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Children's Medical Services - Special services for children with special needs
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Infant Toddler Development Training
Module 6, Lesson 1

Premature Infant Appearance

Premature infants look different than term infants. Generally, most premature infants appear floppy or have lower tone even when they have brain injury that may increase their risk for cerebral palsy and hypertonicity at a later age. Premature infants generally have increased joint mobility as well as low muscle tone. Both factors improve with more advanced gestational age. Other characteristics of the newly born premature infant include:

  • the premature infant will lie in an extended position whereas the term infant will lie in a semi-flexed position.
  • premature infants have more fine body hair called lanugo.
  • their skin is smooth with an absence of creases.
  • their ear cartilage and breast tissue is not well developed when compared to a term infant.
  • premature infants appear passive, and do not have good behavioral state control and are easily overstressed by aversive stimuli because of the immaturity of their nervous system.

Other Health Issues Related to Prematurity

mother holding babyOther health issues of prematurity include a decreased production of surfactant, immature nervous system, inadequate kidney function, immature gastrointestinal tract, immunologic problems, osteopenia of prematurity, and ophthalmologic problems. The decreased surfactant can lead to respiratory distress syndrome (RDS). The immature nervous system puts the infant at risk for:

  • intra-ventricular hemorrhage (IVH),
  • periventricular leukomalacia (PVL), and
  • hydrocephalus.

Inadequate kidney function may lead to acidosis and poor weight gain. Problems of the gastrointestinal system may result in feeding intolerance, necrotizing enterocolitis (NEC), and gastroesophageal reflux (GER), which may persist after the infant is discharged home. The signs of GER include:

  • a refusal of oral feeding
  • apnea (period of non-breathing)
  • arching of the back

Premature infants also have very immature immunological systems and therefore are at an increased risk for infection. This can lead to poor neurodevelopmental outcomes.

The premature infant is at risk for osteopenia of prematurity. Osteopenia of prematurity is caused by not being able to supply the premature baby with an adequate amount of calcium and phosphorous so the body can make new bone. This can result temporarily in brittle bones that are prone to being easily broken.

The premature infant is at high risk for ophthalmologic problems. Because of the immaturity of the blood vessels in the retina and their exposure to oxygen, they are prone to retinopathy of prematurity (ROP) and may suffer vision loss. Other problems that may occur during their hospitalization include the same physiological problems that occur in term infants such as:

  • anemia
  • hyperbilirubinemia
  • hypocalcemia
  • hypo and hyperglycemia
  • hypothermia


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