Premature Babies - Preemies

Baby's Bounty Preemie Page

A Primer on Preemies
Caring for Preemies
A Preemie's Future
"Kangaroo" Care
Physical Care of Your Baby

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Preemies R Us - Covering the Needs Of Preemies in Great Big Ways!

Premature infants, known as preemies, come into the world earlier than full-term infants. Prematurity occurs when a pregnancy lasts fewer than 37 weeks; full-term infants are born 38 to 42 weeks after the mother's last menstrual period (LMP).

There are many causes of preterm delivery. Sometimes it's caused by the mother's lifestyle choices during pregnancy: smoking, drinking alcohol, using drugs, eating poorly, not gaining enough weight, exposure to physical stress, and poor prenatal care are all causes of preterm delivery.

Often, however, the cause is not within the mother's control. The mother could have a hormone imbalance, a structural abnormality of the uterus, a chronic illness, an infection, or several other things that could lead to a premature birth. In addition, preterm delivery is more likely when a woman is over age 35, under age 19, or is carrying multiple fetuses. And sometimes the cause is simply unknown.

Premature infants have many special needs that make their care different from that of full-term infants, which is why they often begin their lives after delivery in a neonatal intensive care unit (NICU). The NICU is designed to provide an atmosphere that limits stress to the infant and meets basic needs of warmth, nutrition, and protection to assure proper growth and development.

Due to many recent advances, more than 90% of premature babies who weigh 800 grams or more (a little less than 2 pounds) survive. Those who weigh more than 500 grams (a little more than 1 pound) have a 40% to 50% chance of survival, although their chances of complications are greater.

A Preemie's Basic Needs

Warmth

Premature babies lack the body fat necessary to maintain their body temperature, even when swaddled with blankets. Therefore, incubators or radiant warmers are used to keep the babies warm. Incubators are made of transparent plastic, and they completely surround an infant to keep him or her warm, decrease the chance of infection, and limit water loss. Radiant warmers are electrically warmed beds open to the air. These are used when the medical staff needs frequent access to the baby for care.

Nutrition and Growth

Premature babies have special nutritional needs because they grow at a faster rate than full-term babies and their digestive systems are immature. Neonatologists (pediatricians who specialize in the care of newborns) measure their weight in grams, not pounds and ounces. Full-term babies usually weigh more than 2,500 grams (about 5 pounds, 8 ounces), whereas premature babies weigh anywhere from about 500 to 2,500 grams.

So, what are premature babies fed? Breast milk is an excellent source of nutrition, but premature infants are too immature to feed directly from the breast or bottle until they're 32 to 34 weeks gestational age. Most premature infants have to be fed slowly because of the risk of developing necrotizing enterocolitis (NEC), an intestinal infection unique to preemies. Breast milk can be pumped by the mother and fed to the premature baby through a tube that goes from the baby's nose or mouth into the stomach.

Breast milk has an advantage over formula because it contains proteins that help fight infection and promote growth. Special fortifiers may be added to breast milk (or to formula if breastfeeding isn't desired), because premature infants have higher vitamin needs than full-term infants. Some premature babies receive additional vitamin supplements, too. The baby's blood chemicals and minerals, such as blood glucose (sugar), salt, potassium, calcium, phosphate, and magnesium, are monitored regularly, and the baby's diet is adjusted to keep these substances within a normal range.

Common Health Problems of Preemies

Premature infants are prone to a number of problems, mostly because their internal organs aren't completely ready to function on their own. In general, the more premature the infant, the higher the risk of complications.

Hyperbilirubinemia

A common treatable condition of premature babies is hyperbilirubinemia. Infants with hyperbilirubinemia have high levels of bilirubin, a compound that results from the natural breakdown of blood. This high level of bilirubin causes them to develop jaundice, a yellow discoloration of the skin and whites of the eyes. Although mild jaundice is fairly common in full-term babies, it's much more common in premature babies. Extremely high levels of bilirubin can cause brain damage, so premature infants are monitored for jaundice and treated quickly, before bilirubin reaches dangerous levels. Jaundiced infants are placed under lights that help the body eliminate bilirubin. Rarely, blood transfusions are used to treat severe jaundice.

Apnea

Apnea is another common health problem in premature babies. During an apnea spell, a baby stops breathing, the heart rate may decrease, and the skin may turn pale, purplish, or blue. Apnea is usually caused by immaturity in the area of the brain that controls the drive to breathe. Almost all babies born at 30 weeks or less will experience apnea. Apnea spells become less frequent with age.

In the NICU, all premature babies are monitored for apnea spells. Treating apnea can be as simple as gently stimulating the infant to restart breathing. However, when apnea occurs frequently, the infant may require medication (most commonly caffeine or theophylline) and/or a special nasal device that blows a steady stream of air into the airways to keep them open.

Anemia

Many premature infants lack the number of red blood cells necessary to carry adequate oxygen to the body. This complication, called anemia, is easily diagnosed using laboratory tests. These tests can determine the severity of the anemia and the number of new red blood cells being produced.

Premature infants may develop anemia for a number of reasons. In the first few weeks of life, infants don't make many new red blood cells. Also, an infant's red blood cells have a shorter life than an adult's. And the frequent blood samples that must be taken for laboratory testing make it difficult for red blood cells to replenish. Some premature infants, especially those who weigh less than 1,000 grams, require red blood cell transfusions.

Low Blood Pressure

Low blood pressure is a relatively common complication that may occur shortly after birth. It can be due to infection, blood loss, fluid loss, or medications given to the mother before delivery. Low blood pressure is treated by increasing fluid intake or prescribing medication. Infants who have low blood pressure due to blood loss may need a blood transfusion.

Respiratory Distress Syndrome

One of the most common and immediate problems facing premature infants is difficulty breathing. Although there are many causes of breathing difficulties in premature infants, the most common is called respiratory distress syndrome (RDS). In RDS, the infant's immature lungs don't produce enough of an important substance called surfactant. Surfactant allows the inner surface of the lungs to expand properly when the infant makes the change from the womb to breathing air after birth. Fortunately, RDS is treatable and many infants do quite well. When premature delivery can't be stopped, most pregnant women can be given medication just before delivery to help prevent RDS. Then, immediately after birth and several times later, artificial surfactant can be given to the infant. Although most premature babies who lack surfactant will require a breathing machine, or ventilator, for a while, the use of artificial surfactant has greatly decreased the amount of time that infants spend on the ventilator.

Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) is a lung reaction to oxygen or a ventilator needed to treat a preemie with a lung infection, severe RDS, or extreme prematurity. Preemies are often treated with medication and oxygen for this condition.

Infection

Infection is a big threat to premature infants because they're less able than full-term infants to fight germs that can cause serious illness. Infections can come from the mother before birth, during the process of birth, or after birth. Practically any body part can become infected. Reducing the risk of infection is why frequent hand washing is necessary in the NICU. Bacterial infections can be treated with antibiotics. Other medications are prescribed to treat viral and fungal infections.

Patent Ductus Arteriosus

The ductus arteriosus is a short blood vessel that connects the main blood vessel supplying the lungs to the aorta, the main blood vessel that leaves the heart. Its function in the unborn baby is to allow blood to bypass the lungs, because oxygen for the blood comes from the mother and not from breathing air. In full-term babies, the ductus arteriosus closes shortly after birth, but it frequently stays open in premature babies. When this happens, excess blood flows into the lungs and can cause breathing difficulties and sometimes heart failure. Patent ductus arteriosus (PDA) is often treated with a medication called indomethacin, which is successful in closing the ductus arteriosus in more than 80% of infants requiring this medication. However, if indomethacin therapy fails, then surgery may be required to close the ductus.

Retinopathy of Prematurity

The eyes of premature infants are especially vulnerable to injury after birth. A serious complication is called retinopathy of prematurity (ROP), which is abnormal growth of the blood vessels in an infant's eye. About 7% of babies weighing 1,250 grams or less at birth develop ROP, and the resulting damage may range from mild (the need for glasses) to severe (blindness). The cause of ROP in premature infants is unknown. Although it was previously thought that too much oxygen was the primary problem, further research has shown that oxygen levels (either too low or too high) play only a contributing factor in the development of ROP. Premature babies receive eye exams in the NICU to check for ROP.

After the NICU

Premature infants often require special care after leaving the NICU, sometimes in a high-risk newborn clinic or early intervention program. In addition to the regular well-child visits and immunizations that all infants receive, premature infants receive periodic hearing and eye examinations.

Careful attention is paid to the development of the nervous system, including the achievement of motor skills like smiling, sitting, and walking, as well as the positioning and tone of the muscles.

Speech and behavioral development are also important areas during follow-up. Some premature infants may require speech therapy or physical therapy as they grow up. Infants who have experienced complications in the NICU may need additional care by medical specialists.

Also important is support of the family. Caring for a premature infant is even more demanding than caring for a full-term infant, and the high-risk clinics pay special attention to the needs of the family as a whole.

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Caring for Preemies

There is a popular belief that preterm infants, those born before 37 weeks gestation, are positively affected by touch. It is important to both parents and practitioners to understand the context of this touch. When a baby is born significantly before his or her “due date” this newborn is subject to more poking and prodding than a full term baby would typically receive. Infants are subjected to a battery of tests and measures to ensure their safety and health. These babies are at a high risk for developmental delays, such as weak fine and gross motor skills, slow cognitive skills, late developing language skills, as well as attention and behavioral disorders.

Physically, their bodies are just not ready for the world outside the womb and they may experience breathing difficulties and respiratory dysfunction, sight impairment, and jaundice, due to incomplete development of the liver. They are also at a risk for Necrotizing Enterocolitis (NEC), which is an infection of the stomach and intestines. NEC is most common in preterm and especially low weight babies. There is currently no cure. In order to prevent, catch, or diagnose a dysfunction or illness with preterm babies, close watch must be kept on all of the newborns’ functions and fluids. Blood tests are preformed several times a week, and often several times a day. A prick in the heel to check bilirubin for jaundice seems as simple as a finger prick to test a diabetic’s blood sugar, but when your heel is the size of a thumb with fresh new skin, and you have no idea why you’re being held down on a cold table and stuck with a painful object, it’s pretty traumatic.

I can still see my preemie baby’s confused look turn to horror every time they pricked her teeny heel. Often, a preemie will be subjected to even “scarier” and more painful procedures, such as IVs, catheters, feeding tubes, and phototherapy. Preterm infants have been studied to show adverse reactions to this negative touch, such as “hypoxia, bradycardia, sleep disruptions, or increased intracranial pressure.”

Because of this connection between touch and pain expressed to preterm infants, it is imperative that parents and practitioners counteract the negative connotation with positive examples of touch, so a baby can learn and grow from these interactions.

Gentle and loving touch will not only teach a baby that touch can be a positive thing, it will physically assist in physical and psychological growth. A study performed at the University of Alabama at Birmingham evaluated the effects of gentle touch on 42 preterm infants. “Nurses placed one hand on the back of each infant's head and one on each infant's lower back for 10 minutes, twice per day for 10 days. During these periods, infants showed significantly fewer stress behaviors (eg, clenching fists, facial grimaces)” (AORN, 2001).

In Bergen Community Hospital in NJ where my friend’s son was born 3 months early, they promoted Kangaroo Care for tiny 1 ½ pound Tyler. Every day, although he was attached to three monitors and several tubes all over his little body, his mommy was encouraged to put him against her body and allow him to feel her skin. Kangaroo Care is a method of holding a preterm infant directly to his or her parents’ skin. First initiated by two South American neonatologists, Edgar Rey and Hector Martinez, Kangaroo Care has been used throughout the world to increase bonding and emotional closeness, as well as regulating baby’s heartbeat, body temperature, and initiation of lactation.

Positive touch such as Kangaroo Care, breastfeeding, and rubbing a baby’s back is beneficial to both baby and parents, leading to stronger emotional, psychological and physical well-being.

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Despite Disadvantages, Small Babies Make Happy Adults

Low-birth-weight babies attain lower professional and economic levels as adults than their normal-weight counterparts, but social class and family environment play a greater role in determining future achievements, a new study shows.

The study, appearing in this week's Journal of the American Medical Association, also showed that despite their lower socioeconomic status, these babies, known as small for gestational age (SGA), were as likely to go on to get married and express satisfaction with life as those born of normal weight. "Therefore," writes author Richard S. Strauss, MD, "previous studies that have focused on developmental and neurological outcomes of children who were SGA do not present a complete picture of the long-term consequences. Solely focusing on [developmental] testing ignores the social and emotional outcome of adolescents and adults who were SGA, which appears to be excellent."

Strauss arrived at these conclusions using data from the 1970 British Birth Cohort study. Initially developed to provide insight into obstetrical and neonatal care in the United Kingdom, the study has since become a vehicle for observing the physical, social, and emotional development of those children into adulthood. The children were followed up at age 5, 10, 16, and 26 years, by evaluators unaware of each child's birth weight. All of the over 14,000 subjects were full-term, and nearly 1,000 were SGA, defined as weighing approximately 5 pounds or less at birth. The average weight of the normal birth weight (NBW) infants was approximately 7 pounds.

From age 5 to 16, the children born SGA exhibited small deficits in a wide range of standardized tests, but in others, such as the 10-year reading score and the 16-year spelling and word recognition test, there was no significant difference between the two groups. Children born SGA were more likely to receive lower ratings from their teachers in terms of academic ability and class rank. By age 26, those who were SGA were less likely to have professional or managerial occupations and were more likely to have jobs as unskilled, semiskilled, or manual laborers. They also reported a significantly lower income than their NBW counterparts. However, there was no significant difference between the groups in marital status, satisfaction with life, and perception of standard of living.

While being born SGA is a significant predictor of professional and economic achievement in adulthood, Strauss writes, the deficits attributable to being SGA "were relatively small compared with the impact of parental social class. In addition, social class was associated with long-term differences in satisfaction with life, while SGA was not. ... This study supports the use of early intervention programs such as Head Start for children who were born to disadvantaged families."

"A consistent, loving home environment is much more important than where you start out, in relation to where you finish," says Craig Shoemaker, MD, chairman of pediatrics at MeritCare Children's Hospital in Fargo, N.D. Shoemaker, who was not involved in the study, says, "I'm very much a nurture vs. nature kind of person," and tells WebMD that he has two adopted children who were born SGA, both of whom are 'A' and 'B' students.

Craig questions the efficacy of programs like Head Start, whose effects fade once a child leaves. For maximum benefit, he recommends that the interventions continue through organizations such as Big Brothers and Big Sisters and various mentoring programs. "The important point is that SGA children tend to perform adequately in society and to be satisfied with their lot in life. This is something we try to tell parents all the time: that your child is going to be normal."

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Kangaroo Care:
The Human Incubator For The Premature Infant

The birth of a premature infant is documented to be a time of stress and crisis for parents. Among these stressors are perceived losses and grief from the early and abrupt termination of pregnancy, feelings of guilt and failure from inability to carry the infant to term, uncertainty regarding the infant's future health and developmental potential, and immediate and long-term separation of the infant and family.

Nursing staff at the Health Sciences Centre, Winnipeg, Manitoba introduced "Kangaroo Care" to their neonatal units in an attempt to diffuse some of the stressors associated with premature birth. During "Kangaroo Care", small stable premature infants, dressed only in a diaper and hat, are placed in "skin-to-skin" contact with their parent's chest, for up to 2 to 3 hours per day. Cardiorespiratory monitoring and oximetry are continued, if necessary, during "Kangaroo Care" while infants in the "Kangaroo Care" position are kept warm through close contact with their parent's skin.

This intimate handling encourages bonding, interaction and "cuddling" between parents and small infants who would otherwise be confined to incubator care. The emotional and psychological benefits of this practice for both parents and infants have been immediately obvious. Reactions from parents and infants support nursing perceptions that "Kangaroo Care" is the best thing we've done for parents and premature infants in a long time".

A POCKET GUIDE TO KANGAROO CARE - in the Neonatal Intensive Care Unit and Intermediate Care Nursery. An information guide to the practice of skin-to-skin contact to promote parent/infant bonding in special care babies.

What Is Kangaroo Care?
It is a method of skin-to-skin contact to promote parent/infant bonding especially for premature babies. KC was first initiated by two South American neonatologists. It is the practice of holding a premature infant dressed only in a diaper and a hat between a mother's bare breasts or father's chest, similar to a kangaroo carrying their young. Through contact with their parents' skin, the babies are kept warm and allow a close interaction with their parents. KC has not been shown to have any physical risks to the preterm babies.

Why Kangaroo Care?
The practice of KC was first introduced to neonatal units to involve parents in the care of their preemies and to decrease some of the stress associated with an infant needing neonatal intensive care. Parents who have experienced KC have expressed excitement and joy with the practice and many feel like parents for the first time since their infant's birth.

Infants have been observed in a restful sleep state while in the kangaroo position. As well, KC has been found to promote parent/infant bonding, breastfeeding and an early discharge for premature infants.

Where Is Kangaroo Care Practiced?
The neonatal intensive care unit (NICU) at Children's Hospital and the Intermediate Care Nursery (IMCN) at Women's Hospital both promote and encourage the practice of KC.

Who Can Practice Kangaroo Care?
Any mom, dad and babe who wishes to do so, of course.

When Can Kangaroo Care Be Initiated?
At Children's NICU and Women's IMCN, the policy includes stable babies who are less than 1500 grams and are breathing on their own. Babies needing oxygen or nasal continuous positive airway pressure (CPAP), may also be eligible. Cardiopulmonary monitoring and oximetry may be continued during KC. The bedside nurse will be nearby to monitor the infant as necessary during this procedure.

How Do You Do Kangaroo Care?
With mom or dad sitting in a rocking chair, baby is placed in a head-up position between mom's breasts or on father's chest. Babe is dressed only in a diaper and a hat with a light blanket to cover baby after he/she is in position. Screens are available for privacy. Initially KC should be practiced for 30 minutes once a day and gradually increased to 2-3 hours per day as tolerated.

About Kangaroo Care...

"I used to be worried of what I would see or hear in the nursery, but as I learned to feel my baby get stronger in the K position, I started to visit the baby more often because it was not a scary place anymore."

"I feel like I have moved into the nursery. I now can walk in and out of any room in the nursery and be comfortable. Such a difference, and it's because I'm not afraid for my baby anymore."

"I used to feel my baby had to be monitored by the machines or it might die without it. But as I saw and felt my baby doing well on my breasts, I now know the machines are there to help the nurses when I'm not here to put the baby in this K position. So I'm not afraid of anything in this place anymore."

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How to Participate in the Physical Care of Your Premature Baby in the NICU

In most NICU's, the nurses try to concentrate their care into discrete sessions and otherwise allow your baby to sleep undisturbed. IF you time your visits to coincide with these activity periods, you will have more opportunities to help care for your baby. You may want to call your baby's nurse before your visit; she can tell you when she expects your baby to be awake, or she may be able to adjust his schedule so that you can provide his care when you get there.

All preemies need to have the following tasks done regularly. Your baby's nurse can teach you how to do them and help you until you feel comfortable on your own.

Taking Your Baby's Temperature
This is often of the first tasks that parents feel comfortable performing. When you take your baby out of the incubator to hold or feed him, his nurse will want you to take his temperature to make sure he is not losing too much body heat. IF you are using a traditional glass thermometer, you will probably take your baby's axillary temperature by placing the end of the thermometer in his armpit with this arm down at this side and leaving it in place for three to five minutes. If you have never used a glass thermometer before, the nurse will show you how to use and read it. Some hospitals use thermometers that give instant digital read-outs.

Changing Diapers
Although diapering is not an inherently difficult task, it can be challenging to work with a tiny baby who is inside an incubator and connected to IV tubes, monitoring wires, and /or respiratory equipment. In addition, preemies who are less than about 32 weeks old are weak and floppy. If your baby is lying on his stomach or side, you must turn him over on his back to change his diaper. Unlike a full-term baby who feels like a compact, connected bundle when you handle him, your preemie is floppy and his bottom half may feel only loosely connected to his top half. You'll need to scoop both of your hands under your baby to support his whole body and head as you turn him. This can take some practice, particularly if you are a new parent.

If you are uncomfortable moving your baby, have the nurse get your baby into position first and then take over. And if working through the portholes is very difficult, ask your baby's nurse if you may open the front of the incubator and slide the bed out to give you a platform that is easier to work on. She may place warming lights above your baby so he doesn't become chilled while you work. The nurse will want to look at your baby's diaper and weigh it in order to keep track of his output of urine and feces, so leave it on top of the incubator when you have finished.

Mouth Care
If your baby is on a respirator with an endotracheal tube in his mouth, you can help keep him comfortable by wiping away secretions that accumulate around the tube and applying glycerin ointment to his lips to keep them from getting chapped. This is a simple task that you can do very early in your child's hospitalization when you may be able to do little else. Some parents also learn how to suction mucous and other secretions from their baby's nose and mouth if he must remain on respiratory equipment for an extended period of time.

Bathing
At first, your baby will only be given sponge baths inside the incubator or on the warming table. Because preemies tend to have very thin and sensitive skin, they are usually just wiped with a soft wash cloth and plain warm water. As your baby gets older and bigger, you will be able to give him tub baths. In some hospitals, baths are given during the night shift when the nursery is generally less busy. If you want to start bathing your own baby, talk to the staff and try to rearrange the schedule so that you can do it yourself. Your baby's nurse will get you set up and teach you how to bathe your baby.

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