Prematurity

A baby is considered premature if it is less than 37 weeks old at birth.  A premature baby, or preemie, is not fully developed, meaning some vital organs may not be functioning to their full potential or not yet ready to operate at all. While a full-term newborn weighs about seven pounds at birth on average, a premature baby will weigh closer to five pounds.  Because preemies are in such a fragile state, they may require extra medical support and be kept at the hospital in the Neonatal Intensive Care Unit (NICU) after birth.  Some of the health issues associated with prematurity are:

Temperature Regulation

Premature babies lack the proper amount of body fat to maintain their body temperature, so incubators or radiant warmers are used to keep them warm in the NICU. Incubators are transparent enclosed cases that completely surround babies to keep them warm. Radiant warmers are electrically warmed beds which are open, rather than fully surrounding the baby. A small thermometer taped onto the baby measures his/her temperature and regulates the heat accordingly.

Feeding Problems

Preemies grow faster than full-term babies but they have specific nutritional and dietary needs because their digestive systems are not fully mature. Breast milk is a good source of nutrition, but preemies cannot feed directly from the breast or bottle until 32 to 34 weeks gestational age. Additionally, most premature babies need to be fed slowly because of an increased risk of developing an intestinal infection. In this case, preemies are often fed with pumped breast milk through a tube that goes from the baby’s nose or mouth into the stomach.

Apnea

Apnea is a temporary disruption in or cessation of breathing for a short time.  When a preemie experiences apnea, the heart rate may decrease and skin color may become pale, purplish, or blue. In the NICU, preemies are often hooked up to a cardiorespiratory monitor that tracks the heart rate and sounds an alarm after a certain number of seconds with no breath.  A nurse may gently rub the baby’s back, arms and legs to stimulate and restart breathing. If apnea occurs regularly, the preemie may need medication and/or a nasal device that constantly blows a stream of air, opening the airways.

Breathing Problems and Low Oxygen Levels

Often times, preemies need assistance with breathing and may require a ventilator. There are a few different ventilation options available, depending on the severity of the baby’s breathing problems:

  • Mechanical ventilation through an endotracheal tube (intubation): A small plastic tube is inserted through the baby’s nose or mouth into the windpipe, and air is blown in and out of the lungs. This machine essentially breathes for the baby.
  • Continuous positive airway pressure (CPAP): A mask or short prongs are placed around the nose, and air or oxygen is blown in at a constant pressure. The baby breathes all on his/her own, but this machine ensures that the lungs are kept open in between each breath.
  • Nasal prong: Tiny prongs are used to carry oxygen through the nostrils. This choice is used when the baby does not need pressure to keep the lungs open, but needs additional oxygen to maintain healthy oxygen levels in the bloodstream.

Jaundiced Skin

When a baby’s liver is not fully formed or functional, it may cause a buildup of the protein called bilirubin in the blood.  Jaundice occurs when high levels of bilirubin cause the skin and whites of the eyes to turn yellow.  Premature babies with Jaundice are placed under special blue florescent lights that break down the bilirubin in the skin and turn it back to a normal color.  A blue light blanket may also be used.

Caring for a Premature Baby

If a preemie is in the NICU, it may be very difficult for new parents because they may need to spend a significant amount of time away from their baby.  It is important for parents to remember that, in the NICU, their baby will receive care from highly trained staff, as well as the most technologically advanced equipment. The baby is in a safe and stable environment and parents can visit often.

When the day finally arrives for the baby to come home from the NICU, parents may feel both excited and worried. Caring for a preemie at home may be nerve racking at first, simply because of the baby’s fragile state.  As long as parents are prepared, however, there is no need for concern.  If a baby is sent home with special equipment, parents need to make sure they understand how to properly use it.  They should not be afraid to ask questions and practice using the equipment before they leave the hospital.  It is important for parents to know exactly how to react in the event of an emergency, especially with a medically fragile child, so parents should stay up-to-date with CPR training and techniques they learned from NICU staff.

During the first few months, parents dedicate huge amounts of time caring for their newborn. While this is very important, it is also crucial to take care of themselves and not underestimate the stress of an early delivery. Parents should be sure to get plenty of sleep, eat healthy, and exercise in moderation. They should also seek support and encouragement from medical professionals, family members, support groups, or counselors. In order to best care for a preemie, it is essential that parents have the proper energy, care, and health.

If you have had a premature baby, we encourage you to share personal insight, advice, or stories from your own experiences, so that others may learn and benefit from a veteran parent!

Reviewed by Melissa Hendrickson, RN and Director of Health Services at Penfield Children’s Center.

“What is Prematurity?” Babyfirst. 3 June 2013. <http://www.babyfirst.com/en/parents-corner/what-is-prematurity.php>.

“Taking Your Preemie Home.” KidsHealth. 3 June 2013. <http://kidshealth.org/parent/pregnancy_center/newborn_care/preemie_home.html#>.

“Caring for a Premature Baby.” Healthychildren.org. American Academy of Pediatrics. 3 June 2013. <www.healthychildren.org

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