Caring for a premature baby

An average full-term baby weighs about 3kg at birth; premature babies are likely to weigh 2.6kg or less. Preemies born after the 30th week of pregnancy have a much better chance of being more developed at birth and have fewer complications to deal with. It’s important to remember that the earlier your baby is born before 37 weeks are done, the smaller he or she is likely to be. 

A premature baby’s head is likely to look larger than the rest of the body. The amount of fat in the body is also likely to be considerably less, so your baby may look weak and frail. The baby’s skin may be more transparent and you may even be able to see the blood vessels. Since your preemie baby lacks a thicker layer of fat in the body, he or she might feel cold at room temperature and may not be able to maintain their body temperature due to underdeveloped organs. This is the reason why a preemie is shifted to an incubator immediately after birth and any interaction with the baby—including breastfeeding—has to be done in the NICU.

Check with your doctor if skin-to-skin contact with the baby in the first hour after birth is possible in your case. Studies show that skin-to-skin contact can improve heart rhythm, neurodevelopment, quality of sleep, thermoregulation, respiratory rate and oxygen saturation in preterm babies.

Babies need about 40 weeks to develop fully. The womb is a protective environment where the baby gets the time and nutrients needed to get to that level of growth.

A premature baby born before 37 weeks has had considerably less time, as the last few crucial weeks of development are missing. The NICU at the hospital provides a protective environment for preemies to grow in the absence of the womb.

NICUs are fitted with temperature-controlled incubators, monitoring and alarm systems, respiratory and resuscitating equipment, and experienced nurses, doctors and paediatricians who are available at all hours of the day and night.

If you’ve had a preemie, the NICU is likely to be their home for the first few weeks at least, so it’s best to get familiar with this place.

The first few days at the NICU are focussed on providing the baby’s vital organs support to mature fully. The baby’s heart rate, blood pressure, blood oxygen levels and breathing are monitored constantly. Since a preemie’s lungs and other organ systems are not yet fully developed, he or she might not be able to suckle at the breast. This means breastfeeding is not possible soon after the birth of the preemie baby, and so, the baby will have to be fed intravenously or via a tube. Once the baby has developed enough and is strong, breastfeeding may be initiated.

Skin-to-skin contact is vital for the baby’s bonding with the parents, so you and your spouse may be allowed to visit and initiate contact with the baby in the NICU at certain occasions if the baby is strong and safe enough. The first few attempts at breastfeeding may also be initiated while your baby is in the NICU. The baby is only discharged from the NICU if he or she meets the following criteria:

• The baby is able to maintain his or her body temperature for 24-48 hours without needing the incubator or any other supportive equipment.
• The baby is able to feed without a supplemental or intravenous means. This means the baby’s bottle or breastfeeding intake is sufficient.
• The baby is gaining weight steadily.

Once a preemie baby is discharged from the hospital, they might not need any specialized medical care and support unless they are severely sick. However, they will require regular medical care and evaluation during their early months and years. The following are the long-term health conditions a premature baby might have to face in the upcoming months and years.

Whether you’re a new parent or an experienced one, caring for a premature baby is a tough job. Communicating with your doctors is important to understand what your baby’s particular needs may be. Often parents of preemies are taught how to handle and care for the baby properly by the doctor or paediatricians at the NICU itself. But if you are particularly anxious about the wellbeing of your preemie, then you could discuss further things to do. The following are some things that all parents and caregivers of preemies need to know.

Once your premature baby is home, you have to be on your toes and care for him or her to the fullest possible extent. Rehospitalization is a scary but real prospect for preemies, so you need to make sure that such an occasion does not arise. This is not an easy job, so both you and your partner are needed for your baby’s care—and you may need to enlist the help of friends and family too. The following are some home care tips that you can adopt while caring for your preemie:

• Ensure your home and especially the baby’s room has a comfortable temperature. Adding layers of clothing for your baby may help with this, but you may want to consult the doctor about the right temperature too.
• Make sure your preemie’s sleep environment is safe. Ensure that your baby sleeps on his or her back, the cot or mattress is firm, and there are no loose objects around that can impair the baby’s breathing. Keeping a watch on your baby’s sleep can also help avoid sudden infant death syndrome (SIDS).
• Preemies are likely to have sensitive skin, which is underdeveloped at birth like most of their other organs. This is why do not wash or bathe your baby without consulting your doctor. Ask them how and when to do it properly, if at all, during the first few months since the baby’s birth. You may have to keep the baby’s umbilical stump clean with wipes, but otherwise, avoid getting the baby wet. 
• Do not expose your baby to outdoor areas or unknown people until they are more than six months old. This is because preemies are more vulnerable to infections, the chances of which increase with exposure to unknown elements.
• Invest in good quality things you may need to care for your preemie, including a humidifier, a good thermometer, etc.

Kangaroo mother care is a specific method devised to care for preemies and those babies who had a very low birth weight. As you know, preemies are underdeveloped, cannot maintain their own body temperature, have difficulties breastfeeding, are vulnerable to infections, and require more safety, stimulation and love. Kangaroo mother care is believed to be a method that eases the burden of all these issues, and the WHO says that an estimated 450,000 preemies per year can be saved by the adoption of this method.

This method involves the preemie, an adult (usually the mother) and a specially designed cloth. The baby is placed on the mother’s chest, held in place by the cloth which is wrapped around the mother’s back, and stays there for extended periods of time. This technique promotes skin-to-skin contact and meets the baby’s needs for warmth, safety and love. It stimulates frequent breastfeeding, protection from infections, and improves the bond between mother and babies. 

Kangaroo mother care is a technique specifically developed by observing kangaroos, who carry their baby or joey in a warm, comfortable pouch. The WHO believes this method to be very effective, and suitable for both premature and full-term babies. This method is quickly gaining popularity in India as well. Consult your paediatrician to learn how to try kangaroo mother care properly.

Having a premature baby can be very stressful indeed. Not only can it be distressing to see your baby in the NICU surrounded by and fitted to machines, but it’s also likely that you may experience feelings of guilt, helplessness, anxiety, anger, sadness and trauma. These feelings are often mixed with the feelings of joy and happiness that you would normally experience after meeting your baby for the first time. 

It’s important to understand that these feelings are quite normal. You may feel a lack of control over what’s happening to your baby, and a surge of negative feelings and apprehensions. But, it is important to remember that with proper care and time, your baby will be fine and you will be able to overcome all the challenges thrown at you. The following ideas may help you cope with the negative feelings and stress, and help you feel more positive and capable of caring for your baby.

• Accept your feelings instead of trying to suppress them. If you try to suppress them, they might emerge later in a more intense form and you may find it more difficult to cope with these feelings then.
• Talk to someone about how you are feeling and your experiences. This could be your spouse, family, friends, a support group of parents with preemies, or a counsellor.
• Look after yourself by eating nutritious food, sleeping enough, getting some exercise and fresh air. You will need to get your strength up and your baby’s care will soon depend on you, so you need to be prepared for it.
• Take some time to relax and refocus yourself by trying meditation, yoga and other activities. This will help you reconnect with positive feelings and help you care for your preemie better.
• Remember that a preemie may be slower to develop than full-term babies, but as long as they are healthy, they will continue to have happy lives. Focus on your baby’s future and analyse his or her needs right now to make your hopes come true.
• Don’t feel ashamed to reach out for help. Remember there’s only so much you can do alone, so enlist the help of everyone who offers it, including friends and family.
• Keep a check on your mental health as well as your physical health, because postpartum depression does occur to a lot of new parents. Get help from a professional if needed.