Premature Infant

Overview

Is this topic for you?

This topic is for people who want to know what to expect when a baby is born early. For information about early labor, its causes, and its treatment, see the topic Preterm Labor.

What is premature birth?

Pregnancy normally lasts about 40 weeks. A baby born 3 or more weeks early is premature. Many premature babies-those born closer to 37 weeks-do not have problems.

Babies who are born closer to 32 weeks (just over 7 months) may not be able to eat, breathe, or stay warm on their own. But after these babies have had time to grow, most of them can leave the hospital.

Babies born earlier than 26 weeks (just under 6 months) are the most likely to have serious problems. If your baby was born very small or sick, you may face a hard life-or-death decision about treatment.

Doctors and nurses often call premature babies 'preemies.'

Why is premature birth a problem?

Babies who are premature may not be able to feed by mouth, breathe without stopping, or stay warm. Their bodies simply need more time to fully develop and grow. After they outgrow the problems caused by being born too soon, most babies can safely go home from the hospital.

When a baby is born too early, his or her major organs are not fully formed. This can cause health problems. Any premature baby can have medical problems. But those who are born before 32 weeks are more likely to have more serious problems.

Having a premature baby is stressful and scary. To get through it, you and your partner must take good care of yourselves and each other. It may help to talk to a spiritual advisor, counselor, or social worker. You may be able to find a support group of other parents who are going through the same thing.

What causes premature birth?

Premature birth can be caused by a problem with the fetus, the mother, or both. Often the cause is never known. The most common causes include:

• Problems with the placenta.
• Pregnancy with twins or more.
• Infection in the mother.
• Problems with the uterus or cervix.
• Drug or alcohol use during pregnancy.

What kind of treatments might a premature infant need?

Premature babies who are moved to the neonatal intensive care unit (NICU) are watched closely for infections and changes in breathing and heart rate. Until they can maintain their body heat, they are kept warm in special beds called isolettes.

They are usually tube-fed or fed through a vein (intravenously), depending on their condition. Tube-feeding lasts until a baby is mature enough to breathe, suck, and swallow and can take all feedings by breast or bottle.

Sick and very premature infants need special treatment, depending on what medical problems they have. Those who need help breathing are aided by an oxygen tube or a machine, called a ventilator, that moves air in and out of the lungs. Some babies need medicine. A few need surgery.

Breast milk can give a baby extra protection from infection. So your hospital may urge you to pump your breast milk and bring it in for at least the first few weeks after the birth.

NICU doctors and nurses are specialists in premature infant care. If your premature baby is in NICU, you can learn a lot from the medical staff about how to take care of your baby.

Does premature birth cause long-term problems?

Before the birth, it is hard to predict how healthy a premature baby will be. But your doctors can prepare you for what may lie ahead. They can base this on your condition and how many weeks pregnant you will be when you give birth.

Most premature babies do not develop serious disabilities. But the earlier a baby is born, the higher the chances of problems.

• Most premature babies who are born between 32 and 37 weeks do well after birth. If your baby does well after birth, his or her risk of disability is low.
• Babies most likely to have long-term disability are those who are born before 26 weeks or who are very small, 1.7 lb (771.1 g) or less. Long-term problems may include mental retardation or cerebral palsy.

What can you expect when you take your baby home?

When you're at home, don't be surprised if your baby sleeps for shorter periods of time than you expect. Premature babies are not often awake for more than brief periods, but they wake up more often than other babies. Because your baby is awake for only short periods, it may seem like a long time before he or she responds to you.

Premature babies get sick more easily than full-term infants. So it's important to keep your baby away from sick family members and friends. Make sure your baby gets regular checkups and shots to protect against serious illness.

Sudden infant death syndrome (SIDS) is more common among premature babies. So make sure your baby goes to sleep on his or her back. This lowers the chances of SIDS.

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Frequently Asked Questions

Delivery of Your Premature Infant

Preparing for the premature birth

A premature delivery may happen suddenly or after days or weeks of waiting and worrying. If you know you may deliver early, you, your partner, and your doctor can prepare for a premature birth.

• Use a hospital with a neonatal intensive care unit (NICU). If you deliver in a hospital without an NICU, your infant may need to be moved to the closest hospital that has one.
• Get to know the NICU. If you can't visit the unit, someone from the NICU can visit or call you to discuss your questions.
• Mature your fetus's lungs over a 24-hour period by taking a course of corticosteroids. A tocolytic drug also may be used, to delay labor while the corticosteroids work. Corticosteroid treatment is considered the single most effective measure for preventing infant complications of prematurity.¹ For more information, see the topic Preterm Labor.

If you deliver after 36 weeks of pregnancy, your infant's risks of problems are very low. Although a special medical team is usually nearby for such a delivery, most 36- and 37-week newborns aren't treated any differently than full-term newborns.

The premature delivery

Unlike many full-term or near full-term childbirths, you and your premature infant (preemie) are considered high-risk during preterm labor. As a result, you will have less freedom, both to make birth-related decisions and to move about freely. You can expect the following:

• Your birth plan and birthing choices will be less useful during this birth. You can refuse medicines such as painkillers during preterm labor. But other treatments such as antibiotics or corticosteroids can be important to ensure your infant's chances of good health after birth. Be sure to ask as many questions as you can think of about your medical care. The more you understand about your doctor's decisions, the less anxious you will feel.
• You will be on intravenous (IV) medicines and fluids. (For more information about medicines, see the topic Preterm Labor.)
• You will be on constant electronic fetal heart monitoring. You also will be checked regularly for changes in heart rate, body temperature, and uterine contractions.
• You will probably deliver vaginally, rather than by cesarean section (C-section), as long as you and your fetus show no signs of distress.

A childbirth (obstetric) team and a new baby (neonatal) team will be present for your delivery. The neonatal team will bring special equipment with them, including a bed with an overhead heater and resuscitation equipment for your infant. You may deliver in a surgical room that is ready for cesarean delivery, or you may deliver in your hospital room.

After the premature birth: The infant

As soon as the umbilical cord is cut, the neonatal staff will watch over and stabilize your infant. If your infant is less than 36 weeks' gestation at birth, he or she will then be moved to the NICU for observation and specialized care. If you deliver in a hospital without an NICU, your infant may need to be taken to another hospital. This typically requires a specially equipped ambulance.

At birth, little can be predicted about how well or how poorly your premature infant will do. If there are no signs of problems, you can feel cautiously hopeful. But during the first hours and days, your infant will adjust to living outside of the maternal 'life-support system.' This is a time when birth defects and complications of prematurity often become apparent. For more information, see The Premature Newborn and The Sick Premature Infant sections of this topic.

How can I make informed decisions about my extremely premature infant?

After the premature birth: The mom

While the neonatal staff attends to your infant, the obstetric staff will care for you. Depending on your condition, your postpartum care and recovery time will take at least a few hours. Meanwhile, your birth partner may want to accompany your infant to the NICU.

Before your breast milk comes in (3 or 4 days after childbirth, or postpartum), you will be asked to decide whether you plan to breast-feed your premature infant. If you decide to breast-feed, expect initially to pump milk for feedings until your infant is mature enough to feed orally. Providing breast milk for and later breast-feeding a premature infant can be an emotional and logistical, yet rewarding, challenge. You may have mixed feelings about it and worry that it may be too difficult. Before making your final decision, consider the following.

• Breast milk contains antibodies that help protect your vulnerable infant against early, serious infections, including sepsis and necrotizing enterocolitis, as well as ear and upper respiratory infections during early childhood.
• The benefits of breast milk over formula include better nutrient absorption, digestive functioning, and nervous system development.
• Both specialized formula and breast milk can offer your infant excellent nutrition.
• Pumping and breast-feeding can be one of the most beneficial and rewarding things you do for your premature infant, but it may also be exhausting and difficult. If you cannot breast-feed, decide not to breast-feed, or find that you have to discontinue doing so, formula feeding will meet your infant's nutritional needs.

Because formula does not give your infant added protection from early infection, your hospital may strongly encourage you to pump milk for your infant during the first weeks of life, at a minimum. Your hospital's lactation consultant can be very helpful with pumping and breast-feeding questions and problems, both before and after the birth. For more information, see the topic Breast-Feeding.

Taking Care of Yourselves

If your premature infant is moved to the neonatal intensive care unit (NICU), expect that you will become overwhelmed with new emotions and information. Don't be surprised if you and your partner handle this crisis differently, which may or may not create a strain on your relationship. Both of you, in different ways, may feel:

• Fearful and helpless.
• Extremely sad. Separation from your infant at birth is a sudden and profound loss. Allow yourself to grieve this loss and the loss of your original hopes for your full-term infant, yourself, and your family.
• Angry. You may find yourself becoming angry with your doctor, yourself, your family, even your infant. This is all normal.
• Guilty. You may blame yourself for your infant's condition, even if you've done everything possible to have a healthy pregnancy. This is a good time to remember that the pregnant body often runs its own course, regardless of all efforts to control it.
• Isolated. Not only can the NICU be a lonely place to spend your hours, but you may feel that no one can possibly understand what life is like for you right now.
• Ambivalent. It is normal to fear attachment to an infant with an uncertain future, even if it's your own child. You may have a mixture of feelings, including love, longing, numbness, and detachment from your infant.

Combined with your recovery after the birth (postpartum recovery), the NICU experience increases your risk of depression and anxiety. Some parents of particularly sick or dying premature infants can also develop post-traumatic stress disorder.

To get through this crisis, you and your partner must take good care of yourselves and each other. Thinking of yourselves and your relationship may not be easy when you are under extreme stress. But your child or children depend on both of you to be physically and emotionally able to care for them.

Take a quiet moment and focus on yourself. Ask yourself, 'How am I doing? What do I need right now?' Consider whether you've had sufficient rest, food, exercise, and fresh air and sunlight. Do you have someone you can talk to-a partner, friend, parent, spiritual advisor, or counselor? If any of these basic needs aren't being met, make them a top priority.

• Arrange for and accept as much help from friends and family as you can.
• Keep a journal of your thoughts and feelings.
• Visit with a spiritual advisor, counselor, or your NICU social worker.
• If your hospital has a support group for NICU parents, try it out. Sometimes the best possible support comes from people who are going through the same type of crisis you are.
• See a mental health professional or go to your hospital emergency room immediately if you are having thoughts of hurting yourself or another person. Such thoughts can sometimes arise due to postpartum depression, severe stress, or both.

Depression: Managing postpartum depression

The Premature Newborn

A premature infant's health at birth is influenced by many factors, including:

• Gestational age at birth.
• Weight at birth.
• Maternal illness and medical treatment during pregnancy.
• Congenital birth defects.

Most infants born at 36 and 37 weeks' gestation are mature enough to be discharged from the hospital with the mother. But many premature infants are too immature to survive without medical care in the neonatal intensive care unit (NICU). Symptoms of prematurity that require hospital care include:

• Underdeveloped lungs.
• Inability to breathe continuously (apnea of prematurity).
• Inability to maintain body heat.
• Inability to feed orally.

While in the NICU or at home, many healthy premature infants also need treatment for jaundice and for anemia (infants born early have not had enough time before birth to build sufficient iron stores).

The Sick Premature Infant

Many premature infants are resilient and surprise everyone by overcoming great odds. But premature infants are also vulnerable to infection and to complications related to immature body organs. Expect that your infant can progress for several days but may then have a medical setback.

With each additional week of prematurity, a newborn is at greater risk of having medical problems. Infants who have reached their 32nd week of development before birth are considered less at risk for complications than those who are born earlier.

The most common complications of prematurity result from immature organs and an immature immune system and include:

• Low blood pressure.
• Low blood sugar.
• Anemia.
• Respiratory distress syndrome.
• Chronic lung disease (previously known as bronchopulmonary dysplasia). For more information, see the topic Chronic Lung Disease in Infants.
• Necrotizing enterocolitis. For more information, see the topic Necrotizing Enterocolitis.
• Patent ductus arteriosus. For more information, see the topic Congenital Heart Defects.
• Infection (including sepsis).
• Retinopathy of prematurity.
• Intraventricular hemorrhage, or bleeding in the brain, which can result in cerebral palsy or mental retardation. For more information, see the topic Cerebral Palsy.
• Inguinal hernia. For more information, see the topic Inguinal Hernia.

Any infant born before term (before 37 completed weeks' gestation) has an increased risk of developing medical complications.

• Infants born at 32 weeks' gestation or older are least likely to develop complications.
• With each additional week of prematurity before 32 weeks, risks begin to increase dramatically.
• Infants born at 23 to 26 weeks' gestation are extremely underdeveloped and have a significantly higher risk of death and disability. Parents of these infants are likely to be faced with difficult life-or-death medical decisions.

How can I make informed decisions about my extremely premature infant?

Getting to Know the Neonatal Intensive Care Unit (NICU)

If your premature infant (preemie) is admitted to the neonatal intensive care unit (NICU) after birth, you will find out about new technologies, a new medical language, and new rules and procedures. You will depend on the NICU staff members to know how to care for your infant and to be your teachers. With their help, you can quickly learn about the technology, your infant's needs, and what you can do for your infant. Throughout your infant's stay in the NICU, you will want to keep open communication with the medical staff.

NICU technology

After first learning to scrub up before visiting your infant's bedside, you may be surprised by the number of machines and instruments surrounding your child. Thanks to this medical technology, your premature infant has a significantly greater chance of doing well than ever before. At a minimum, your infant will be warmed and monitored with equipment that includes:

• Isolette or overhead heater.
• Temperature probe, to keep track of body temperature.
• Cardiorespiratory monitor, to keep track of breathing and heart rate.
• Pulse oximeter to keep track of how much oxygen is in the blood.

If your infant has additional medical needs, other tests and equipment also may be used, including:

• Transcutaneous oxygen and/or carbon dioxide monitor, to constantly measure these levels in the blood without using a needle.
• Intravenous (IV) site, for giving medicine, fluids, and feedings.
• Umbilical catheter, for giving medicine, fluids, and feedings, and for drawing blood.
• Continuous positive airway pressure (CPAP), for help with breathing (usually for mild to moderate apnea of prematurity and mild lung problems or for weaning from a ventilation machine).
• Ventilator, for help with breathing.
• Cranial ultrasound, to check for brain bleeding or damage, usually between days 3 and 7 after birth.
• Chest X-ray, to check for lung damage and to check the positioning of an endotracheal tube if one is used to assist with breathing.
• Abdominal X-ray, to check the intestines for necrotizing enterocolitis and to check the position of the umbilical catheter.
• Echocardiogram, to check the heart for congenital heart defects or patent ductus arteriosus.

Your role in your infant's care

At first sight, you may question whether and even how to touch your tiny infant. Unless your newborn is very sick or immature, you will be allowed to touch and possibly hold him or her. But your infant's nurse or doctor will first need to show you how to work around the technology and to alert you to your infant's special needs. When visiting with your premature newborn, remember that:

• A premature infant has limited energy for recovering and growing. Avoid waking your infant from sleep.
• A premature newborn is not neurologically prepared for interacting with the world. Be alert to signs that your infant is being overstimulated by your gaze, voice, or touch, or by sound and light in the room.
• A stable, more mature preemie will thrive on periods of cuddling (kangaroo care), infant massage, and calming music.

During this time when you have limited ability to hold or help your infant, you can give him or her an immunity boost by providing breast milk. Regardless of whether you plan to breast-feed later on, pumped breast milk for tube-feeding reduces your infant's risk of infection. Your hospital's lactation consultant can be very helpful with pumping and breast-feeding questions and problems, both before and after the birth. For more information, see the topic Breast-Feeding.

If your infant is sick or especially immature, you may experience good days followed by not-so-good days as your infant struggles to heal and grow at the same time. By paying attention to your infant's cues as well as your health professionals' recommendations, you will be able to provide the contact or distance that your preemie needs.

As your infant grows stronger, you will be able to take on more caregiving tasks, ranging from holding and feeding to changing diapers to bathing. You can count on the NICU nurses to teach you and answer your questions. If you are breast-feeding, you may be asked to spend the night with your infant to establish whether he or she is strong enough to nurse around the clock.

Taking Your Baby Home

Whether you have spent days, weeks, or months visiting and leaving your infant at the hospital, the homecoming is a long-awaited event. Your premature infant is considered ready to go home when he or she is able to:

• Take all feedings by nipple and continue to gain weight. In rare cases, infants are discharged while still on partial tube-feedings that are given by parents at home. If your infant is sent home with tube-feedings, you will be trained by the NICU staff before discharge.
• Maintain body heat in an open infant bed.
• Breathe well. (An infant whose lungs have suffered damage may be sent home with portable oxygen.)
• Have normal breathing and a normal heart rate for a week. (An infant who is otherwise mature enough yet still stops breathing occasionally or has lung disease or other breathing problems may be sent home with an apnea monitor.)

Some infants are ready to go home as early as 5 weeks before their due date. Other infants, usually those who have had medical complications, may be discharged later than their due date.

Preparing to go home As your infant's discharge from the hospital approaches, you may feel excitement, impatience, and a new kind of anxiety. Responsibility for your infant's care, which has so recently required high technology and medical training, is now being transferred to you. You can best prepare yourself for this transition by learning:

• Infant cardiopulmonary resuscitation (CPR), as taught by a certified instructor.
• How to safely transport your infant in the car.
• Basic infant care skills.
• How to handle any necessary medicine or medical equipment at home.

You will also want to:

• Discuss your questions and concerns with the neonatal intensive care unit (NICU) staff and your baby's doctor.
• Make a pediatric appointment for a few days after your infant's homecoming. Weekly medical checks after discharge are especially important for a premature infant, as well as reassuring for you.

If home-based health care and supportive therapies are available to you, take advantage of them. Home-based services spare you and your infant the physical and emotional stress of traveling to numerous appointments.

The First Weeks at Home

As you and your infant adjust to being at home, you will gradually establish a routine together. You also may find that your premature infant is truly different from what you'd expect of a full-term infant. During the first weeks at home, consider these important points:

• Sleeping and wakefulness. Because their brain functions aren't as fully developed at birth as full-term newborns, premature infants:
  • Sleep more per 24-hour period than full-term infants do but for shorter periods of time. Expect that you may be awakened frequently at night until 6 months after your due date.
  • Are seldom awake for more than brief periods until about 2 months after their due date. It may seem like a long time before your infant is responsive to your presence.
• Fussiness and hypersensitivity. It is normal for full-term infants to cry for up to 3 hours per day by 6 weeks after their due date. Most premature infants will do the same and then some. Your premature infant may be easily overstimulated by too much light, sound, touch, or movement or by too much quiet after living in the noisy NICU. If so, gradually create a more calming environment, swaddle your infant in a blanket, and hold him or her as much as possible.
• Sleeping position. Laying your infant on his or her back reduces the risk of sudden infant death syndrome (SIDS), which is more common among premature infants than full-term infants. (Your infant's risk of SIDS is in no way affected by a history of apnea of prematurity; the conditions are considered to be unrelated.)
• Feedings. Your infant probably will come home on a hospital feeding schedule, which will tell you how often to nurse or bottle-feed at home. To avoid infant dehydration, never go longer than 4 hours between feedings. Small feedings may help reduce spitting up. If you see signs of reflux during or after feedings, talk to your infant's doctor.
• Nutrition. Your infant's doctor may recommend adding iron, vitamins, or supplemental formula to a breast-fed diet. Iron supplementation is typical treatment for all premature infants (preemies), because they lack the iron stores that full-term infants have at birth. Some preemies simply need extra energy and vitamins from supplemental formula to keep up their growth.
• Exposure to communicable disease and smoke. Your premature infant is more vulnerable than a full-term infant, particularly due to immature lungs at birth.
  • Keep your infant away from sick family members and friends as well as from enclosed public places during his or her first two winter seasons.
  • Don't allow tobacco smoke near your infant.
• Protection from serious illness(immunizations, influenza vaccine, and RSV antibody). With the exception of the hepatitis B vaccine, the preemie's schedule for childhood immunizations is the same as for a full-term infant, figured from the date of birth (chronological age). Your infant may also need protection from influenza and respiratory syncytial virus (RSV).
• Hearing and vision screening. Premature infants are at greater risk of hearing loss. Those born at or before 30 weeks' gestation or weighing less than 1500 g (3.3 lb) are more likely to develop a vision problem called retinopathy of prematurity.
  • The United States Preventive Services Task Force recommends that all newborns be screened for hearing loss.² Your infant's hearing will have been assessed in the NICU, but be alert to new or increased hearing problems during your child's first 5 years of life.
  • Vision screening is recommended for infants born at or before 30 weeks, whose birth weight was below 1500 g (3.3 lb), or who have serious medical conditions. The first screening is recommended between 4 and 7 weeks after birth.³

Looking Ahead to the Childhood Years

Your infant's "age"

Age is both a measure of time and a marker of development. Unlike with a full-term infant, a premature infant's age and development can be defined in different ways. This can be confusing to any parent. When following your premature infant's growth and development, it can be helpful to know the difference between the following "ages":

• Gestational age is the fetus's age, as measured from the first day of the mother's last period. This figure is used to define your premature infant's age and point of development at the time of birth. This is the same as the length of your pregnancy.
• Postconceptual age is the infant's age, also measured from the first day of the mother's last period (the same as gestational age, but with a different name). This figure may be used early in your premature infant's life and is useful for estimating his or her point of growth and development.
• Chronological age is measured from the day of birth. Your child's birthdays are celebrations of his or her chronological age.
• Corrected age is the infant's or child's chronological age minus the amount of weeks or months he or she was born early. For example, if your 1-year-old was born 3 months early, you can expect him or her to look and act like a 9-month-old (corrected age). You may find this figure to be most reassuring when following your child's growth and development for the first 2 years after birth.

Your infant's development

Most premature infants who are born between 32 and 37 completed weeks' gestation do well after birth. If your infant does well after birth (has no oxygen deprivation, severe infection, or brain or lung damage), his or her risk of disability or developmental delay is low.

During your child's first 2 years of life, he or she will appear to be developmentally behind full-term children of the same age. But you can expect your infant and young child to achieve the same sequence of developmental milestones as any other child. For more information about infant and child developmental milestones, see Growth and Development, Newborn, Growth and Development, Ages 1 to 12 Months, and Growth and Development, Ages 12 to 24 Months.

Expect that your premature infant's "lag" in development will catch up at about 2 years of chronological age. As your child grows into the preschool years, a 2- to 4-month difference in age or development blends right in among a group of preschoolers. For more information about preschooler development, see the topic Growth and Development, Ages 2 to 5 Years.

As your child begins formal schooling, be alert for signs of learning problems. Learning, reading, and math disabilities due to prematurity may first become apparent during the early school years.

Severe delays and disability

Most premature infants do not grow up to have serious developmental delays or disabilities. Generally, the smaller, more premature, or sicker the newborn, the more likely he or she is to have a developmental delay or severe disability.

If your infant was born extremely prematurely (before 26 weeks' gestation) or was very small [about 800 g (1.8 lb) or less], he or she is most likely to develop a severe disability. Of these very premature and tiny infants, the following disabilities are most common:

• Mental retardation
• Cerebral palsy
• Blindness
• Deafness

Some infants born between 1500 g (3.3 lb) and 2500 g (5.5 lb) later have some IQ differences compared with full-term infants, but these differences usually are small.

Newborns weighing over 2500 g (5.5 lb) have only a slightly increased risk of developmental disabilities. Those who do have signs of developmental delays are likely to improve with the help of an enriched home life and attentive caregivers.

Other Places To Get Help

Organizations

Related Information

• Breast-Feeding
• Cerebral Palsy
• Chronic Lung Disease in Infants
• Congenital Heart Defects
• Crying, Age 3 and Younger
• Dealing With Emergencies
• Grief and Grieving
• Growth and Development, Newborn
• Health and Safety, Birth to 2 Years
• Inguinal Hernia
• Jaundice in Newborns (Hyperbilirubinemia)
• Necrotizing Enterocolitis
• Preterm Labor
• Respiratory Syncytial Virus (RSV) Infection
• Sensory Integration Dysfunction
• Speech and Language Development
• Umbilical Cord Care
• Umbilical Hernia in Children

References

Citations

1. Antenatal Corticosteroids Revisited: Repeat Courses. NIH Consensus Statement, vol. 17, no. 2 (2000 August 17-18). Available online: http://consensus.nih.gov/2000/2000AntenatalCorticosteroidsRevisted112html.htm.

2. U.S. Preventive Services Task Force (2008). Screening for newborn hearing loss. Available online: http://www.ahrq.gov/clinic/uspstf/uspsnbhr.htm.

3. American Academy of Pediatrics Section on Ophthalmology, et al. (2006). Screening examination of premature infants for retinopathy of prematurity. Pediatrics, 117(2): 572-576. Also available online: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;117/2/572.pdf. [Erratum in Pediatrics, 118(3): 1324. Also available online: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;118/3/1324-a.pdf.]

Other Works Consulted

• Chandra S, Baumgart S (2005). Temperature regulation of the premature infant. In HW Taeusch et al., eds., Avery's Diseases of the Newborn, 8th ed., pp. 364-371. Philadelphia: Elsevier Saunders.

• Committee on Fetus and Newborn, American Academy of Pediatrics (2007). Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics, 119(2): 401-403. Also available online: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;119/2/401.pdf.

• Cunningham FG, et al., eds. (2005). Diseases and injuries of the fetus and newborn. In Williams Obstetrics, 22nd ed., pp. 649-691. New York: McGraw-Hill.

• Halliday HL (2006). Recent clinical trials of surfactant treatment for neonates. Biology of the Neonate, 89(4), pp. 323-329.

• Lemons JA, et al. (2001). Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 through December 1996. Pediatrics, 107(1): E1. Also available online: http://www.pediatrics.org/cgi/content/full/107/1/e1.

• Thilo EH, Rosenberg AA (2007). The newborn infant. In WW Hay et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., chap. 1, pp. 1-64. New York: Lange Medical Books/McGraw-Hill.

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