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The 3 levels of prematurity in children
Average prematurity:
The prematurity of the baby is said to be average when the birth takes place between the 32nd and the 36th week of complete amenorrhea (7 to 8 months of pregnancy). Below 35 weeks, the baby must be transferred with his mother to a type II maternity unit with a neonatal unit, or directly to a neonatal unit. It is generally little exposed beyond the 35 / 36th week. In a large number of cases, it is simply more fragile but it can remain in place, under the supervision of the maternity pediatrician.
The great prematurity:
extreme prematurity concerns the birth which takes place between the 28th and the 32nd week (6 to 7 months of pregnancy). He must receive special care in a neonatal intensive care unit where he is transferred after his birth. If he was born in a type III maternity hospital, which is more and more frequent, he is treated on site.
Very great prematurity:
We speak of very great prematurity when birth before 28 weeks (before 6 months of pregnancy). He must absolutely be transferred to a neonatal intensive care unit (unless he was born in a type III maternity hospital).
Among children born prematurely, 85% are medium premature, 10% are very premature and 5% are very premature.
Prematurity: more or less important consequences
In general, the closer the baby is born to term, the less severe the consequences. Indeed, the vital functions (respiratory, digestive, neurological…) are mature after 9 months of pregnancy (41 weeks of amenorrhea). A premature child has not reached the same level of development as that at term and therefore presents a more or less marked immaturity according to its gestational age.
• The respiratory problems are common in prematurity. Assistance with nasal ventilation or a tube is sometimes necessary. Two drugs have greatly improved the respiratory prognosis: intravenous corticosteroids given to the mother before birth; the surfactant given to the baby during his stay in intensive care which allows lung maturation.
• The premature baby has not yet sucking reflex and cannot coordinate swallowing and breathing. This explains why before 34 weeks he is fed by tube.
• A neurological monitoring by electroencephalogram and MRI is essential during the first weeks to detect possible anomalies, in particular in the event of very prematurity.
• Others digestive, liver, kidney, or immune system complications justify specialized medical surveillance.
Medical progress recently accomplished make it possible today to compensate for this immaturity, at least in part, and to reduce its consequences. Research is continuing to further improve the care of these children who arrive in the world too early. The first data from Epipage 2 (Inserm 2011) show a significant improvement in survival in children born between 25 and 31 weeks.