Baby Care & Child Health Problems

Part I
BABY CARE

VII
Premature Baby Care

Every parent-to-be naturally hopes for a baby to be born healthy and full-term. But even with modern medicines and hi-tech facilties, seven percent of babies are born prematurely. A premature baby is born before the 37th week of gestation and is sometimes nicknamed as a ‘preemie’. Babies can be born prematurely for different reasons like pregnancies with twins, triplets or more babies, stressful events like long distance air travel, emotional stress of the death of someone very close, etc. However, normal day-to-day stresses of living have no evidence on inducing premature labour. Mothers who deliver premature babies are often scared and nervous as their newborns have a higher risk of developing complications. The earlier the baby is born, the higher the baby is likely to develop complications.

Since premature babies are not fully equipped to deal with the outside world, they require special care. Their little bodies have areas that are yet to mature and fully develop such as lungs, digestive system, immune system and skin. A baby born healthy requires special and extra care and attention. Here comes the role of the parents to keep their baby as healthy and comfortable as possible. A few tips are required on the parents’ part to smooth out the process of caring for a preemie. This chapter of baby care will help you out with feeding your premature baby and the needs demanded by a preemie. Also look out for the growth chart of a premature baby and the various health problems faced by such a baby.

1. Feeding Your Premature Baby

Before your baby was born, you might have probably dreamt about how it would feel to hold him/her in your arms and feed him/her. You might have already decided and planned out what all to feed or how to feed him/her a nutritious diet. However, if your baby has been born prematurely, you may have to reconsider your plans. Feeding a premature baby can really be a stressful task for any parent. It becomes an issue of daily care and concern. In the womb, the baby might have got all the nutrients and fluids via the placenta and umbilical cord. But when a baby is born premature, this chain of receiving nutrients and fluids is broken. As such, the deficiency that results can be taken care by nursing the baby or by feeding him/her formula, or by following other methods as prescribed by the doctor to fulfill the baby's basic requirements.

Total Parenteral Nutrition

Total Parenteral Nutrition (TPN) is a method of feeding used for extremely premature babies or one who are very sick. In this method, nutrients, such as glucose, protein and fat solutions are introduced directly into the baby's bloodstream through a vein. Babies have an immature digestive system, so this method is brought to use. This method also helps the kids to preserve their energy. TPN provides all the necessary nutrients to your baby to help him/her grow and thrive.

Tube Feeding Method

Supply of adequate amount of nutrients to the baby is necessary for them to grow properly. Tube method makes sure that the baby gets enough nutrients. Babies have a higher metabolism, their brain is developing and they are growing fast. However, premature babies have limited supply of energy and nutrients. Thus it becomes important to tube feed them, so that they can take in small intake of nutrients without using too much of energy. The coordination of sucking, swallowing, and breathing needed for feeding is not developed in babies born before 34-36 weeks, so a tube is passed through their nose or mouth down to their stomach.

Premature baby being fed with tube

Nursing

Nursing is the best way to protect your kids from different illnesses. Your body produces specialised proteins called antibodies to fight off infection. Mothers transfer these antibodies to their babies through placenta during the last three months of pregnancy. This process is broken if a baby is born prematurely. Mothers also can transfer these antibodies through breast-feeding. This will help in providing immunity to the babies against any virus or infection.

Supplementary Feeding

In the early stages of your baby's development, proper supply of enough energy and fluids is important. Sometimes, it may get difficult for mothers to express enough milk because of some illness during pregnancy. Two of the alternatives that can be used in such a case can be to use additional breast milk donated to some hospitals by other mothers, or to use formula milk. This is a temporary method to be adopted. Full inspection of the donated milk will be conducted by the doctors before feeding it to babies.

Bottle Feeding

When in hospital, babies are fed on formula milk, made particularly for their nutritional needs. When your baby is out of hospital and ready for coordinating sucking, swallowing and breathing, he/she can be fed by a bottle. These formulas or formulae contain more of nutrients that a premature baby requires, such as iron, fat, protein, several vitamins, calcium, phosphorous and magnesium.

2. Premature Baby Growth Chart

You can measure your premature baby's growth by a growth chart. A growth chart is a tool that the specialists use to evaluate and keep a track of your baby's physical growth. Parents at times get worried with the results of this chart, especially if the baby is premature. They should remember that their child will grow at his/her own pace, and that this test is conducted to get the data, so that you can work towards better growth of your kid if he/she is lagging behind. Growth chart is just a normal guide for you and your doctor to keep a track of your baby's growth, there is nothing to get worried with the result. What a growing baby requires is just the intake of all necessary nutrients and fluids. If the baby is getting these nutrients in some form or the other, there is nothing to worry, as the baby will grow at his/her own pace.

Doctor's Way of Measurement

 Weight
The doctor or the nurse will put your baby on a scale, either a traditional beam scale or an electronic model, to weigh them. Both the types will be set to zero before your baby is laid down. Your baby should not be wearing any clothing during this test. The measurement is usually taken in kilograms and recorded to the tenth of a kilo. The doctor or nurse will tell you your baby's weight in pounds to the closest ounce.

 Head Circumference
The doctor will measure your baby's head with a flexible measuring tape. He will place the tape at the area where the circumference is the largest, like just above your baby's eyebrows and ears, around the back of their heads. It is important to measure your baby's head circumference to get to know whether your baby's brain is growing properly with the right pace or not. The brain growth is reflected in the size of the skull. So, if your baby's brain is not growing normally, his/her head circumference may not be increasing as it should. There is even a problem if the circumference of the head is increasing very fast. This means your baby's brain is growing very fast, which may be an indicator of problems like hydrocephalus (the formation and buildup of fluid in the brain). Both the ends are quite dangerous and alarming, so the brain growth should just be apt. But do not get alarmed if your baby's head looks big. If you have any doubt, go for a checkup, as the head may look big even because either of the parent's head is big.

 Height
The doctor or the nurse will measure your baby from the top of their head to the bottom of their heel. Some practitioners use a special device with a headboard and a movable footboard for accurate results. There is again nothing to get worried with the measurement, as your baby will grow only as much he/she should. The length of the baby is also affected by his/her genes.

Growth Measurement at Home

 You can weigh your baby at home by using a weighing scale. Get your baby on the scale and note the number. Then, put your baby down and you get on to the scale without the baby. Subtract the number from your combined weight and get your baby's appropriate weight.

 Also measure your baby's length. Lay your baby down, take a measuring tape and stretch it down from head to toe. It is better if there is someone to help you. Your results will not be the same as the doctor's figures, but you will get a rough idea.

 Wrap a flexible measuring tape over your baby's head to measure his/her head circumference. The goal is to measure the head at the spot, where it has the largest circumference. After all the results are there with you, place them on a growth percentile calculator to find out whether your baby is growing properly or not.

3. Premature Baby Health Problems

Bringing up a baby is a great but difficult experience, because a parent needs to take many health and safety precautions. If the baby is premature, the difficulty, the precautions and the care to be taken, increases. Parents of a premature baby have only one question to ask, what the different problems are that their babies will encounter. There is a stage of development that all babies go through inside the womb. However, a premature baby will not be able to complete the development cycle, facing multiple problems after birth. This will call in for extra care and effort on parent's part. The parents should not only take good care of a premature baby and get him/her medical attention, but should also make an effort to learn about the different diseases that their babies may face. This will help them understand their baby's problem and get him/her the right treatment.

Health Problems in Preemies

These are some common health problems that the premature babies are more prone to have.

 Respiratory Problems
Respiratory distress is the common problem faced by as many as 43% of premature babies born between 30 to 32 weeks, or before that time. For lungs to inflate properly, a chemical called 
surfactantis needed, which a full-term baby or a normal baby can produce, but a premature baby can't. They may need artificial surfactant, or might need breathing help till the time they and their lungs grow up.

 Jaundice
It is caused by a product of 
red blood cell called bilirubin. Preemies are the most affected by a rapid rise in bilirubin, and are treated more often than full-term babies to prevent a risk of high number of bilirubin damaging the brain.

 Apnea
Babies born before 34 weeks of full gestation period develop Apnea, or a period where breathing stops, because their brains and lungs are not developed fully. Apnea may be accompanied by Bradycardia, where the heart slows down. Stimulation or other respiratory help may start the normal breathing process again in babies.

 Gastro Esophageal Reflex Disease
Gastro Esophageal Reflex Disease (GERD) affects half of the premature population. In this disease, the babies throw up whatever they eat due to the stomach contents coming up the esophagus. The infants suffering with GERD have many other symptoms too, such as they spit up, lose weight, or may have respiratory problems like cough or pneumonia.

 Intraventricular Hemorrhage
Preemies born before 30 weeks have fragile blood vessels in their brains. An Intraventricular Hemorrhage may occur if these blood vessels break. This bleeding in the brain may be mild or severe. This bleeding may also have serious consequences, such as developmental delays. A mild bleed does not usually have long-term effects.

 Retinopathy of Prematurity
Retinopathy of prematurity or ROP is the abnormal growth of blood vessels in the eyes of premature babies. This abnormal vessel growth may lead to retinal detachment and blindness. The disease affects half of the babies born before 26 weeks, but only 1 % of them born before 30 weeks.

 Patent Ductus Arteriosis
Before birth, the babies depend on the placenta for oxygen and have a different circulatory system after the birth. They have ductus arteriosis, an opening between the major vessels. This ductus usually closes after birth for food to flow in normally. However in preemies, this opening might not close even after birth. This causes Patent Ductus Arteriosis or PDA which occurs in younger preemies and leads to abnormal circulation. Medication or surgery will be needed to close the ductus.

 Necrotizing Enterocolitis (NEC)
Necrotizing Enterocolitis (NEC) occurs in as many as 13% of babies before 26 weeks, and 3% babies born between 30-32 weeks. NEC affects the intestine of the infants. Various symptoms of this problem are a distended belly, lethargy and feeding intolerance. The early it is tracked, the better and safer it is for the preemies. It can be treated by antibiotics. A severe case may also require surgery.

 Sepsis
Sepsis is a serious problem in preemies and is caused by bacteria in blood. It may occur earlier by exposure to the bacteria in the womb or birth canal, or later from contaminated equipment or IV lines. The symptoms may include breathing problems, swollen belly and lethargy. If caught early, it can be treated very easily with antibiotics.

 Broncho-Pulmonary Dysplasia
Broncho Pulmonary Dysplasia (BPD) is a chronic lung condition caused by airway inflammation. It affects those babies more who were on ventilator for a longer time. It may cause difficulty in breathing and low blood oxygen levels. Babies with BPD need extra oxygen, till the time the condition subsides.

4. Premature Baby Needs

What babies look for in their parents is a secure and caring hand. Babies really do require that extra bit of care and concern. When a baby is premature, he/she requires even more care and protection. Premature babies often are lacking in some or the other aspect, as compared to a normal baby. Special care for preemies is required to overcome any developmental loopholes. Premature babies face a number of physical and emotional challenges, such as impaired vision and hearing, jaundice and anaemia, etc. These are definitely situations to be handled medically, but parents also play a major role in promoting healthy development of their babies. Parents can help the premature babies to give emotional strength to develop both mentally and physically. However, there are times when the parents may not know what their babies need or expect from them, and how they need to take care of their premature babies.

Tips to Take Care of Premature Babies

 Learn more about your baby. Always, be aware about your baby's condition and medical assistance given to him/her. Uncertainty or lack of knowledge can be a risky situation. Ask as many questions as you can and seek answers for all your queries, because it is the question of your baby and their health.

 Be an observant parent. Know about each and every move and action of your baby. Do share your concerns and any change in your baby's condition with the medical team. Bring to their notice all recent developments in your baby, so that they can function accordingly.

 Breast milk is a must for a premature baby, as it contains proteins that will help in fighting infections. Your baby may not be able to take breast-feed initially but do not let the milk supply dry up. Once the baby is strong enough put him/her exclusively on breast milk.

 Provide lots of love and concern to premature babies. Speak to them in a loving tone. When they are ready, cuddle them, hold them close to you, turn their head so that they can hear your heartbeat, try and make skin to skin contact. All this gives them a sense of security.

 Dress up your baby comfortably. Premature babies are small in size and they lack in body fat, so they need special clothes. Their clothing should be such that it fits them properly and keeps them warm. The warmness will make them comfortable, relaxed and happy. Their clothes should also have easy openings for easy diaper change and hook up to any hospital equipment.

 You can bond very well with your baby at time of feeding him/her. Mothers develop skin to skin contact during nursing; this increases the bonding between the baby and the mother. Some babies may also require gavage method (tube feeding) to feed them. When solid food is introduced after 4 or 6 months, the meals should be small and frequent.

 A premature baby needs diaper change around 5 to 6 times a day. Don't get worried, as it indicates that your baby is getting required amount of nutrition. There are special diapers available for premature babies, which fit them well and can be removed without undressing them.

 Premature babies have a different sleeping pattern. They sleep for longer hours because of their developmental needs. To make sure that they get adequate amount of sleep, limit their exposure to stimulating environment and outsiders. They are also at greater risk of SIDS. Make sure they sleep in a proper position, i.e. on their backs and not on stomach. Also check that their bedding is firm and without any loose or suffocating items.

FAQs

Q-1. What are the common causes for premature birth of babies?

Ans. Any baby who is born before the 37th week of pregnancy is termed as a premature baby. In india, about ten percent of all births are premature. The main causes of premature births are malnutrition, infection, high blood pressure, toxaemia of pregnancy, diabetes and severe heart and lung diseases in the mother. Sometimes a baby is delivered prematurely if the doctor finds the baby suffering from lack of proper oxygen supply in the mother's womb.

Q-2. What are the problems a premature baby has to face?

Ans. The earlier the premature baby is born, the lower would be his/her birth weight and the greater would be the severity of the handicaps the baby may have to face. Such babies are likely to have difficulties in breathing, maintenance of body temperature and feeding.

Q-3. What is an incubator?

Ans. An incubator is a machine which has the environment similar to the mother's womb. The incubator's inside temperature and the humidity can be controlled as per the needs of the baby. The oxygen content of its air can be adjusted externally. The nutritional requirements of the baby who is kept in the incubator are met through intravenous feeding or feeding through a tube passed into his/her stomach.

Q-4. What is the care required by a premature baby on reaching home?

Ans. Premature babies have a reduced ability to maintain their body temperatures. The room in which they are kept should have a comparatively higher temperature. The baby should be covered with proper clothes at all times. Since the immune system of a premature baby is deficient, he/she needs extra-protective measures. Always handle such a baby with clean hands after washing them with soap and water. The number of visitors must be severely restricted. Anyone suffering from throat or respiratory infection, fever or any other communicable disease should not be allowed to come near the baby.

Q-5. What kind of nutrition is required by a premature baby?

Ans. Breast milk is the best for a premature baby. If the baby is unable to suck at the breast, then the milk may be expressed and given to the baby with a bottle having an extra soft nipple. Since premature babies are deficient in body stores of vitamins and iron, they should be given vitamins and calcium and administered iron supplements from the age of six weeks onward to prevent the development of anaemia.