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What to Expect With Your Premature Baby, Part 1

As your due date nears, the feelings of excitement and being anxious can have you and your partner on a rollercoaster that just does not seem to end. You may find yourself rushing to make sure everything is perfect, but what do you do when the unexpected happens. What happens if you and your family experience a premature birth? This is a situation that we tend to not want to think about, but it happens more than you would expect. Hopefully throughout this article we can give you an idea of what to expect, and help you understand a few situations more in depth.

Many babies born prematurely do not get to leave the hospital at the same time as their mothers. It can be very disappointing waiting all of this time to not be able to bring your baby home with you. Keep in mind, it is for the best. The time a baby spends in the hospital is different for everyone. Your baby may spend days, weeks or even months in the hospital. The time all depends on how your baby is progressing. During the time you are waiting, there are plenty of things you can do to prepare to bring your preemie home. As anxious as you may be, health care professionals do not send premature babies home until the baby is ready.

Requirements for Discharge

Your preemie must meet many basic requirements before being discharged from the NICU, Neonatal Intensive Care Unit. These requirements help ensure that their health is in good standing and reduce the risk of medical problems. There are a few nurseries that have a weight requirement for a baby to be discharged, but more often these three criteria are the important decision makers.
  1. During a 24-48 hour period, is the baby able to maintain a body temperature in an open crib? This will also depend on how premature the baby is.
  2. Is the baby taking all of their feedings by breast or bottle without a supplemental feeding tube?
  3. Is the baby steadily gaining weight?
Most premature babies will reach this criteria between 2 and 4 weeks before reaching their expected due date. In cases of babies who had surgery, health issues, or have spent time on breathing machines and oxygen, this time will most likely extend further than their expected due date.

Medical Needs After Discharge

A great number of premature babies do not need special medical support after discharge, but they will all need routine medical care and evaluations. This routine includes scheduled immunizations,like with a full-term baby.

There are a few medical issues premature babies may experience long term:
Apnea

It is not uncommon for a preemie to encounter apnea. Apnea is a pause in breathing that can cause a change in color or heart rate, or require stimulation to help the baby breathe again. A baby will not be discharged with these issues, but if the case is very mild, the baby may be sent home with an apnea monitor. Some NICU nurseries will monitor the baby’s breathing patterns until full maturity of post-conceptional age, about 44 weeks.
Your doctor will decide if a monitor is needed for you baby. If your baby is sent home with an apnea monitor, anyone who will be caring for your baby will need to attend a training session. This session with teach you how to use the monitor and you will learn how to perform CPR, Cardiopulmonary Resuscitation.
Additional Breathing Issues

Premature babies may also have other breathing difficulties and require supplemental oxygen or a mechanical ventilator. However, by the time most babies are ready to leave the NICU, they will no longer require supplemental oxygen. Though, few babies may develop a chronic lung condition referred to BPD, bronchopulmonary dysplasia. BPD is a condition that involved irritation and scarring of the lungs. Babies with BPD will more than likely need supplemental oxygen and medication for an extended amount of time after discharge. Until their lungs are functioning better, the baby may be discharged on medications or oxygen.

Oxygen equipment for home care will be arranged before being discharged, if you baby will require oxygen.

Feeding Issues

Preemie babies have to catch up growth wise to full-term babies, so they require extra nourishment. You should also keep in mind that a premature baby’s intestines are not fully matured, so it is important to be careful on how much the baby is being fed. When your baby is discharged, they will have a specific feeding plan to fit their needs. In order to continue to grow steadily, you baby may need more concentrated milk.

Along with underdeveloped intestines, preemie babies may have issues with sucking, swallowing, and breastfeeding. These babies are assisted with their feedings until they are able to eat on their own. A NG Tube, Nasogastric tube, may be used. This tubed if passed through the nose and down into the stomach. Another tube that may be used is a G Tube, Gastrostomy Tube. The G Tube is inserted surgically through the skin and travels to the stomach. In other cases, some premature babies are placed on a TPN, Total Prenatal Nutrition, feed that is given through a vein. This is done when the baby cannot be fed through their stomach. Speak with you baby’s nurses and doctors to learn more about the needs of your baby.

Infections

A premature baby’s immune system does not work as well as babies that are born at term, older kids or adults. Due to this, preemie babies are more at risk for contracting infections, especially viral, after discharge.
While your preemie is in the NICU, they typically receive vaccines corresponding with doctor recommended schedules. It is essential that your household, along with anyone who is to be in close contact with your baby should ensure that they are up to date on their pertussis immunization, as well as their seasonal flu vaccine.

Preemie babies can become infected by many different viruses, but they are especially susceptible to RSV, Respiratory Syncytial Virus. RSV is a viral infection that is common among young children. This infection is often mistaken for a common cold or flu. While adults and older children experience fewer issues with RSV, it is dangerous to preemies. The RSV infection can lead to breathing complications, severe illness, or even become fatal. It is a common reason why premature babies are rehospitalized.

When it comes to the prevention of RSV, there is a medication available to help your baby. If your baby is born before 29 weeks, they should receive this medication. If a baby requires oxygen while being born before 32 weeks, they should receive this treatment as well.

A preventive medicine, Synagis, is available to help protect infants from RSV. Preemies born at less than 29 weeks should receive this medicine, as well as any born under 32 weeks who required extra oxygen for the first month of life. For more information of this medication, please speak with your baby’s doctors.

The first injections is normally administered before your baby is discharged in the winter months. Throughout the RSV season, the injections are then given monthly. This reason runs during late fall to late winter, or early spring. If your preemie is discharged at a different time in the year, they may need the medication once winter arrives. There are cases in which your baby may need this again throughout their second RSV season. This is usually only the case is babies who are very premature, or at risk for other breathing complications.

Your premature baby can have their injections administered at home by a nurse or in the doctor’s office. Like with many medications, there is always a risk that this medicine may not prevent RSV. Even so, it can minimize the severity. Do not hesitate to ask your baby’s doctor if your baby should have these preventives.

Upcoming Discharge

Life may seem very hectic at this time, but there are still a few things you can do as your baby’s discharge date nears. An important lesson you and your family can learn together is CPR and specialized training for your new addition.

Though CPR training is required for the caretakers of baby’s on apnea monitors, you should consider taking a course for you baby. This will help you in an emergency situation where CPR can be a lifesaver. Your hospital should offer this course before taking your baby home. This is a great lesson that the entire family can learn from. The NICU staff should offer this program, but if this is not the case, The American Heart Association and American Red Cross can inform you on where you can receive this training.

If your baby is sent home with an oxygen tank, apnea monitor, or any other special equipment, you will be trained on how to use it. Don’t be afraid to ask questions. This training will help you work your way through an issue if something goes wrong.

Circumcision

If circumcision is something you and your partner have decided on, your preemie baby can usually be circumcised before they are discharged.

This may seem like a lot to take in, and can feel a bit scary. Be sure to keep in mind that everything that is done is to help your preemie baby continue to grow and lead a happy, healthy life. If you ever feel unsure about something, ask your baby’s healthcare team. They are there to out only help your baby, but you as well throughout this time.

If you have questions or concerns about the health of your premature infant, please give us a call at 239-573-2001.


About author MacKoul Pediatrics

MacKoul Pediatrics is an amazing local pediatrics office in Cape Coral, FL where caring, compassionate doctors and nurses work with you to keep your children as healthy as possible. MacKoul cares for children from birth to college age, from Cape Coral, Fort Myers, Naples, and beyond.

February 24, 2017