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
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 Initially only one normal feed was possible per day, but gradually all the tube feeds have been replaced by normal feeds.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.
STIMULATION AND OVERSTIMULATION
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.
AND HOW ARE YOU?
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
EVEN THOUGH YOUR BABY IS MORE FRAGILE THAN A FULL-TERM BABY IT IS IMPORTANT THAT YOU TREAT YOUR BABY AS A NORMAL BABY