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Research Center

Monitoring Development of Premature Babies

12/10/2009

Question:

My baby boy was born 6 weeks premature. At the time of birth his weight was 1.02 kilograms and his head circumference was 28 centimeters. Now he is 9 months old. His weight is 7.24 kilograms and his head circumference is 39.5 centimeters. Please let me know if this is fine. Currently, he can laugh and sit,but he does not reply to us with eye contact. He can hear, but he can't catch anything. He doesn't feel strange to any one,so what should we do? Where should we contact?

Answer:

Having a preterm baby is always challenging! They are have a very different growth pattern and developmental pathway than do full term babies, especially when they are born over a month early.

I am presuming in this response that his age of 9 months is not corrected for his early birth but rather is his age in months since his birth. So in actuality, in terms of growth and development, he should be considered as a 7.5 month-old infant, not a 9-month-old infant.

Plotting his current weight and head circumference on the IHDP (Infant Health and Development Program) growth chart for very low birth weight infants, his weight is very close to the 50th percentile for boys 7.5 months old. This means that half of very low birth weight boys 7.5 months old weigh more than he does and half weigh less. However, when it comes to his head circumference, his growth percentile is below the lowest percentile curve on the chart, meaning that very few preterm boys his age would have a smaller head circumference than your son's.

In general, this is very concerning. Ideally, a preterm infant's head circumference percentile should be higher than the percentiles for weight and length. Both older and recent research studies find that poor head circumference growth indicates a risk for poor mental development for the child. However, head circumference is the growth measure most poorly done in many pediatric practices. Great must be taken to do the measurement correctly. Baby head size is also influenced by parent head size. If you and or his father have a smaller head than average, your child's head may be smaller. One worry you can eliminate is that your son is not getting enough calories for growth. His weight gain is fine, so feeding is going well.

Most 7.5 month-old babies cannot catch objects tossed to them. That is truly a skill for an older child. Laughing and sitting with support are normal skills for a baby his age. Many preterm babies struggle with social skills such as smiling and vocally responding to parents and others. There are actually two parts to language competence - receptive skills that involve accurately hearing sounds and expressive language skills that involve producing sounds. I am hoping that you know he hears because he had a hearing test that confirms that he can hear and that he also turns to sounds or makes other responses to sounds that indicate he can hear. While it is too soon to expect any words, many babies your son's age will imitate sounds made to them by adults and will make sounds back and forth with their parents. Preterm babies are well known for problems with both receptive and expressive language skills or problems in one or the other areas of early language.

Not making eye contact or seeming not to feel positively towards parents are also common problems for babies born early. It may not be until 6 months of corrected age that very early babies feel strong enough to handle face and eye contact with parents and others. Very fragile, early babies often engage in a long period of time during which they are fairly unresponsive to their parents as they gain their strength and overcome the physical challenges of being born too soon.

However, knowing the frequent problems very small babies born early tend to have and also knowing the many benefits of early intervention to build language and social skills, I strongly recommend that you obtain a referral to early intervention services in your community. In most communities, parents can refer their babies themselves. Federal entitlement programs guarantee early developmental services to young children. Your child's doctor's office should be able to help you with this process. There really are no risks in asking for an early developmental evaluation for your son and starting therapies he may need early. However, there is significant risk for harm to his development from waiting too long to start extra therapies we know help children with developmental delays.

I recommend obtaining a good book on the parenting challenges faced by the parents of preterm infants. Most public libraries have these types of books available and you can browse through them to find one you like before purchasing it. Major book stores also having parenting sections that focus on preterm infants. Take a selection of books to a comfy chair and look through them to find one with the level of information, style of writing and types of pictures and diagrams that appeal to you. Two books many mothers have liked include Parenting Your Premature baby and child by Deborah davis and Preemies: The Essential Guide for Parents by Linden and Paroli.

Remember to always turn back your expectations for a preterm baby's development by subtracting the number of weeks the baby was born early from your baby's number of weeks of age. This should be done throughout the first 2 years of age in order to have the best standard for determining what your child should be doing developmentally.

I hope this information is helpful. You are asking great questions and being a good observer of your baby's progress. Keep up the great work!

References

Blackman, J.A. (2007). NICU micropreemies: How do they fare? Contemporary Pediatrics, 24 (2), 65-73.

Gad, A., Shah, S. (2007). Special immunization considerations fro the preterm infant. Journal of Pediatric Health Care, 21, 385-391.

Hintz, S.R., Kendrick, D.E., Vahr, B.R., Poole, W. K., & Higgins, R.D. for the NICHD Neonatal Research Network. (2008). Community supports after surviving extremely low-birth-weight, extremely preterm birth. Archives of Pediatric & Adolescent Medicine, 162, 748-755.

Hubbard, E., Stellwagen, L., & Wolf, A. (2007). The late preterm infant: A little baby with big needs. Contemporary Pediatrics, 24 (11), 51-59.

Kelly, M.M. (2006). The medically complex premature infant in primary care. Journal of Pediatric Health Care, 20, 367-373.

Kelly, M. (2006). The basics of prematurity. Journal of Pediatric Health Care, 20, 238-244.

Kelly. M.M. (2006). Primary care issues for the health premature infant. Journal of Pediatric Health Care, 20, 293-299.

Russell, R.B., Green, N.S., Steiner, C.A., Meilke, S., Howse, J.L., Poschman, K., et al. (2007). Cost of hospitalization for preterm and low irth weight infants in the United States. Pediatrics, 120, e1-e9.

Sullivan, M.C., McGrath, M.M., Hawes, K., & Kester, B.M. (2008). Growth trajectories of preterm infants: Birth to 12 years. Journal of Pediatric Health Care, 22, 83-93.

Vanderbilt, D., Wang, J,C., & Parker, S. (2007). The do's in preemie neurodevelopment. Contemporary Pediatrics, 24 (9), 84-92.

McInerny, et al. (2009). Textbook of Pediatric Care. Elk Grove Village, IL: American Academy of Pediatrics

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University