BEFORE TIME

GETTING TO KNOW YOUR PREM BABY

Apreterm birth is the birth of a baby before 37 weeks of pregnancy. About a quarter of these are actually planned due to a medical condition that the mother or baby may suffer from. The remaining three quarters, however, are spontaneous and unexplained. Additionally, prematurity can be classified according to a baby’s birth weight: low birth weight – 1 500g to 2 500g, very low birth weight – less than 1 500g and extremely low birth weight – less than 1 000g.

However it comes about, the premature birth of a baby is a huge shock to the parents, family and friends. As nursing sister and midwife Adrienne Utian explains: “Not only do parents have to deal with a pregnancy coming to a sudden and unexpected end, but often there are medical complications which arise for both the mom and the baby. Parents have to deal with the loss of their ‘perfect’ pregnancy, being totally unprepared for the baby’s unexpected arrival, while at the same time facing the reality of a premature baby and its medical needs.”

AN EXTRA SPECIAL BABY

Your tiny bundle is a bit different from his full term counterparts – he is not just very small, but he may also experience certain complications when it comes to his health and development.

A prem baby’s shortterm health is influenced by many things, including his gestational age at birth, his weight at birth and your health during your pregnancy. In general, the closer to full term a prem baby is at birth,

A PREMATURE BABY’S SHORT-TERM HEALTH IS INFLUENCED BY MANY THINGS

the better his chances are of surviving and being healthy.

The most common complications of prematurity result from organs that have not yet matured properly (for example, a baby’s lungs are one of the last organs to mature) and an underdeveloped immune system. Such issues can result in, among others, breathing difficulties, digestive ailments, vision and hearing impairments, brain bleeds and various potentially dangerous infections. Additionally, prem babies often have difficulty regulating their body temperatures because they did not have enough time in the womb to build up their fat stores.

Premature babies may also have developmental delays. “We allow the time they should have spent in the womb as a catch up, so instead of their actual age in terms of milestones, we look at the age they would have been if they were born at full term,” Adrienne explains. “Premmies occasionally need additional therapies – occupational therapy, physiotherapy, speech therapy – to help them to meet their milestones. If recommended, it is often better for the baby to start these sooner rather than later as the outcomes improve with early intervention.”

A PLACE OF HIS OWN

Depending on his gestational age and overall health, your baby may be taken to the neonatal intensive care unit (NICU) that specialises in caring for premature babies. It’s a high-tech environment with lots of machines, beeps and low lights, not to mention the drips and wires attached to the tiny babies. It can be frightening, but you will become accustomed to the place and its routines. Understanding what all the equipment is for also helps to dispel some of the anxiety you may feel.

The incubator keeps your baby warm, dry and safe from any possible infection. The air inside the incubator is kept humid to stop water loss and prevent your baby’s skin getting dry. A respirator or ventilator helps with breathing, providing oxygen. Equally importantly, your baby is monitored constantly by nurses and by special machines that measure vital signs. Your baby is getting excellent medical care, but you have an important role in nurturing your baby too. He needs the comfort and warmth of his parents’ touch. Research has shown that babies who are cuddled and stroked grow quicker. If your baby’s in an incubator, just allowing him to hold your finger may help calm him and enable him to breathe better.

You can also ask the doctor or nurses if you or baby’s dad can do kangaroo care while you visit him. Kangaroo mother care (KMC), also known as skin-to-skin care, where you place your naked baby on your naked chest, is good for bonding with your baby. Research has shown that babies who receive skin-to-skin care grow faster, regulate their temperature better and breathe better. It mimics the soothing environment of the womb and it enhances lactation.

Keep in mind that your baby will stay in the NICU until his health has stabilised and he is of an acceptable

weight to go home. It is often a long and emotional process, so remember to look after yourself too and get enough rest – it’s not just your baby who needs some special care during this period.

GOING HOME

A premature baby is usually discharged from the hospital when he weighs at least 2kg, can control his body temperature, can breastfeed well, gains weight steadily, can breathe on his own and has a normal heart rate. Your doctor will advise you on your baby’s specific needs, but regardless it’s quite normal to feel anxiety about looking after baby at home.

You can overcome these fears by remembering that you are the best person to care for your baby now. “The more care parents do with the support of the nursing staff while baby is still in hospital, the less afraid they will be when taking their baby home. Building confidence allows parents to feel more secure in handling their infants,” suggests Adrienne. To further allay your angst and to empower yourself, Adrienne recommends doing a CPR and first aid course before bringing your baby home from hospital.

LITTLE NIGGLES

“Bonding is often delayed with premmies, as they are sometimes so sick that moms subconsciously keep their distance from them. The hospital environment is also not very conducive to allowing moms to take full care of their babies,” explains Adrienne. To ensure bonding takes place, continue KMC with your baby once you’ve brought him home, or start it with him at that point if you weren’t able to do it in hospital.

Your premature baby may also find it difficult to adjust to the silence of home after having lived in a noisy hospital environment. Additionally, he is used to the strict routine he kept in at hospital, which may not be as easy to follow at home, and this could be unsettling for him. Calm him by swaddling him and by holding him as much as possible. Try to make sure that the room temperature is comfortable for him because he may still have some difficulty regulating his body temperature. “Room temperature should be kept around 20°C. As a rule, we advise dressing babies in one more layer than what the parent is wearing, and removing or adding layers as is necessary when baby gets hot or cold. Test the baby’s temperature by feeling the back of his neck,” advises Adrienne.

“Babies who have had breathing problems in hospital may need to be monitored once they get home, especially if they have experienced apnoea attacks, where they have ‘forgotten’ to breathe and have needed a bit of stimulation (lifting baby, tapping on its feet) to start breathing again,” adds Adrienne. Baby monitors that have a pad placed under the mattress to regulate baby’s breathing are easily available at baby stores for peace of mind.

FEEDING YOUR PREMMIE

Neonatologist Dr Eric Reynolds maintains that “even healthy preterm infants have more nutritional needs than term babies”. Much of this need for extra calories, he says, is to play catch up and to help get the baby to a healthier height and weight. “A premature baby’s gut is also less efficient when it comes to absorption of nutrition, so the baby must take in more calories from feeds in order to get the required nutrients into the body,” he adds. Once he’s home, your baby’s feeding needs remain unique. “Due to the fact that premature babies are so small, we try to get them to take their feeds (actual sucking time) within around a 20 minute time period. The longer they spend feeding, the more calories they burn, and as a result don’t gain weight as well. Usually babies will need to feed every three to four hours day and night,” says Adrienne. As a guideline to assess that your baby is coping well, she advises parents to check that their baby passes urine six to eight times in a 24 hour period.

Remember, that in caring for your baby, you must not neglect to care for yourself. Your physical and mental wellbeing is essential for your baby to thrive. “Childbirth is a time of emotional turmoil, and more so for the mom of a premature baby. In most cases, there is a huge amount of guilt – moms can feel that their bodies have failed them. It is a good idea for moms of premature babies to seek counselling to deal with the range of emotions that they are experiencing,” advises Adrienne. YB

REMEMBER, THAT IN CARING FOR YOUR BABY, YOU MUST NOT NEGLECT TO CARE FOR YOURSELF. YOUR PHYSICAL AND MENTAL WELLBEING IS ESSENTIAL FOR YOUR BABY TO THRIVE