The Premature Baby Book

Sears Parenting Library

The Pregnancy Book

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The Attachment Parenting Book

The Breastfeeding Book

The Fussy Baby Book

The Discipline Book

The Family Nutrition Book

The A.D.D. Book

The Successful Child

Parenting.com FAQ Books

The First Three Months

How to Get Your Baby to Sleep

Keeping Your Baby Healthy

Feeding the Picky Eater

Sears Children's Library

Baby on the Way

What Baby Needs

Eat Healthy, Feel Great

You Can Go to the Potty

Copyright

COPYRIGHT © 2004 BY WILLIAM SEARS AND MARTHA SEARS

ALL RIGHTS RESERVED. NO PART OF THIS BOOK MAY BE REPRODUCED IN ANY FORM OR BY ANY ELECTRONIC OR MECHANICAL MEANS, INCLUDING INFORMATION STORAGE AND RETRIEVAL SYSTEMS, WITHOUT PERMISSION IN WRITING FROM THE PUBLISHER, EXCEPT BY A REVIEWER WHO MAY QUOTE BRIEF PASSAGES IN A REVIEW.

Little, Brown and Company

Hachette Book Group

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New York, NY 10017

Visit our website at www.HachetteBookGroup.com

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First eBook Edition: March 2010

ISBN: 978-0-316-05203-0

1

The First Day — The Top 10
Questions About Premature Babies

DURING PREGNANCY, parents dream of those magical moments after birth when they will meet their new baby: those first moments of bonding, of gazing deeply, with wonder, into their newborn's questioning eyes. They look forward to skin-to-skin contact, to baby's first suckling at the breast, to holding baby close to their heart. These prenatal visions of the birth experience are important. They prepare you to love your baby.

Parents of a baby born prematurely do not get to experience the fulfillment of these dreams right away. They are challenged with a different beginning to their baby's life. Instead of holding and comforting their new bundle of joy in their arms, they find their arms empty. Instead of reading helpful handouts from the nurses about caring for their newborn, they must scrutinize the fine print on a consent form that authorizes any and all necessary treatments their baby may need in the Neonatal Intensive Care Unit, or, as you will come to know it, the NICU. Instead of learning to recognize and respond to their own baby's unique cry, they must endure the cries of healthy newborns in the hospital hallway. When Mom and Dad look at each other, they don't see joy and excitement. They see only worry.

Not all parents of premature babies go through such an abrupt and dramatic break from the expected newborn routine. Every baby's start in life is different. Some premature babies are born with mature lungs, and their condition is very stable right from the start. These babies and their parents may enjoy several hours together before the baby is taken to the hospital nursery. Other babies are accompanied to the NICU by the father or a friend or family member, who will learn right away that the baby is doing well, despite the need for special care. Other babies are born with very immature lungs and struggle right from birth. For these families, the delivery room is a place of drama and uncertainty. Their baby is immediately whisked away to the NICU, where he or she is surrounded by doctors, nurses, flashing lights, beeping monitors, tubes, and sensors.

What do parents feel in those first hours? Worry. Fear. Loss. These are natural reactions that anyone would experience in this situation. But perhaps the most pervasive feeling at this early stage is uncertainty. You wonder, Where is my baby? How is my baby doing? Is my baby fighting for his little life? What do the doctors and nurses think? Is my baby worse off than I fear, or not so bad? This initial period of not knowing exactly how your baby is doing can be tough, especially if you are not able to be with your premature newborn during the first few hours in the NICU. A hundred questions go through your mind, and there are few immediate answers.

Whether you begin reading this book in the first hours after birth, when you are still very uncertain about what lies ahead for your baby, or later, when your baby's condition is stable and you know more about what to expect, there are probably many things you wish to know. We have written this chapter to answer the questions most parents ask in the first hours and days after their baby's premature birth. We have relied on "experts" — parents of preemies — to tell us what mothers and fathers most want to know at this stage. (You will find comments from these parents throughout the book.)

1. How premature is my baby, and will my baby be okay?

When your baby is born prematurely, your immediate concern is whether or not he will be all right. How serious is the situation when baby is born at 34 weeks' gestation? At 28 weeks' gestation? Will your baby have any long-term medical or developmental problems? How likely is it that your baby will have a "normal," healthy life? Unfortunately, the answers you want most are the ones your doctors are not able to give — at least not yet. They must first assess your baby's condition and see how he responds to initial supportive measures.

In general, the earlier a baby is born, the more likely she may be to have short-term or long-term difficulties. The baby's weight at birth also affects the outcome. However, every baby is unique, and every baby responds differently to the challenges of coming into this world early. It is entirely possible that a baby born at 34 weeks will have a more difficult course than a baby born at 29 weeks.

Dr. Bob notes: Recently, I had the pleasure of doing a checkup on a beautiful five-year-old girl named Maria, who was a new patient. After giving her a clean bill of health and finding no developmental or learning problems, I asked her mother if Maria had experienced any major medical problems in the past. I was surprised when she told me that her child had been born at 28 weeks' gestation. Despite being born almost 3 months early, she had encountered no long-term health problems whatsoever.

This child is just one example of how the dramatic advances in neonatology are helping more premature babies not only survive but also live normal, healthy lives. While some babies will have ongoing medical or developmental challenges once they leave the NICU, the majority of preemies grow up just fine.

2. What caused my baby to be born prematurely?

The first question anybody asks when hardship comes along is why? It is natural for parents to ask themselves, "Why did this happen?" "What did I do to cause this?" "What could I have done to prevent this?"

There are a number of medical conditions during pregnancy that can lead to premature birth (we will discuss these shortly), but in most cases, premature birth comes without warning and has no apparent medical cause. A mother who has a normal pregnancy with no detectable medical conditions and who receives regular prenatal care may still give birth prematurely. There is absolutely nothing she did to cause her baby to be born prematurely, and there is nothing she could have done to prevent the premature birth. Even if a woman has a complication during her pregnancy that leads to a prematurely born baby, such a complication also happens by chance, and again, there is nothing she did to cause it. For example, a woman may develop preeclampsia (high blood pressure) during her pregnancy, and this may induce premature labor, but usually there is nothing she could have done to prevent the preeclampsia. This is true for all of the causes of premature birth discussed below.

Known medical conditions that make a premature birth more likely include the following:

• previous premature birth, miscarriage, or multiple abortions
• history of kidney disease
• structural problems in the uterus: a weakened cervix, heart-shaped uterus, or bifid uterus (uterus divided into two separate parts)
• prenatal complications: placental problems, too much or too little amniotic fluid, uterine fibroids (benign growths), preeclampsia or toxemia, early rupture of the membranes (your water breaks too early), or infection of the uterus
• multiple babies: twins, triplets, or more have a greater chance of being born prematurely
• obesity
• being very underweight from under-nourishment

Three factors that can increase the risk of prematurity are under a woman's control:

• Cigarette smoking retards the growth of the placenta and can therefore lead to an early birth.

• Drug abuse can lead to many pregnancy complications, including premature birth.
• Lack of adequate prenatal care increases the risk of prematurity. When prenatal complications are identified and treated early, a premature birth may be prevented.

Aside from these last three factors, there is nothing a woman does to cause, and nothing she can do to prevent, the premature birth of her baby. It is important to resolve any feelings of guilt or blame you may have and move on to focusing on your baby. If you need to know more about why your baby was born early, talk with your birth attendant. Or ask your nurse if you can speak with a hospital chaplain or counselor to help you address these feelings.

3. What is happening to my baby right now?

The frustrating, helpless feelings you may have on your baby's first day may come from not knowing what your baby is going through. You may wonder, How is my baby doing? What exactly is being done for my baby right now? Why does my baby need so many wires and tubes? What does all that equipment and monitoring actually do? Is my baby in pain? In the next chapter, we will explain in detail the medical procedures and equipment that are used to care for your baby. For now, here's a brief discussion of what typically happens to a premature baby during the first twenty-four hours. This basic understanding of what's happening may be all you need at this stage. As your baby's condition stabilizes and you spend more time at her side, you can learn more details about your baby's care. If you are reading this book when your baby is already a few weeks old, then the following information may give you some insight into what happened during that hectic first day.

Doctors' first concern in the hours after baby's birth is his respiratory status. How well are his lungs working? Are the lungs mature enough to provide oxygen to the body unassisted? Over the first twenty-four to forty-eight hours, the doctors and nurses will closely monitor baby's respiratory status and observe his breathing pattern carefully. Is he breathing comfortably, or is his breathing becoming more rapid, shallow, and strained?

The level of oxygen in his blood is monitored using a sensor taped to his hand or foot, as well as with blood tests.

At this point, premature babies fall into one of two categories: those whose lungs are mature enough to handle the transition from the womb into open air, and those who temporarily need assistance with breathing.

Babies with mature lungs may need nothing more than some oxygen blown into their nose to make breathing a bit easier. Many infants, however, especially those born before 32 weeks, have immature lungs that are not ready to absorb oxygen correctly. This may be immediately apparent in the delivery room, or the doctors and nurses may conclude after several hours of observation that baby's breathing is becoming more labored. If your baby is not breathing adequately on his own, a breathing tube is inserted through his mouth into his lungs. This procedure is called intubation. The tube is attached to a machine called a ventilator, which breathes for your baby. As baby's lungs start to mature and absorb oxygen better, his reliance on the ventilator will decrease. Depending on the degree of prematurity, babies can require ventilation for as little as a few hours or as long as several weeks. If your baby needs intensive respiratory support, do not worry that he is stressed or in pain. Babies are given relaxing and pain-relieving medications during this invasive period. They generally sleep through most of it.

An intravenous line (an IV) will be placed in your baby's umbilical cord. This site provides easy access to blood samples for testing. Baby will also receive fluids through the IV, since he won't be able to eat right away.

Don't drown yourself in information. The Internet is a wonderful thing, but it can make you crazy. Your child is unique and so is your situation. There is no way you can predict the outcome by reading about all the possibilities. ^*

4. Why is my baby being transferred to another hospital?

If your baby is born in a large hospital with a busy obstetrics unit, chances are that the neonatal nursery there is equipped to care for your premature baby. However, if your baby is born at a small suburban or rural hospital, your baby may need to be transferred to a larger hospital with a higher-level nursery. Neonatal nurseries are classified by their ability to handle complex problems:

Basic Care Nursery (formerly called Level I). Any hospital that has an obstetrics unit has at least a Basic Care Nursery. It is equipped to handle healthy babies born at 35 weeks' gestation or older who do not have any respiratory or other significant medical problems. This type of unit has a pediatrician (or sometimes a neonatologist) available to handle unexpected complications and stabilize a sick baby for transport to a larger hospital. If your baby is born prior to 35 weeks, weighs less than 4 pounds (1800 grams), or has any significant breathing problems regardless of gestational age, she will probably be transferred to a Specialty Care NICU (see below).

Specialty Care NICU (formerly Level II). Found in many large urban hospitals and most large rural regional medical centers, this type of NICU is well equipped and staffed by full-time neonatologists. A Specialty Care Unit is able to care for most premature babies born at 32 weeks or later and can care for babies with moderate but stable problems that are expected to improve quickly.

Subspecialty Care NICU (formerly Level III). This more advanced type of unit is usually found in most major university hospitals and large medical centers. It cares for premature babies with moderate to severe complications, including birth defects, that require specialized care from pediatric subspecialists, such as surgeons, cardiologists, neurologists, neurosurgeons, and radiologists.

5. How can I help care for my baby in the NICU?

Every parent's natural impulse is to help their child who is hurt or sick. But when a premature baby goes to the NICU, many parents feel helpless. You want to do something for your sick baby, but there seems to be nothing you can do. You may try to shut down this impulse to help and settle for feeling helpless, or your helping energy may get diverted into worrying or trying to control things over which you have little influence.

Take heart! There actually are many things you can do to help your baby, both immediately and throughout the NICU stay. Your involvement with your baby at this time is critical, for both of you. Here are several ways you can help your baby:

Provide breast milk. A mother of a premature baby may decide that she might as well resign herself to the fact that she won't be able to breastfeed. Or the parents of a preemie may feel that breastfeeding is bound to fail, since the normal pattern for the beginning of the feeding process has been disrupted. Nothing is further from the truth. Not only will you eventually be able to breastfeed your baby, but it is critical for your baby's health that he receive breast milk as soon as feeding is possible. Giving your milk to your baby is so important that we devote two chapters to this subject. In chapters 6 and 7 we will discuss in detail how you can provide breast milk and eventually breastfeed your baby, as well as explain the numerous medical benefits of giving your baby breast milk, but here's what you need to know right away.

As soon as you feel ready, ask the nurse about pumping your breasts. The sooner you start, the better. Pump every three hours or as often as possible. Use a hospital-grade electric breast pump with a double pumping kit, so that you can pump both breasts at the same time. Ask to have a breast pump in your hospital room and begin storing all the milk you pump. You will start off getting very little, but every little bit adds up. This is probably the single most important thing you can do for your baby. Some preemies can be fed breast milk in the first day of life, depending on a variety of factors.

If the thought of breastfeeding overwhelms you right now, and you are worried that it might be too stressful for you and baby, realize that actual breastfeeding may be several weeks away. You will be much more able to face these challenges at that time. In the meanwhile, pumping your milk will give your baby the best nutrition possible.

If I felt he was too warm or too cold, they would let me fix it.

Get attached to your baby. The quiet, focused time that a mother, father, and baby spend together in the hours and days after birth helps the parent-infant relationship get off to a good start. When parents are separated from their baby after birth because of medical problems, the usual bonding process is disrupted. Finding opportunities to get attached to their baby is vital to the emotional well-being of both parents. One way to do this is to begin spending time in the nursery, touching your premature baby. If your baby is relatively stable and needs little intervention, you will be able to hold him right away. If your baby is on a ventilator to assist his breathing, you may not be able to hold him, but you can still touch him, gently kiss him, and speak to him. Spend as much time with your baby as you can, right from the start. Not only will you benefit from this early bonding, but research has shown that preemies are more stable and grow better when they spend more time physically in touch with their parents.

Begin "kangaroo care." This type of parent involvement in the care of a premature newborn is modeled after the way a kangaroo cares for its young. A baby kangaroo is born at a very early stage of development — like a premature baby — and spends many weeks living inside the mom's pouch, where it is nourished and kept warm. Kangaroo care for your baby involves holding your baby skin-to-skin for many hours each day. In chapter 5 we will provide a crash course in how to do K care as well as discuss the research that has shown how K care can greatly benefit a premature baby.

Dr. Jim advises: Years down the road, you want to have no regrets. Don't let fears about the future and the problems your preemie may develop keep you from expressing your love and concern for him through touch, soft words, and time spent together. Whatever happens in the days to come, you will know that you gave him your best. Take full advantage of every moment.

Become involved. Mom and Dad are both a valuable part of the medical team. It is easy to let yourselves be overwhelmed by all the high-tech equipment that you see around your baby in the NICU and by the medical terminology used by the staff. While there are many things that you cannot do for your baby in the NICU, your level of involvement and daily interest in your baby's care will be noticed by the NICU staff. The more they see of you, the more they will respect and seek your input in decisions made about your baby's care.

6. When will I be able to hold and breastfeed my baby?

Usually, parents are allowed to hold their baby as soon as he is off the ventilator. For extremely premature babies, this will be several weeks after birth. You can certainly touch and caress your baby during this time. If your baby does not require a ventilator, you should be able to hold him right away.