The excerpt below from the book Preemies: The Essential Guide for Parents of Premature Babies describes the physical characteristics of a premature baby at various gestational ages.

The material is for information purposes and does not constitute medical advice. The opinions expressed in Preemies are those of the authors and do not necessarily reflect the views of the March of Dimes.

To order: The book costs $16.95 (item no. 09-1833-03). Call the March of Dimes Fulfillment Center at 800-367-6630. Outside of the U.S., call 770-280-4115.


EXCERPT
Preemies: The Essential Guide for Parents of Premature Babies
Your Beautiful Newborn: A Portrait

Parents seeing their premature babies for the first time often have conflicting feelings. Pain and pleasure. Shock and a touch of relief. Most parents are shocked by how tiny their babies are—but impressed by their complete, perfectly formed little bodies. It's not unusual to see mothers and fathers staring in awe at a beautiful set of micro-sized eyelashes, fingers or toes, complete with all of the knuckles. Everything is already in place, just waiting to grow.

Obviously, though, preemies are not full-term babies, and you can't expect them to exactly resemble 40-weekers any more than you can expect 40-weekers to exactly resemble older, two or three-month-old babies.

What are some of the differences you might notice?

• Preemies younger than 30 to 32 weeks have thin skin, lacking the layers of body fat that would have been put on during the final weeks of pregnancy. When skin is thin, the arteries and veins below it are easily visible, so the skin has a reddish-purple tint, regardless of the infant's ethnic background. (So don't be concerned that your baby was switched accidentally with someone else's! Babies born to African-American parents often look similar in color to white babies at this stage. Natural pigmentation may not be obvious until around the eighth month of gestation.)  Until those layers of fat appear and fill out the skin's folds, babies also tend to look a bit wrinkled. But their slender fingers and toes look unusually long and graceful.
• In extremely premature babies, the coarse, top layer of skin hasn't formed yet. So their skin can look smooth and shiny, and may be too fragile to caress and rub for the time being. (You can touch it gently.) This usually changes by the 26th week.
• The very youngest preemies don't have any body hair at all, and the hair on their head is just a fine fuzz. An older preemie, though, is covered by lanugo—soft, fuzzy, fetal hair—over much of her body. It is particularly heavy on the back, upper arms, and shoulders, and dark hair is more noticeable than light. Don't worry if your baby has more lanugo than the baby in the bed next to her; some preemies have more, some have less, but it always goes away. Even some full-term babies are born with some lanugo. Most preemies shed theirs by their due dates, or at the latest a few weeks after. It's not until approximately 36 weeks gestation that the hair on a preemie's head becomes thick and silky.
• A premature baby's eyes may still be fused shut if she is born before the 26th week. But around that time, they will open on their own—already framed by beautiful little eyelashes.
• Fingernails and toenails may look like tiny buds at first. By roughly your baby's due date, her nails will reach the end of her fingers or toes, and you'll have to pull out the emery board or scissors.
• A preemie's ears have a little developing yet to do. Many parents get worried when they see one of their baby's ears doubled over, as if it's folded. Actually, that's a common sight in the NICU, and nothing to worry about. Before the 35th week or so, ears are very soft, without the firm cartilage that develops later. So an ear that gets folded (perhaps when a baby is laid down on her side) will stay that way, rather than springing back on its own. A mere touch from your gentle fingers can fix that.
• Breast nipples usually don't appear until the 34th week, although both boys and girls may already have hints of their areola—the circles of dark skin around where their nipples will be. Sexual organs are clearly differentiated even on extremely premature babies, but they aren't mature yet, as most parents quickly notice. A premature boy's testes have not descended yet from inside his body into his scrotum. Thus, his scrotum looks small and unusually smooth. A premature girl's outer labia, or vaginal tissues, are still small and spread widely apart, leaving the inner labia and clitoris looking large and fully exposed. This will change when the outer labia fill in with fat and come together. Some girls also have a little “tag,” as the doctors call it, protruding from their vagina. Strange-looking? Yes. But don't worry; it will soon disappear. Both boys and girls will look just like full-term babies around their due date. In fact, neonatologists can often estimate a preemie's gestational age by looking at his or her genitalia.
• Whether a newborn is full-term or premature, it's hard to tell on the first day whether she has inherited your nose or Grandpa's chin. If your preemie is on a ventilator, it will be even harder, because parts of her face may be covered and stretched by tape that holds the equipment in place. When she finally comes off the ventilator, you'll see your baby's little face unobscured at last.
• A premature baby's posture and movements depend on how old she is at birth. Younger babies have less muscle tone. So while full-term newborns hold their arms and legs flexed and can curl themselves up into the fetal position, a very young preemie tends to lie flat on her back, with her arms and legs, splayed out, frog-like.
• Before around 28 weeks, a premature baby doesn't move much. She'll sometimes curl her fingers into a fist, or stretch or flex an arm or leg—reminding you of those pokes your belly got while she was still inside you. A slightly older preemie, between 29 and 32 weeks of gestation, moves more often, but her movements are jittery and jerky. She can turn her head from one side to another to get comfortable, and she can grasp your finger (although not strongly enough to hold on if you try to pull her up to a sitting position).
• By around 35 weeks, a preemie has enough muscle tone to tuck herself into a fetal position, just like a full-term newborn. Although she startles more frequently than a full-term baby, her grasp is strong enough to keep hold of your fingers while you lift her, and her movements are more fluid and purposeful. Some babies are even coordinated enough to get their hands in their mouths and suck on them. Sounds easy? Many 40-weekers wish they could do it!

HOW TO ORDER
The complete book Preemies: The Essential Guide for Parents of Premature Babies costs $16.95 (item no. 09-1833-03). To order, call the March of Dimes Fulfillment Center at 800-367-6630. Outside of the U.S., call 770-280-4115.

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