Q. I was born six weeks premature, and as a result I have some visual problems. I’m now 28 years old and I need to make a decision soon about starting a family. I’ve been concerned that there might be problems if I had a premature baby. Can these problems be avoided now?
A. Enormous strides have been made in the care of premature babies since you were born, resulting in better and better survival rates for babies born even as much as 10 weeks early. The vision problems you experienced are now alleviated in most instances through the use of vitamin E supplements and an increase in omega-3 essential fatty acid intake. The next project for the medical community will be to improve the developmental progress of those babies after they are born, since about half of them will have difficulty keeping up with the babies born at full term. The omega-3 essential fatty acids may help in that department as well.
A premature baby needs extra care in many ways. One is a need for more oxygen than is required by full-term infants. Oxygen, however, can be damaging unless sufficient antioxidants are provided. When you were born the need for extra antioxidants for preemies kept in oxygen-enriched incubators was not appreciated, and thus eye damage often occurred.
Another exceptional requirement is for additional fat. The last few weeks of a baby’s time in the womb, time denied a preemie, is spent building up reserves of fat. This fat reserve is important not only to fulfill the elevated energy requirements of infancy but also to provide the important structural components of brain and nerve tissue. During the few weeks before birth, the fat-rich myelin sheath that surrounds nerves develops. The myelin sheath increases the speed of nerve impulse transmission by 100-fold and facilitates the coming intellectual development. Preemies, more than full term babies, benefit from breast-feeding, which supplies the fat and other nutrients he or she needs in ideal amounts and proportions.
Preemies also need certain proteins found generously in breast milk. One protein, lactoferrin, protects breast-fed babies against bacterial infection by “hiding” the iron needed by the bacteria. The serum lactoferrin level of premature babies falls very quickly in the first week after they are born, leaving them vulnerable if they are fed formula rather than breast milk. Other components of breast milk, not found in formulas, protect against viral infection.
The lessons learned over the past few decades include these:
Premature babies exposed to an oxygen-enriched environment require additional antioxidants, especially the fat-soluble antioxidants such as vitamin E and coenzyme Q-10.
Premature babies require additional fat, especially the long-chain polyunsaturated fats in the omega-3 family, found abundantly in breast milk.
Premature babies, and full-term babies alike, are more likely to thrive if fed breast milk. When a premature infant is too weak to nurse, the mother can still supply breast milk by using a breast pump.
By applying what we now know about caring for preemies, these infants nowadays can be nurtured to attain virtually the same level of health as full-term infants.
This article appears in April 26 • 2002.