Dr. Mythili Sivarman
Small babies have fewer defences against infection. One of the ways we can prevent infection is to wash hands regularly with soap and water all the way below the elbows before we touch the baby. Breastfeeding also helps the baby to fight infection.
Breast milk alone is sufficient for most babies. Some very small babies need calcium and phosphate supplements and after a few weeks extra iron as well.
The main reaction on the birth of a preterm baby is that of fear and helplessness.
- Grief- Separation from your infant at birth is a sudden and profound loss. Allow yourself to grieve this loss and the loss of your original hopes for your full-term infant, yourself, and your family.
- Anger- You may find yourself becoming angry with your doctor, yourself, your family, even your infant. This is all normal.
- Guilt- You may blame yourself for your infant’s condition, even if you’ve done everything possible to have a healthy pregnancy. This is a good time to remember that the pregnant body often runs its own course, regardless of all efforts to control it.
- Isolation– Not only can the NICU be a lonely place to spend your hours, but you may feel that no one can possibly understand what life is like for you right now.
- Ambivalence– It is normal to fear attachment to an infant with an uncertain future, even if it’s your own child. You may have a mixture of feelings, including love, longing, numbness, and detachment from your infant.
- Combined with your recovery after the birth (postpartum recovery), the NICU experience increases your risk of depression and anxiety. Some parents of particularly sick or dying premature infants can also develop a post-traumatic stress disorder.
The most common complications of prematurity result from immature organs and an immature immune system and include:
- Low blood pressure.
- Low blood sugar.
- Respiratory distress syndrome.
- Chronic lung disease.
- Necrotizing enterocolitis.
- Patent ductus arteriosus. Infection (including sepsis).
- Retinopathy of prematurity.
- Intraventricular hemorrhage, or bleeding in the brain, which can result in cerebral palsy or mental retardation.
- Inguinal hernia.
Infants born at 32 weeks’ gestation or older are least likely to develop complications. With each additional week of prematurity before 32 weeks, risks begin to increase dramatically. Infants born at 22 to 26 weeks’ gestation are extremely underdeveloped and have a significantly higher risk of death and disability. Parents of these infants are likely to be faced with difficult life-or-death medical decisions.
Sleeping and wakefulness. Because their brain functions aren’t as fully developed at birth as full-term newborns, premature infants:
- Sleep more per 24-hour period than full-term infants do but for shorter periods of time. Expect that you may be awakened frequently at night.
- Are seldom awake for more than brief periods until about 2 months after their due date. It may seem like a long time before your infant is responsive to your presence.
- Fussiness and hypersensitivity. It is normal for full-term infants to cry for up to 3 hours per day by 6 weeks after their due date. Most premature infants will do the same and then some. Your premature infant may be easily overstimulated by too much light, sound, touch, or movement or by too much quiet after living in the noisy NICU. If so, gradually create a more calming environment, swaddle your infant in a blanket, and hold him or her as much as possible.
- Your infant probably will come home on a hospital feeding schedule, which will tell you how often to nurse
- To avoid infant dehydration, never go longer than 3 hours between feedings. Small feedings may help reduce spitting up. If you see signs of reflux during or after feedings, talk to your infant’s doctor.
Relatives and friends are always excited about a newborn baby. Gently discourage them from visiting until the baby has gained weight and is well settled in your home. Do not allow the baby to be picked up and kissed as they can pick up infections quickly. Do not allow smoking in the house.
With the exception of the hepatitis B vaccine, the preemie’s schedule for childhood immunizations is the same as for a full-term infant, figured from the expected date of birth (chronological age).
Most preemies who are born between 32 and 37 completed weeks’ gestation do well after birth. If your infant does well after birth (has no oxygen deprivation, severe infection, or brain or lung damage), his or her risk of disability or developmental delay is low.
- During your child’s first 2 years of life, he or she will appear to be developmentally behind full-term children of the same age. You can expect your infant and young child, however, to achieve the same sequence of developmental milestones as any other child.
- Expect that your premature infant’s “lag” in development will catch up at about 2 years of chronological age. As your child grows into the preschool years, a 2- to 4-month difference in age or development blends right in among a group of preschoolers.
- As your child begins formal schooling, be alert for signs of subtle learning problems. Learning, reading, and math disabilities due to prematurity may first become apparent during the early school years.
Severe delays and disability
- Most premature infants do not grow up to have serious developmental delays or disabilities. Generally, the smaller, more premature, or sicker the newborn, the more likely he or she is to have a developmental delay or severe disability.
- If your infant was born extremely prematurely (before 26 weeks’ gestation) or was small [about 800 g (1.8 lb) or less], he or she is likely to develop a severe disability.
- Those who do have signs of developmental delays are likely to improve with the help of enriched home life and attentive caregivers.