Babies born before the 37th week of gestation are considered premature and are sometimes referred to as “preemies”. Mothers whose babies are born prematurely are often scared and nervous. Premature newborns have increased risk of complications. The risks increase the earlier the child is born. Any complications of a premature newborn will be addressed in the neonatal intensive care unit (NICU). The following is a brief description of what to expect in the care for a newborn preemie.
Why do premature newborns need special care?
Premature babies are not fully equipped to deal with life in our world. Their little bodies still have underdeveloped parts that include the lungs, digestive system, immune system and skin. Thankfully, medical technology has made it possible for preemies to survive the first few days, weeks or months of life until they are strong enough to make it on their own.
A first glance at the Neonatal Intensive Care Unit (NICU)
The NICU is your newborn’s protective environment and home for a limited period. Therefore, it is wise to become as familiar with it as possible. The NICU is equipped with a caring staff, monitoring and alarm systems, respiratory and resuscitation equipment, access to physicians in every pediatric specialty, 24 hour laboratory service and YOU!
The amount of sophisticated equipment in the NICU can be overwhelming and sometimes scary. Understanding how the various machines and equipment function can help you relax and prevent you from losing your focus.
Monitoring and alarm systems
Monitoring machines differ depending on the hospital and NICU. However, monitors are similar in that they all record heart rate, respiratory rate, blood pressure, and temperature. A pulse oximeter may be used to measure the amount of oxygen in the blood. You might notice that your newborn has various sticky pads or cuffs on the chest, legs, arms or other parts of the body. These pads and cuffs have wires that connect to a monitor that resembles a television screen and displays various numbers.
*Alarms are triggered periodically in the NICU. When this happens it does not necessarily point to an emergency. More often than not it is a routine matter and nothing to be unduly concerned about.
Methods of respiratory assistance (Depends on the premature newborn’s individual needs)
Endotracheal tube – This is a tube that is placed down the newborn’s windpipe in order to deliver warm, humidified air and oxygen.
Ventilator – This machine is sometimes referred to as a respirator. It is the breathing machine connected to the endotracheal tube that can monitor the amount of oxygen, air pressure and number of breaths.
Continuous Positive Airway Pressure (C-PAP) – This method is used for babies who can breathe on their own but need help getting air to their lungs.
Oxygen hood – This a clear plastic box that is placed over the baby’s head and is attached to a tube that pumps oxygen to the baby.
Methods of feeding (Depends on the premature newborn’s individual needs)
Intravenous lines – These lines carry nutrition directly into the baby’s blood stream. They are used for premature babies who have immature digestive systems and are unable to suck, swallow and breathe normally. This method is sometimes used when treatment for other health complications is being implemented. This approach utilizes an IV that may be placed in the scalp, arm or leg.
Umbilical catheter – This painless method involves a tube that is surgically placed into a vessel of the umbilical cord. However, there are risks associated with this method that include infection and blood clots. Therefore, the method is normally used only in the most critical cases and where the baby might need this type of feeding for several weeks. For these babies, it is the safest and most effective way to receive nutrients.
Oral and nasal feeding – This method utilizes a narrow flexible tube that is threaded through their nose (nasogastric tube) or mouth (orogastric tube). It is a solution for babies who are ready to digest breast milk or formula but not yet able to suck, swallow and breathe in a coordinated manner.
Central line (sometimes referred to as a PICC line) - This is an intravenous line that is inserted into a vein, often in the arm, that allows the use of a larger vein. This is a method of delivering nutrients and medicines that might otherwise irritate smaller veins.
Incubator – Incubators are clear plastic cribs that keep babies warm and help protect them from germs and noise.
Bili lights – A bright blue fluorescent light located over the baby’s incubator used to treat jaundice (yellowing of skin and eyes).
The staff usually consists of respiratory therapists, occupational therapists, dietitians, lactation consultants, pharmacists, social workers, hospital chaplains and a neonatologist. A neonatologist is a pediatrician with additional training in the care of sick and premature babies. It is important to familiarize yourself with the staff. You will find that they can be very informative and helpful.
Knowing that your newborn is receiving the best possible care will provide you comfort and reassurance.
What is Kangaroo Care?
Kangaroo care is a technique where the premature baby is placed in an upright position on its mother’s bare chest allowing tummy to tummy contact and positioning the baby between the mother’s breasts. The baby’s head is turned so that its ear is positioned above the mother’s heart. Many studies have shown that Kangaroo Care offers significant benefits. According to Krisanne Larimer, author of “Kangarooing Our Little Miracles”, Kangaroo care has been shown to help premature newborns with:
- Body temperature – Studies have shown that a mother has thermal synchrony with her baby and that if her baby was cold, her body temperature would increase to warm up the baby and visa versa.
- Breastfeeding – Kangaroo care allows easy access to the breast, and skin-to-skin contact increases milk let-down.
- Increase weight gain – Kangaroo care allows the baby to fall into a deeper sleep allowing it to direct more energy to other bodily functions. Increased weight gain also means shorter hospital stay.
- Increased intimacy and bonding
We have all heard how breastfeeding strengthens a baby’s immune defenses and increases emotional connections between a mother and her baby. However, in cases where a baby is born prematurely, a mother might not be allowed to breastfeed her baby. Most premature newborns, between 25-29 weeks gestational age, are fed intravenously or through a tube. So if you are planning to breastfeed you should tell your doctor and nurses immediately after the birth. You can then begin expressing and storing your breast milk for the time when your baby is ready for it. The baby’s digestive system and control of electrolytes will determine when he/she will be able to ingest breast milk through a tube and when you can use the milk you have stored. Once the baby’s respiratory system is stabilized it can begin breastfeeding. Most babies born 35-37 weeks can go straight to breastfeeding.
How YOU can participate in the Neonatal Intensive Care Unit (NICU)
There are additional ways to provide care for a baby in the NICU. Both the mother and father are encouraged by the NICU staff to interact with their baby. As a mother or father you might not be aware of all the ways that you can interact with your baby. Here are some suggestions:
1. Touch your baby as much as possible. You can do this by using a gentle touch and stroking motions.
2. Talk to your baby. Your baby can recognize your voice(s) and be comforted by hearing you. Together with talking, you can read or sing to your baby.
3. Change your baby’s diaper.
4. Participate in your baby’s first bath. Depending on your baby’s progress, you may choose washcloths or sponges.
5. Take your baby’s temperature.
For more information on premature newborns you can visit: www.marchofdimes.com/prematurity
Compiled using information from the following sources:
March of Dimes, www.marchofdimes.com
Premature Baby Premature Child, www.prematurity.org