Caring for Your Premature Infant

Babies born before the 37th week of gestation are born prematurely. Premature newborns are sometimes given the nickname, "preemies." Mothers who have their baby prematurely are often scared and nervous. It is true that premature newborns face an increased risk of having one or more complications. The risk of complications increases the earlier the baby is born. Any complications that a premature newborn experiences will be cared for in the Neonatal Intensive Care Unit (NICU). Below is a brief description of what to expect when it comes to the care for your newborn preemie.

Why do premature newborns need special care?
A premature newborn is not fully equipped to deal with our world. Their little bodies still have areas that need to mature and fully develop. Some of these areas include the lungs, digestive system, immune system and skin. Thankfully medical technology has made it possible for preemies to get through the first few days, weeks or months of life until they are able to make it on their own.

A first glance at the Neonatal Intensive Care Unit (NICU)
The NICU is your newborns protected environment. It may also be his or her home for a while. Therefore it is a good idea to get acquainted and know as much as you can about it. You should know that it 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!

When it comes to all of the equipment in the NICU it can be overwhelming and sometimes scary. Knowing what every thing does can help you relax and prevent you from being distracted.

Monitoring and alarm systems
Monitoring machines vary depending on the hospital you are in. Different hospitals use different equipment. However, all monitors monitor the heart rate, respiratory rate, blood pressure, and temperature. A pulse oximeter is another measurement that may be taken that measures the amount of oxygen in the blood. You may notice that your newborn has various sticky pads or cuffs on his chest, legs, arms or other body parts. These sticky pads and cuffs have wires that connect to the monitor which often looks like a television screen that displays lots of numbers.

*Alarm systems go off periodically in the NICU and it does not always indicate an emergency. In fact more often than not it is nothing to worry about. Therefore do not panic when you experience this and do not be surprised when everyone else does not panic.

Methods of respiratory assistance (Depends on the premature newborn's individual needs):

Endotracheal tube -- This is a tube that is placed down the newborns windpipe. It delivers warm humidified air and oxygen.

Ventilator -- This is also sometimes referred to as a respirator. This is the breathing machine that the endotracheal tube is connected to. It can monitor the amount of oxygen, air pressure and number of breaths.

Continuous Positive Airway Pressure (C-PAP) -- This method is used for preemies who can breathe on their own but just need some help getting air to their lungs.

Oxygen hood -- This is an actual clear plastic box that is placed over the preemie's head and is attached to a tube that pumps oxygen to the preemie.

Methods of feeding (Depends on the premature newborn's individual needs):

Intravenous lines -- This method carries nutrition directly into the blood stream. This method is used for premature babies who have immature digestive systems and are not able to suck, swallow and breathe in a coordinated manner. This method may also be used when treatment for other health complications is being implemented. An IV may be placed in the scalp, arm or leg.

Umbilical catheter -- This method involves a tube that is surgically placed into a vessel of the umbilical cord. Don't worry it is not painful. This method can carry potential risks (infection or blood clots) and therefore is used only for the most critical infants and with those who may need this type of feeding for several weeks. For these critical preemies, it is the safest and most appropriate way to supply nutrients.

Oral and nasal feeding -- This method involves a narrow flexible tube threaded through their nose (naso-gastric tube) or mouth (oro-gastric tube). This method is provided for preemies who are ready to digest breast milk or formula but still not 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 which allows use for a larger vein. This is normally used to deliver nutrients and medicines that would otherwise irritate smaller veins.

Other equipment:

Incubator -- A clear plastic crib that keeps babies warm and help protect them from germs and noise.

Bililghts -- This is a bright blue fluorescent light that is located over your baby's incubator. This light is used to treat jaundice (yellowing of skin and eyes).

The Staff
The staff is incorporated 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. Get to know the staff. They are very informative and encourage parental involvement.

Knowing that your newborn is receiving the best care can provide comfort and reassurance.

What is Kangaroo Care?
Kangaroo care consists of placing a diaper clad premature baby in an upright position on a mother's bare chest allowing tummy to tummy to touch and placing the premature baby in between the mother's breasts. The baby's head is turned so that the ear is above the parent's heart. Many studies have shown 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 mothers have thermal synchrony with their baby. The study also concluded that when the baby was cold, the mother's body temperature would increase to warm the baby up and vise 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 deep sleep which allows the baby to conserve energy for more important things. Increase in weight gain means shorter hospital stay.
  • Increased intimacy and attachment

Breastfeeding
We have all heard how breastfeeding strengthens a baby's immune defenses and provides emotional connections between a mother and her baby. However, when a newborn is born prematurely a mother may not be allowed to breastfeed her baby. Most premature newborns, between 25-29 weeks gestational age, are feed intravenous or through a tube. If you are planning to breastfeed you should tell your doctor and nurses immediately after labor. Then you can begin expressing and storing your breast milk for when your baby is ready for it. Your baby's digestive system and control of electrolytes will determine when he will be able to handle breast milk through a tube. This is when you can use the milk you have stored. Once your baby's respiratory system is stabilized he can begin breastfeeding. Most babies born 35-37 weeks usually can go straight to breastfeeding.

How YOU can participate in the Neonatal Intensive Care Unit (NICU)

There are other ways besides breastfeeding and Kangaroo Care that a mother or father can help care for their baby in NICU. Both the mother and father are encouraged by the NICU staff to interact with their baby. As a mother or father you may not see how it is possible to interact with your baby with all the wires, machines and incubator in the way. Surprisingly, there are quite a few ways you can accomplish this:

  1. Touch your baby as much as possible. You can do this through gentle touch or even stroking motions.
  2. Talk to your baby. Your baby is used to your voice(s) and it could be comforting to hear you. Along 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 use washcloths, sponges or q-tips to do this.
  5. Take your baby's temperature.

Reprinted with permission from American Pregnancy Association.