Your Growing Preemie: Week by Week

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Preemies are born into a world that is far different from that of a fetus growing within the womb. Because fetal development happens quickly and many changes take place in utero week to week. Prematurely born infants will vary in their development depending on how early they were born. Although they may all have similar challenges, the earlier a baby is born the more complicated the journey may be. A baby born in the 24th week will be a lot smaller and require a lot more complex medical intervention and care than a baby that is born in the 34thweek of pregnancy.

 

23 Weeks:

Babies born at 23 weeks gestation have approximately a 17 percent chance of survival. At this date, 23 weeks is considered the lowest age of viability outside the womb. The term micro-preemie is used to describe a baby born at 23 weeks. Babies born at this time will be covered in a fine thin hair medically termed lanugo. The eyes will typically be fused shut but they will have fully developed eyelashes and eyebrows. The tiny fingernails have formed but their skin is thin and very vulnerable. These babies do not have any brown fat yet so they will be very tiny and often weigh less than 500 grams. The 23 weeker is growing a sensitivity to sounds and will be familiar with your voice however, loud sounds are over stimulating and can be over bearing to their under developed neurological system. Most of the body’s systems are underdeveloped, including the lungs. Only the lower airways are beginning to develop so respiratory support will be needed in order to survive. A long and often complicated NICU stay awaits the baby born at 23 weeks gestation.

 

24 weeks:

Approximately 39 percent of premature babies born at 24 weeks gestation will survive delivery. The term micro-preemie is used to describe a baby born in the 24th week of pregnancy. Babies born at this time will often have fused eyes but will have fully developed eyebrows and eyelashes. The toenails are also fully formed. Their skin is very thin, sensitive and vulnerable to touch. 24 weekers are born before they develop the brown fat to keep them warm and protected and often weigh less than 600 grams at birth. Most of the body’s systems are underdeveloped. Although they can hear and recognize your voice, loud sounds are over stimulating to their neurological system. Their lung walls are beginning to secret surfactant; a surface-activated fat on their lungs necessary for breathing however, the lungs of the baby born at 24 weeks remain underdeveloped making them susceptible to injury and will be dependent on respiratory support in order to survive. A long and often complicated NICU stay awaits the preemie born at 24 weeks gestation.

 

25 Weeks:

Babies born at 25 weeks gestation have approximately a 50% chance of survival. The term micro-preemie is used to describe the preemie born at 25 weeks. Babies born at this gestation will generally weigh less than 700 grams. Babies born at this time will often have fused eyes but will have fully developed eyebrows and eyelashes. The toenails are also fully formed. Their skin is very thin, sensitive and vulnerable to touch. Although most of their development has taken place by 25 weeks, their nervous system is still very immature. The lung walls have started to produce small amounts of surfactant; a surface-activated fat on their lungs necessary for breathing however, the lungs of the baby born at 25 weeks remain underdeveloped making them susceptible to injury and will likely be dependent on respiratory support in order to survive. These micro-preemies often face long NICU stays and could have complicated health issues related to their prematurity.

 

26 weeks:

Approximately 80% of babies born in the 26th week of pregnancy will survive. Babies born at this gestation typically weigh less than 800 grams and are termed micro-preemies. At 26 weeks, the eyelids are now open, the eyebrows and eyelashes are fully formed, along with fingernails and toenails. The footprints and fingerprints have begun to develop but their tiny feet will often be smooth to touch with very little creases. Although the 26 weeker can hear your voice, loud noises are often too much for their underdeveloped neurological system and they will startle at loud noises. The lungs have started to develop alveoli, the air sacs that allow gas exchange (breathing!) and their lung walls have begun to secret surfactant; a surface-activated fat on their lungs necessary for breathing however, the lungs of the baby born at 26 weeks remain underdeveloped making them susceptible to injury and may be dependent on respiratory support in order to survive. A long and sometimes complicated NICU stay awaits the preemie born at 26 weeks gestation.

 

27 weeks:

Thanks to modern medicine, premature babies born at 27 weeks gestation have a 90 percent chance of survival. Babies born at this gestation typically weigh about 900 grams. At 27 weeks a baby is no longer considered a micro-preemie but is now termed a very premature infant. At 27 weeks  the eyelids are now open, the eyebrows and eyelashes are fully formed, along with fingernails and toenails. The footprints and fingerprints have begun to develop but their tiny feet will often be smooth to touch with very little creases. Although the 27 weeker can hear your voice, loud noises are often too much for their underdeveloped neurological system and they will startle easily. By 27 weeks, premature babies are also starting to develop more coordinated sleep-wake cycles and are starting to have periods of REM sleep. The lungs sacs (alveoli) are formed and are capable of breathing air as their vascular system can now handle oxygen carbon dioxide exchange and their brain stem can now regulate rhythmic breathing; although they often still have underdeveloped lungs and may need extra help with respiratory support as they grow stronger. The 27 weeker has begun to regulate their basal body temperature but will need help keeping warm as they lack brown fat and their brain is unable to regulate their tiny body’s temperature. The preemie born at 27 weeks will still require a lot of medical care and can be expected to stay in the Neonatal Intensive Care for an extended period of time.

 

28 weeks:

Babies born at 28 weeks gestation have a 90-95percent chance of survival. Babies born at this gestation will typically weigh about 1kg. At 27 weeks a baby is no longer considered a micro-preemie but is now termed a very premature infant. At 28 weeks, the eyelids are now open, the eyebrows and eyelashes are fully formed. The eyes can now blink and respond to light and to dark. Their retinas are still developing (making them at risk for retinopathy of prematurity) but their eyes can form images. Although the 28 weeker can hear your voice, loud noises are often too much for their underdeveloped neurological system and they will startle at loud noises. The bright lights may also be too much for them to handle and they may tire easily. Keeping their space dimly lit will help them get the rest they need to learn and grow. By 28 weeks, premature babies are also starting to develop more coordinated sleep-wake cycles and are starting to have periods of REM sleep. The bones are fully formed at 28 weeks but are still very soft and vulnerable. The stomach and intestines are slowly maturing by 28 weeks . The lungs sacs (alveoli) are formed and are capable of breathing air as their vascular system can now handle oxygen carbon dioxide exchange and their brain stem can now regulate rhythmic breathing. Although they often still have underdeveloped lungs and may need extra help with respiratory support as they grow stronger. The 28 weekers body fat has begun to increase and they are able to regulate their basal body temperature but will need help keeping warm as they still lack brown fat and their brain is unable to regulate their tiny body’s temperature. Premature babies born at 28 weeks will still require long NICU stays with extensive medical care before they are discharged to home.

 

29 weeks:

Approximately 90-95% of babies born in the 29th week of pregnancy will survive. Babies born at this gestation will typically weigh about 1.1 kg. The 29 weeker has accumulated enough baby fat to account for nearly 3.5% of their overall body weight. They have started to shed their lanugo, the fine hair that covers a preemie’s body.The eyes can now blink and respond to light and to dark. Their retinas are still developing (making them at risk for retinopathy of prematurity) but their eyes can form images. Although the 29 weeker can hear your voice, loud noises are often too much for their underdeveloped neurological system and they will startle easily. The bright lights may also be too much for them to handle and they may tire easily. Keeping their space dimly lit will help them get the rest they need to learn and grow. By 29 weeks, premature babies are also starting to develop more coordinated sleep-wake cycles and are starting to have periods of REM sleep. They enjoy being swaddled and nesting helps with feelings of security. The 29 week preemie’s stomach is still growing and maturing and the intestines are beginning to mature. They will not be ready to nipple feed but allowing the preemie to suck on a pacifier while being fed will help develop the muscles necessary to eat when the time comes. In addition to the noticeable outside maturity of a 29 week preemie, the brain also goes through a period of rapid growth as well. Their brains are starting to look wrinkled and grooved, and are mature enough to begin to control their own body temperature. Premature babies born at 29 weeks gestation will still require long NICU stays but may not have some of the more complex medical issues that come with being born at an earlier gestation.

 

30 weeks:

Babies born at 30 weeks gestation have a 90-95 percent chance of survival. Babies born at this gestation will typically weigh about 1.3 kg. Babies born at 30 will have some layers of subcutaneous brown fat and will be mature enough to begin to hold their own body temperature but will often still need a little help as they continue to grow. The eyes can now blink and respond to light and to dark. Their retinas are still developing (making them at risk for retinopathy of prematurity) but their eyes can form images. Although the 30 weeker can hear your voice, loud noises are often too much for their underdeveloped neurological system and they will startle easily. When the 30 weeker gets overwhelmed or has had too much activity they may hiccup, sneeze, or even cry- these are outward signs of overstimulation. The bright lights may also be too much for them to handle and they may tire easily. By 30 weeks, premature babies are also starting to develop more coordinated sleep-wake cycles and are starting to have periods of REM sleep. At this stage, a preemie will be awake more, with alert periods lasting several minutes. However, they still will need a lot of sleep and thrive in a dark and quite environment. They are beginning to develop their suck but will not be ready to feed from a bottle or breast yet as they have not developed the coordination to suck, swallow, and breathe all at the same time. Pacifier use and kangaroo care while being fed will help develop the patterns necessary for future feedings. Premature babies born at 30 weeks gestation will still require long NICU stays but may not have some of the more complex medical issues that come with being born at an earlier gestation.

 

31 weeks:

Approximately 90% of babies born in the 31st week of pregnancy will survive. Babies born at this gestation typically weigh about 1.5 kg. Babies born at 31 weeks are considered moderately premature.
Babies born at 31 will have some layers of subcutaneous brown fat and their wrinkly skin looks more like that of a term baby. They are mature enough to begin to hold their own body temperature but may still need a little help as they continue to grow. Babies born at 31 weeks use all five of their senses to learn about their environments. Their eyesight is still developing and they can form images- Faces are their favorite form of stimulation. The 31 weeker can also hear quite well and will recognize their parents voices. However, loud noises are often too much for their underdeveloped neurological system and they may startle easily. When they become overwhelmed or have had too much activity they may hiccup, sneeze, or even cry- these are outward signs of overstimulation. By 32 weeks, premature babies are also starting to develop more coordinated sleep-wake cycles and are starting to have periods of REM sleep. They enjoy being swaddled and nesting helps with feeling of security. At this stage, a preemie will be awake more, with alert periods lasting several minutes. However, they still will need a lot of sleep and thrive in a dark and quite environment. It’s important to keep in mind that the 31 weeker’s immune system is still not fully developed and even though they may look like smaller versions of full term babies- they will require special care and handling as their immune system matures and grows. They are beginning to develop their suck but will not be ready to feed from a bottle or breast yet as they have not developed the coordination to suck, swallow, and breathe all at the same time. Pacifier use and kangaroo care while being fed will help develop the patterns necessary for future feedings. All babies born at 31 weeks will require a NICU stay but may quickly catch up to their peers and may have few long term effects of prematurity.

 

32 weeks:

Thanks to their recently maturing lungs and a strengthening immune system, over 90% of babies born in their 32nd week survive! Babies born at 32 weeks gestation typically weigh about 1.8 kg. Babies born at this gestation are considered moderately premature. Babies born at 32 will have some layers of subcutaneous brown fat and their wrinkly skin looks more like that of a term baby. They are mature enough to begin to hold their own body temperature but may still need a little help as they continue to grow. Babies born at 32 weeks use all five of their senses to learn about their environments. Their eyesight is still developing and they can form images- Faces are their favorite form of stimulation. 32 weekers will have more spontaneous movements but will still continue to be uncoordinated and not purposeful. At this stage, the preemie will be awake more, with alert periods lasting longer. Premature babies born at 32 weeks will still need a lot of sleep and continue to thrive and grow in a quite environment. The 32 week preemie is beginning to develop their suck but will not be ready to feed from a bottle or breast yet as they have not developed the coordination to suck, swallow, and breathe all at the same time. This milestone will come very soon and with practice such as pacifier use and kangaroo care, while being fed; they will help develop the patterns necessary for future feedings. All babies born at 32 weeks will require a NICU stay but may quickly catch up to their full term peers and may have few or little long term effects of prematurity.

 

33 Weeks:

Babies born at 33 weeks gestation have a 95 percent chance of survival. Babies born at this gestation typically weigh about 1.9 kg. Babies born at 33 weeks are considered moderately premature. The baby born at 33 weeks is getting close to the size of a baby born at term and may be mature enough to begin to hold their own body temperature, but may still need a little help as they continue to grow. Although the 33 weeker looks like a smaller term baby, they’re systems are still immature and they will need time and your patience as they grow and learn. The 33 weeker’s bones are fully formed, their fingernails come to the end of their fingertips and their footprints may be fully formed. However, the respiratory system has not finished fully developing until the last weeks of pregnancy, and antibodies have only started to pass from mother to baby so their immune systems are compromised. The premature baby born at 33 weeks may be able to nipple feed but they may need practice and patience as they remember to coordinate sucking swallowing and breathing. The 33 weeker can still get overwhelmed by too much activity and may show outwards signs of stress by hiccupping, sneezing, arching away, and crying. It’s important to pay attention to these signs as they are signs of overstimulation. Premature babies born at 33 weeks will still need a lot of sleep and continue to thrive and grow in a quite environment. They are developing sleep- wake cycles and their circadian rhythm which are so important for brain development. 33 week preemies will all require some sort of NICU stay although their course may not be complicated with a lot of medical intervention. Patience is needed as learning to eat, maintain their temperature, and gain weight, as these milestones sometimes take the longest in the NICU.

 

34 weeks:

Babies born at 34 weeks gestation have a 90-95 percent chance of survival. Babies born at this gestation will typically weigh about 2.1 kg. Babies born at 34 weeks are often called late pretermers. They are mature enough to begin to hold their own body temperature and may be able to be in an open crib environment instead of an incubator but keep in mind that these babies still need plenty of rest and sleep time to grow. Babies born at 34 weeks use all five of their senses to learn about their environments.Their eyesight is still developing and they can form images. Faces are their favorite form of stimulation.They will begin to wake more often and thrive from touch and familiar sounds. Antibodies have only started to pass from mother to baby by 34 weeks so their immune systems are compromised. The premature baby born at 34 weeks will be learning how to nipple feed but they may need lots of practice and patience because their suck, swallow, breathe, reflex is not well coordinated yet. Although these babies look very similar to full term babies, they are different in many ways. They may need help breathing for a short period of time, but learning how to eat will take the longest. All babies born at 34 weeks will require some sort of NICU stay but may quickly catch up to their full term peers and may have few or little long term effects of prematurity.

 

35 weeks:

Babies born at 35 weeks gestation statistically have about the same likelihood of survival of that of a full term infant. Babies born at this gestation will typically weight about 2.4kg. Infants born at 35 weeks are often called late preterm babies. Although these babies look very similar to full term babies, they are still premature and are different in many ways. The immune system of a 35 weeker may be compromised because antibodies do not pass from mother to baby until the very last weeks of pregnancy. The 35 weeker’s bones are fully formed, their fingernails come to the end of their fingertips and their footprints are fully formed. However, their lungs may not be completely developed for another couple of weeks. The baby born at 35 weeks will still need time to learn and grow and may not have enough fat or energy stores to stay warm and strength to breast or bottle feed effectively- therefore 35 weekers may have to spend some time in the Neonatal Intensive Care learning these things before they can go home.

 

36 weeks:

Babies born at 36 weeks gestation statistically have about the same likelihood of survival of that of a full term infant. Babies born at this gestation will typically weight about 2.6kg Infants born at 36 weeks are often called late preterm babies. Although these babies look very similar to full term babies, and are structurally ready for the real world, they are still premature and are different in many ways. The immune system of a 36 weeker may be compromised because antibodies do not pass from mother to baby until the very last weeks of pregnancy. The 36 weeker’s bones are fully formed and now completely hardened, and their muscle tone is improving, however, their lungs may not be completely developed for another couple of weeks. The baby born at 36 weeks will still need time to learn and grow and may not have enough strength to breast or bottle feed effectively- therefore some 36 weekers may have to spend time in the NICU learning these things before they can go home.

 

 

 

 

 

 

 

 

 

 

 

 

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