Premature Infant

by James W. Kendig, MD, Ursula Nawab, MD

premature infant is an infant born before 34 wk gestation.
Full-term gestation is 40 wk (range 37 to 42 wk). Infants born before 37 wk are
preterm and have an increased incidence of complications and mortality
roughly proportional to the degree of prematurity. Infants born < 34 wk are
considered moderate premature and those born 34 wk and < 37 wk
gestation are considered late preterm (see Late Preterm Infant). Infants born <
32 wk are considered very premature, and those < 28 wk are considered
extremely premature.
The rate of preterm birth was 11.7% in 2011; 8.3% were late preterm and
3.4% were [premature], including 2% who were very premature.
Previously, any infant weighing <2.5 kg was termed premature. This definition
is inappropriate because many infants weighing < 2.5 kg are mature or
postmature but small for gestational age; they have a different appearance
and different problems. Infants < 2.5 kg at birth are considered low-birthweight infants, and those < 1500 g are considered very low-birth-weight
infants (VLBW).
Etiology
In a given patient, the specific cause of premature labor and delivery, whether
preceded by premature rupture of the membranes (see Premature Rupture of
Membranes (PROM)) or not, is usually unknown. There are many known
maternal risk factors, which may involve
Socioeconomic factors

Low socioeconomic status

Mothers with less formal education

Unwed mothers

Cigarette smoking

Past obstetric history

Prior premature births (see Prior preterm delivery)

Prior multiple pregnancies
Prior multiple therapeutic abortions (see Induced Abortion) and/or
spontaneous miscarriages (seeSpontaneous Abortion)

Current pregnancy-related factors

Pregnancy achieved by in vitro fertilization (see In vitro fertilization

(IVF))
Little or no prenatal care

Poor nutrition during gestation (and perhaps before)

Untreated infections (eg, bacterial vaginosis [see Bacterial Vaginosis],

intra-amniotic infection [formerly chorioamnionitissee IntraAmniotic
Infection])

Multiple gestation (eg, twins, tripletssee Multifetal (multiple)

pregnancy)

Cervical insufficiency (formerly cervical incompetencesee Cervical

Insufficiency)

Preeclampsia (see Preeclampsia and Eclampsia)

Placental abruption (see Abruptio Placentae)

However, most women who give birth preterm have no known risk factors.
Symptoms and Signs
The premature infant is small, usually weighing < 2.5 kg, and tends to have
thin, shiny, pink skin through which the underlying veins are easily seen. Little
subcutaneous fat, hair, or external ear cartilage exists. Spontaneous activity
and tone are reduced, and extremities are not held in the flexed position
typical of term infants. In males, the scrotum may have few rugae, and the
testes may be undescended. In females, the labia majora do not yet cover the
labia minora. Reflexes develop at different times during gestation. The Moro
reflex begins by 28 to 32 wk gestation and is well established by 37 wk. The

palmar reflex starts at 28 wk and is well established by 32 wk. The tonic neck
reflex starts at 35 wk and is most prominent at 1 mo postterm.