Facts about your prem baby

Joy and nerves in equal mea­sure are typ­i­cal emo­tions when you fi­nally get to take your pre­ma­ture baby home from the hospi­tal

Your Baby & Toddler - - The Dossier -

ALL NEW PAR­ENTS feel a lit­tle un­cer­tain when they go home for the first time with their new­born. For par­ents of an early-bird baby, this un­cer­tainty can border on feel­ing over­whelmed at times. Stay strong – your lit­tle one has al­ready proven to be a lit­tle fighter and has reached his first mile­stones in the NICU. And now the day has come when he is deemed ready to be handed over to your care. Marvel for a mo­ment at ev­ery­thing your baby has achieved to reach this point:

■ He has man­aged to de­velop out­side of the womb and can now reg­u­late his own body tem­per­a­ture with­out the help of the in­cu­ba­tor.

■ He can take his feed­ing orally, be it bot­tle or breast. Tube-feed­ing is now a thing of the past. This didn’t just hap­pen by it­self! Ini­tially only one nor­mal feed was pos­si­ble per day, but grad­u­ally all the tube feeds have been re­placed by nor­mal feeds.

■ He has been gain­ing weight steadily at a rate of at least be­tween 142 and 170g per week, and most likely he doesn’t need an­tibi­otics or oxy­gen any­more.

■ Ap­noea, a con­di­tion that causes a baby to stop breath­ing for 20 sec­onds or more at a time be­cause his body doesn’t know yet how to breathe by it­self, has been gone for a week. The part of his brain that reg­u­lates breath­ing has de­vel­oped to the point where his body does it au­to­mat­i­cally.

■ Brachy­car­dia (a heart de­lay) is also not present any­more and your baby’s heart­beat is reg­u­lar, not some­times slower.

■ Your baby is neu­ro­log­i­cally sta­bile, which means that dur­ing his time in the NICU he has learned to deal with stress, light and noise and his lit­tle body knows how to pro­tect and calm it­self.

HOW CAN I PRO­TECT MY BABY? Be­cause your baby wasn’t phys­i­cally as far de­vel­oped as ba­bies that were born on their due date, he is more sus­cep­ti­ble to in­fec­tions. Pre­ma­ture ba­bies have thin skin and even 14 days af­ter birth they haven’t de­vel­oped a pro­tec­tive cer­atin layer yet. All the med­i­cal pro­ce­dures he’s had to un­dergo in the NICU also dis­rupt the skin, giv­ing mi­cro-or­gan­isms a greater chance to take hold.

This is why the med­i­cal staff work as hy­gien­i­cally as pos­si­ble when it comes to early ba­bies. Mom’s an­ti­bod­ies, which are nor­mally trans­ferred to the baby late dur­ing the preg­nancy, of course aren’t present and bone mar­row pro­duc­tion of the im­mune cells is eas­ily over­whelmed if an in­fec­tion arises.

This doesn’t mean that vis­i­tors may not touch your baby, though. Even though your baby is more frag­ile than a full term baby it is im­por­tant that you treat your baby as a nor­mal baby and not wrap him un­nec­es­sar­ily in the prover­bial cot­ton wool. If he is healthy, you should treat him as nor­mally as pos­si­ble, but of course, don’t let ill peo­ple come and visit, es­pe­cially not in the first six months to a year of cor­rected age. In the be­gin­ning, fam­ily mem­bers can pick him up at home and vis­i­tors can all be asked to wash their hands be­fore they touch him. Don’t let strangers touch his lit­tle hands while you are out: hands go straight to the mouth and that’s where germs can get in.

THE POWER OF TOUCH Your baby has a great need for hu­man con­tact and it is un­nat­u­ral not to pick him up and cud­dle him. He needs your close pres­ence. Mom and Dad can con­tinue with kan­ga­roo care un­til baby weighs at least 2.5 kg. Af­ter that he will let you know when it isn’t com­fort­able any­more. The close skin-to-skin con­tact al­lows him to feel safe. Re­mem­ber that when you pick him up and carry him to keep his legs and arms to­gether so he doesn’t ex­pe­ri­ence the typ­i­cal star­tled re­ac­tion that early ba­bies often get. They get a fright quite eas­ily when there is a quick move­ment, sharp light or even just a new sen­sa­tion or sit­u­a­tion and then they throw their arms and legs very wide, which makes them feel un­safe. With time, this re­flex will dis­ap­pear and your baby learns to calm him­self.

Be­cause the phys­i­cal de­vel­op­ment of an early baby’s body has not been com­pleted yet, they have un­der­de­vel­oped ner­vous sys­tems. All five their senses were in­tro­duced to the world too early and that is why they are so sen­si­tive to light, noise, smells and touch. Par­ents should be gen­tle but firm, move slowly and their touch should be soft and sen­si­tive. Pre­ma­ture ba­bies’ sense of touch can eas­ily be over­stim­u­lated, which could lead to prob­lems with sen­sory in­te­gra­tion. Feather-light touch can feel the same as pain. This is why baby mas­sage isn’t

SLEEP SE­CRETS Sleep is a great way to stim­u­late growth and de­vel­op­ment. Ide­ally, a pre­ma­ture baby younger than six weeks of age should not be awake for longer than 60 min­utes at a time, and from six weeks to three months not for longer than 60 to 80 min­utes at a time.

Of course, this is eas­ier said than done, but try to es­tab­lish a sleep rou­tine. Even though ev­ery baby is unique with his own tem­per­a­ment and per­son­al­ity, a few guide­lines are still ad­vised:

■ Try to mimic the safe con­di­tions of the womb. Wrap baby firmly, but com­fort­ably with his lit­tle hands close to his face so he can fol­low his in­stinct to suck his hands if he wants to. This is what he did in the womb to calm him­self. It is in fact one of the mile­stones an early-born baby needs to reach – the abil­ity to take a nat­u­ral ac­tion to calm him­self.

■ Just like the nurses did in the NICU, you can roll a blankie and place it along the edges of his body and head to give him a safe feel­ing. Put him in this lit­tle nest that you have cre­ated when you put him down to sleep in his cot.

■ A soft blankie for him to hold or fid­dle with also gives se­cu­rity and is calm­ing, es­pe­cially if you slept with it and it smells like you.

■ Play very peace­ful, soft mu­sic or sing a lul­laby to calm him at bed­time.

■ Keep the light­ing dim.

■ Make sure his clothes aren’t scratchy.

■ Gen­tly rock him when you hold him.

■ Bring some va­ri­ety to his sleep po­si­tions and turn him onto his side and back to help di­min­ish the risk of cot death.

LAZY FEED­ING It can be a great sense of con­cern when your baby doesn’t drink well. Un­for­tu­nately with pre­m­mies this is often the case as they strug­gle to latch to the breast or bot­tle teat. In the NICU your baby most likely got tube feed­ing so to pre­vent him from los­ing his suck­ing re­flex, get­ting him used to a dummy in the NICU was a good idea.

If you’re re­ally wor­ried, by all means con­sult a spe­cial­ist in feed­ing ther­apy.

en­cour­aged in the NICU. Once your baby is home though, you can mas­sage him to soothe and calm him, but use mas­sage care­fully and get ex­pert ad­vice.

She will be able to rec­om­mend the ap­pro­pri­ate treat­ment. The mouth and jaw mus­cles aren’t only used for feed­ing – th­ese mus­cles are also used later on to bring forth sound and speech. There­fore it is of ut­most im­por­tance that your baby’s feed­ing de­vel­ops prop­erly.

Early ba­bies’ di­ges­tive sys­tems are still un­der­de­vel­oped and they are more prone to cramps and winds. If your baby is un­com­fort­able, it can lead to a feel­ing of over­stim­u­la­tion, mak­ing him tear­ful and fussy, or even an­gry or sleepy. It is worth elim­i­nat­ing any med­i­cal cause for his dis­com­fort.


A baby uses his senses to make sense of the world around him. Be­cause a pre­ma­ture baby’s neu­ro­log­i­cal sys­tems are still ripen­ing, he gets over­stim­u­lated much faster by new sen­sa­tions.

For the first three months you need to keep his en­vi­ron­ment peace­ful and calm in or­der for his lit­tle brain to de­velop and get used to new sen­sa­tions grad­u­ally, so he can or­gan­ise and in­te­grate them. If he doesn’t star­tle eas­ily any­more you can ex­pose him to in­flu­ences in his en­vi­ron­ment such as soft voices, mu­sic and light. Pre­ma­ture ba­bies who are healthy can be bathed, played with and fed ex­actly like other ba­bies. The ad­vice on over­stim­u­la­tion is ac­tu­ally ap­pli­ca­ble to full-term ba­bies un­der three months too. They can also be over­stim­u­lated by too much move­ment, bright colours and too many noises. Don’t add any­thing to the en­vi­ron­ment to make it more stim­u­lat­ing. Mom’s and Dad’s faces are ex­cel­lent stim­u­la­tion.

Your baby won’t be awake much in the first six weeks. At about three months his wak­ing times will be­gin to ex­tend. If he looks at you with a “play with me” face, you can stim­u­late him by do­ing the fol­low­ing: ■ Chat to him in a calm voice, sing some songs or re­cite a rhyme. ■ Stim­u­late his vi­sion by let­ting him lie on his back and fol­low the move­ments of your face. Make eye con­tact with him. Keep it full frontal so his head isn’t turned to the side when he looks at you. ■ Stick to one toy only for him to look at when he is awake. Too many bright toys can over­whelm him. Hang­ing toys should be in line with his navel so he can look at them com­fort­ably. ■ Ex­er­cise his mus­cles and move­ments by al­low­ing him to have some tummy time when he is awake. ■ Pedal his lit­tle legs when you change his nappy and he is on his back, but be very gen­tle and move slowly. ■ En­cour­age him to hold his hands to his mouth.


Keep bal­ance in mind as you ac­com­pany your baby on his jour­ney to or­gan­i­sa­tion and in­te­gra­tion. Ad­mit that the ten­sion can be re­lent­less and that the hospi­tal ex­pe­ri­ence was trau­matic, and that the first few months at home can be nervewrack­ing un­til your con­fi­dence has in­creased and your baby is a lit­tle big­ger.

It is im­por­tant that you have a good sup­port sys­tem and get enough sleep and rest. Make time to go for cof­fee while some­one else looks af­ter your baby, or take turns to care for your baby.

In spite of the ini­tial shock at his early ar­rival and the tense times in the NICU and the ad­just­ments to your home life, it is im­por­tant to re­mem­ber to en­joy him!

Don’t hes­i­tate to make use of spe­cial sup­port groups for emo­tional sup­port. Also make use of the ser­vices of var­i­ous ther­a­pists trained in help­ing you un­der­stand your baby’s de­vel­op­ment bet­ter. Many of them have spe­cial train­ing in neu­rode­vel­op­ment. Ask your pae­di­a­tri­cian to rec­om­mend some­one in your area. YB


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