underdeveloped organs or organ systems
• Breathing and respiratory problems because of underdeveloped lungs
• Learning and developmental disabilities
• Cerebral palsy
• Life-threatening infections
• Serious lung condition, known as respiratory distress syndrome
• Vision and hearing loss
• Feeding and digestive problems
• Jaundice

Some premature babies require special care and spend weeks of months in the hospital, often in a neonatal intensive care unit.

When you're short of breath, it's hard or uncomfortable for you to take in the oxygen your body needs. You may feel as if you're not getting enough air. Sometimes you can have mild breathing problems because of a stuffy nose or intense exercise. But shortness of breath can also be a sign of a serious disease.

Many conditions can make you feel short of breath:

• Lung conditions such as asthma, emphysema, or pneumonia
• Problems with your trachea or bronchi, which are part of your airway system
• Heart disease can make you feel breathless if your heart cannot pump enough blood to supply oxygen to your body
• Anxiety and panic attacks
• Allergies

If you often have trouble breathing, it is important to find out the cause.

What is cerebral palsy (CP)?

Cerebral palsy (CP) is a group of disorders that cause problems with movement, balance, and posture. CP affects the cerebral motor cortex. This is the part of the brain that directs muscle movement. In fact, the first part of the name, cerebral, means having to do with the brain. The second part, palsy, means weakness or problems with using the muscles.

What are the types of cerebral palsy (CP)?

There are different types of CP:

• Spastic cerebral palsy, which is the most common type. It causes increased muscle tone, stiff muscles, and awkward movements. Sometimes it only affects one part of the body. In other cases, it can affect both arms and legs, the trunk, and the face.
• Dyskinetic cerebral palsy, which causes problems controlling the movement of the hands, arms, feet, and legs. This can make it hard to sit and walk.
• Ataxic cerebral palsy, which causes problems with balance and coordination
• Mixed cerebral palsy, which means that you have symptoms of more than one type

What causes cerebral palsy (CP)?

CP is caused by abnormal development or damage to the developing brain. It could happen when

• The cerebral motor cortex doesn't develop normally during fetal growth
• There is an injury to the brain before, during, or after birth

Both the brain damage and the disabilities it causes are permanent.

Who is at risk for cerebral palsy (CP)?

CP is more common among boys than girls. It affects black children more often than white children.

Certain medical conditions or events that can happen during pregnancy and delivery that may increase a baby's risk of being born with cerebral palsy, including

• Being born too small
• Being born too early
• Being born a twin or other multiple birth
• Being conceived by in vitro fertilization (IVF) or other assisted reproductive technology (ART)
• Having a mother who had an infection during pregnancy
• Having a mother with certain health problems in pregnancy, such as thyroid problems
• Severe jaundice
• Having complications during birth
• Rh incompatibility
• Seizures
• Exposure to toxins

What are the signs of cerebral palsy (CP)?

There are many different types and levels of disability with CP. So the signs can be different in each child.

The signs usually appear in the early months of life. But sometimes there is a delay in getting a diagnosis until after age two. Infants with CP often have developmental delays. They are slow to reach developmental milestones such as learning to roll over, sit, crawl, or walk. They may also have abnormal muscle tone. They may seem floppy, or they may be stiff or rigid.

It's important to know that children without CP can also have these signs. Contact your child's health care provider know if your child has any of these signs, so you can get a correct diagnosis.

How is cerebral palsy (CP) diagnosed?

Diagnosing CP involves several steps:

• Developmental monitoring (or surveillance) means tracking a child's growth and development over time. If there are any concerns about your child's development, then he or she should have a developmental screening test as soon as possible.
• Developmental screening involves a giving your child a short test to check for motor, movement, or other developmental delays. If the screenings are not normal, the provider will recommend some evaluations.
• Developmental and medical evaluations are done to diagnose which disorder your child has. The provider many use many tools to make the diagnosis:
  • A check of your child's motor skills, muscle tone, reflexes, and posture
  • A medical history
  • Lab tests, genetic tests, and/or imaging tests

What are the treatments for cerebral palsy (CP)?

There is no cure for CP, but treatment can improve the lives of those who have it. It is important to begin a treatment program as early as possible.

A team of health professionals will work with you and your child to develop a treatment plan. Common treatments include

• Medicines
• Surgery
• Assistive devices
• Physical, occupational, recreational, and speech therapy

Can cerebral palsy (CP) be prevented?

You cannot prevent the genetic problems that can cause CP. But it may be possible to manage or avoid some of the risk factors for CP. For example, making sure that pregnant women have been vaccinated could prevent certain infections that can cause CP in unborn babies. Using cars seats for infants and toddlers could prevent head injuries, which can be a cause of CP.

As children grow older, they develop in several different ways. Child development includes physical, intellectual, social, and emotional changes.

Children grow and mature at very different rates. It's hard to say what "normal" is. There can be big differences in height, weight, and build among healthy children. Diet, exercise and genes are all factors. Some children begin puberty or are close to it before they are teenagers.

Children start to become more independent from their parents. They may rebel. They also look outward - to their friends, who are usually of the same sex. Peer approval becomes very important. Your child may try new behaviors to be part of "the group." This can also be the time that parents or teachers recognize learning disabilities or behavioral problems in children. These problems can get worse as time goes on, so it is important to get help early.

If you have low vision, eyeglasses, contact lenses, medicine, or surgery may not help. Activities like reading, shopping, cooking, writing, and watching TV may be hard to do. The leading causes of low vision and blindness in the United States are age-related eye diseases: macular degeneration, cataract and glaucoma. Other eye disorders, eye injuries, and birth defects can also cause vision loss.

Whatever the cause, lost vision cannot be restored. It can, however, be managed. A loss of vision means that you may have to reorganize your life and learn new ways of doing things. If you have some vision, visual aids such as special glasses and large print books can make life easier. There are also devices to help those with no vision, like text-reading software and braille books.

The sooner vision loss or eye disease is found and treated, the greater your chances of keeping your remaining vision. You should have regular comprehensive eye exams by an eye care professional.

Most children hear and listen from the moment they are born. They learn to talk by imitating the sounds around them and the voices of their parents and caregivers. But about 2 or 3 out of every 1,000 children in the United States are born deaf or hard-of-hearing. More lose their hearing later during childhood.

Babies should have a hearing screening before they are a month old. If your child has a hearing loss, it is important to consider the use of hearing devices and other communication options by age 6 months. That's because children start learning speech and language long before they talk.

Hearing problems can be temporary or permanent. Sometimes, ear infections, injuries or diseases affect hearing. If your child does not hear well, get help.

Apnea in infants is the term used to describe episodes of cessation of breathing and may be due to many physiological and pathophysiological processes. Brief periods of apnea that occur in short cycles of 5 seconds to 10 seconds is not pathologic and is referred to as periodic breathing. Periodic breathing is seen predominantly during the age of two to four weeks and resolves by age six months.

Apnea is frequently seen in preterm infants but can occur at any age.

Apnea of prematurity is defined as a sudden cessation of breathing that lasts for at least 20 seconds or is accompanied by bradycardia or oxygen desaturation (cyanosis) in an infant younger than 37 weeks’ gestational age.

Apnea of infancy is defined as “an unexplained episode of cessation of breathing for 20 seconds or longer, or a shorter respiratory pause associated with bradycardia, cyanosis, pallor, and/or marked hypotonia.”

Apnea may be central, obstructive, or mixed.

Central apnea is due to the depressed respiratory center where there is a cessation of output from the central respiratory centers, and there is no respiratory effort.

Obstructive apnea occurs when there is an obstruction to the airway, and respiratory efforts are inadequate to maintain ventilation.

Mixed apnea (a period of central apnea, typically followed by airway obstruction) is the most frequent type among preterm infants.

At a glance: Retinopathy of Prematurity

• Early Symptoms: None

• Late Symptoms: Unusual eye movements, white pupils, vision loss

• Diagnosis: Eye exam or photographs of the retinas

• Treatment: None (for mild cases), laser treatment, freeze treatment, eye injections (for severe cases)

Abnormal increase in RESPIRATORY RATE in the newborn. It is self-limiting and attributed to the delayed fetal lung fluid clearance often in CAESAREAN SECTION delivery.

Blood spot screening (sometimes called the “heel stick” or “24-hour test”) uses a few drops of blood from your baby’s heel to determine if your baby might have one of many serious conditions. Even though some health care providers still refer to blood spot screening as the “PKU test,” this term is no longer accurate because NBS now checks for many conditions.

Following is a step-by-step guide explaining how blood spot screening happens:

• Between 24 and 48 hours after birth, a health care provider will tell you that it is time for your newborn’s blood spot screening.
• Your baby can stay swaddled during blood spot screening.
• To make the process easier, the health care provider will gently warm your baby’s foot to increase blood flow.
• The health care provider will then make a quick pinprick on your baby’s heel. Your baby may feel the prick and start to cry, but it will be over very quickly and will not leave a mark.
• The health care provider will collect a few small drops of blood from your baby’s heel, then drop them onto small circles on a special card.
  • The part of the card with the circles contains a type of paper called filter paper. This paper absorbs the blood drops.
  • The other part of the card has information about your baby. This information tells whose blood is on the card and how to reach you and your baby’s health care provider.
• Once the blood spots have dried, the card is sent off to a laboratory. There, the staff runs laboratory tests looking for signs of certain serious conditions. Each state has its own newborn screening panel, which is a list of the conditions that the state checks during NBS. To see the newborn screening panel for your state, visit the State pages.

Results from blood spot screening are usually ready in about five to seven days. The public health laboratory sends your baby’s results to your baby’s health care provider, not straight to you. If the result suggests the presence of a condition, then either the health care provider or the state NBS program will contact you.

Be sure to ask about your baby’s results at your baby’s first or second well-child visit. It is important to ask about your baby’s NBS results—do not assume that no news means that the results are in-range.

Pulse oximetry screening uses a sensor to determine if your baby might have certain heart conditions called critical congenital heart disease (CCHD).

CCHD is a group of serious heart conditions present at birth. Children with CCHD have any of a wide range of heart problems that arise when parts of the heart do not form correctly.

In some forms of CCHD, the heart has trouble delivering oxygen from the lungs to the rest of the body. Babies with these forms of CCHD have low levels of oxygen in their blood. Measuring your baby’s blood oxygen level can help see if your baby needs urgent heart treatment.

Following is a step-by-step guide explaining how pulse oximetry screening happens:

• Between 24 and 48 hours after birth, a health care provider will tell you that it is time for your newborn’s pulse oximetry screening.
• The health care provider will place a small wrap on your baby’s skin, usually around the right hand or wrist and on either foot. One side of the wrap has a light, and the other has a sensor.
• The health care provider will connect the wrap to a monitor that uses the sensor’s reading to calculate how much oxygen is in your baby’s blood. Using the numbers on this monitor, the health care provider can tell whether your baby might have CCHD.
• Babies who do not pass pulse oximetry screening the first time may repeat it or may need further testing.

Results from pulse oximetry screening are ready as soon as the screening is done.

If your baby does not pass pulse oximetry screening, a health care provider may recommend more testing to see if your baby’s heart and lungs are working well. This testing can involve an echocardiogram, electrocardiogram, and/or chest X-ray, which is usually done right away.

Your baby’s health care provider will help decide what test(s) your baby needs.

Newborn hearing screening uses earbuds or earphones to check your baby’s hearing.

Babies do not usually start talking until they are about 1 year old, but language begins developing at birth. Babies learn sounds, speech, and language by hearing people speaking around and to them during the first months of life.

A child who has even a mild hearing loss may be slow to learn words and how to communicate if not helped early. Newborn hearing screening is important because it finds children that may need help as early in their lives as possible.

Following is a step-by-step guide explaining how newborn hearing screening happens:

• Hearing screening usually happens any time after your baby is 12 hours old. Around or after this time, a health care provider will tell you that it is time for your newborn’s hearing screening.
• Hearing screening works best when your baby is calm and in a quiet room. You may be asked to hold your baby during screening, or your baby may stay swaddled.
• There are two types of hearing screening. Your baby might have one or both types. Both types work similarly and are quick and safe.
  • Otoacoustic emissions (often called “OAE”): In this screening, a health care provider places a small ear bud in each of your baby’s ears. The ear buds play soft sounds for your baby. The ear buds are connected to a computer that measures how the ear responds to the soft sounds. If your baby’s ears are working as they should, the computer will detect a response. If your baby is deaf or hard of hearing, the computer will not detect a response.
  • Automated auditory brainstem response (often called “AABR”): In this screening, a health care provider places earphones over your baby’s ears and small sensors that look like band-aids on your baby’s head and neck. The earphones play soft sounds for your baby. The sensors measure how your baby’s ears and brain respond to the sounds and then send this information to a computer. If your baby can hear typically, the computer records a response to the sounds. If your baby is deaf or hard of hearing, the computer records either a very small response or no response at all.
• Your baby may not pass screening if your baby is deaf or hard of hearing in one or both ears, if there is fluid in the ear, or if there is too much noise during screening (for example, from movement or crying).

Results from hearing screening are ready as soon as the screening is done.

If your baby does not pass the hearing screening, resulting in a “fail,” you will be referred to a specialist for more evaluation and testing of your baby’s hearing. This second check usually happens one to two weeks after the first screening.