Your Premature Baby

By Barbara J. Deloian, PhD, RN, CPNP
From ParentsPlace.com

Having a premature baby is usually stressful and worrisome for parents. The small size of your infant, the uncertainty over the diagnosis and the inability to hold your newborn right away -- combined with learning about procedures in the neonatal intensive care unit (NICU) -- can be overwhelming. But there are positive steps you can take to lessen your worry as you get to know your baby.

One of the most important things you can do after your baby is born is to ask questions. Make a list so you don't forget anything, and add to it as necessary. Then write down the answers so you can refer
advertisement

to them later. Find at least one staff person, perhaps a nurse, with whom you feel comfortable and in whom you can confide. Many parents describe the experience of having their infant in the NICU as being on a roller coaster or living in a fish bowl with their emotions exposed for all to see. Parents I've interviewed have stressed how important it was to have someone they could talk with during this time.

• During the Hospital Stay
• Time to Go Home
• Extra Care
• Baby Checkups
• Charting Development

During the Hospital Stay:

Each hospital differs in the types of services it provides, but all are very interested in making you feel comfortable, teaching you about your baby's needs and making sure that you remain healthy for your baby's eventual homecoming. In the hospital you may ask to have curtains or screens around you for privacy during visits. Many hospitals will assign a primary nurse or team to you and your baby. If it appears that different staff will be in attendance each time you visit, ask to have one main contact nurse. While she may not care for your infant every day, she'll know you both and can help you understand what is happening and how your baby is progressing.

Even if you're not able to hold your baby right away, the infant will sense that you're there. Before a feeding or when your baby is starting to awaken, talk to her softly. She's heard you during your pregnancy, so your voice will be reassuring. You can also touch your baby before you actually hold her. Touch is one of the most important senses for babies. You'll know what type of touch your baby likes by watching her relax or withdraw. Some babies like stroking, while others prefer a light touch without movement. Try both to see what your baby prefers.

If you're allowed to hold your baby, you and your partner can practice what is known as kangaroo care. Hold your baby, clad only in a diaper, against your skin, keeping her back warm with a blanket. Do this for an hour or more at a time; this closeness will benefit both baby and parent.

As babies get ready to leave the hospital, they usually progress from a warming table to an Isolette to a crib, and from taking nothing by mouth to short opportunities for breastfeeding and tube feedings to regular breast or formula feedings. Because they take in only small amounts at each feeding, premature babies will need to eat frequently once they go home. Have the nurses explain your baby's daily routine and any measures the hospital staff takes to make your baby comfortable. As often as possible, try to participate in feeding and bath times so that you can begin to feel confident caring for an infant who seems so small and fragile. And while in the hospital, talk with a lactation consultant and make sure you can have follow-up visits or consultations if you have questions later.

Time to Go Home:

Don't be surprised or alarmed if there is a delay when you're expecting to take your baby home. A few "false starts" are not unusual, because the doctors and nurses want to be absolutely sure that your baby is ready to leave the hospital setting. Sometimes babies simply need a little more time to adjust to the outside world. As they begin to take larger amounts of breast milk or formula, they may need a few extra days to adjust. Don't be overly concerned by any precautionary discharge delays.

Once home with your baby, you'll find great joy in becoming a family. You'll also find that you need to help your baby get into a home routine. Premature babies usually sleep most of the day and eat throughout the night. You can help your baby get into a routine by being consistent about where she sleeps and watching for hunger cues during the day, such as increased sucking, rooting, bringing her hands to her mouth and increased movements. Premature babies do not have the strength to cry very long, and if they do, they use their energy for crying instead of eating. As your baby eats more frequently during the day, about every two to three hours, she'll sleep a little longer for one stretch at night, about four hours.

Most mothers of premature infants are very nervous because they are unsure how much milk their baby is getting. If your baby is nursing at least 8 to 10 times every 24 hours, has at least three to four palm-sized bowel movements and five to six sopping wet diapers each day and is gaining around ? ounce each day you can feel confident that breastfeeding is going well. Many premature babies do not have the energy to nurse this long and may need supplemental milk until breastfeeding is well established. Your lactation consultant and the baby's doctor will be able to help you determine how much supplemental breast milk or formula to provide, and they can also help to guide you when it is time to gradually wean your baby from the supplement as breastfeeding continues to improve. If you have concerns about your baby's weight, ask your primary care provider if you can have a nurse visit for a weight check. Some insurance companies will provide a nurse to come to your home, weigh your baby and answer your questions.

Extra Care:

During the first month at home, many people will want to come and see your baby. Since hands spread infections, request that anyone wishing to hold your baby wash her hands thoroughly with a bactericidal soap. Also, keep in mind that allowing the baby to be handled by many people increases the risk of infection and may be over stimulating to her. In fact, your infant may appear to be sleeping when she's actually trying to handle the stress of being around so many people. If that's the case, you may find that later that day, or in the evening, a feeding will be less vigorous or skipped altogether because your baby's just too tired to eat. Your baby may also become fussy and difficult to console. To protect her, you may sometimes have to limit visits from others as you concentrate on your infant's -- and family's -- needs. Most important in the early months is that you become comfortable caring for your baby, get any help that you require -- and grow together as a family.

Baby Checkups:

Going for health care visits may be challenging if you have to maneuver a monitor, oxygen, feeding tubes or other equipment along with your baby. Organization is key. Write down your questions and pack your diaper bag the night before. Include an extra set of clothes, diapers and a pacifier.

It's important to fit your baby snugly into her car seat. Most premature infants need a little extra support (such as a rolled-up towel or receiving blanket) to make sure their heads are positioned properly and don't fall forward. There are commercially available car seat supports specifically designed for premature babies. Bring your car seat and any supports to the hospital when you're going home so that the nurses can help you make sure your baby fits just right.

Charting Development:

Premature infants go through the same developmental steps as all other babies. However, when looking at growth and development, we adjust the baby's age by subtracting the number of weeks she was early from her current age. For example, if your baby was born eight weeks early, subtract eight weeks or two months. Thus, when your baby is six months old, consider her growth and development as if she were four months old. This is important to remember when you start solid foods and whole milk and when you expect your baby to crawl or walk. There is no difference in the timing of your baby's immunizations, however.

By the time your baby is two years old, there is very little difference in growth and development if she was born one or two months early. At that age, you would no longer consider your baby's prematurity when looking at development. But for babies born three months early, it may take a little longer.

Your primary care provider will be watching your baby's growth and development. Also, health or education departments in all communities sponsor free early intervention programs to monitor your baby's development and assist you and your family with any concerns you may have.

Barbara Jones Deloian, PhD, RN, CPNP, is a pediatric nurse practitioner who currently works in a feeding clinic for children with feeding problems at the Children's Hospital in Denver and an early intervention homecare program for infants and toddlers who were born prematurely or with special health care needs.