The wait is over. For the last 10 months, you’ve spent endless hours in preparation and anticipation of the day you’d look into your baby’s face. And now that day is here.
Your labor and delivery — whether it was a marathon session or shockingly short — is behind you. Now is the time to hold, caress and enjoy that precious little person you’ve been waiting for so long to meet.
Even though you’re probably eager to go home and start your new life, take advantage of your time in the hospital or birthing center. Many mothers are surprised by how much private time they want after birth. Although your family and friends will want to see you and hear about how you and the baby are doing, you might want to limit calls and visits. It’s OK to turn off the phone, and the nurses can help restrict visitors to ensure your privacy. Good friends — especially if they’re parents themselves — will understand if you need time for yourself and your baby.
Think about it — your body has been through a significant workout. So sit back and let the hospital staff wait on you and help take care of you. It’s not a luxury you’ll be afforded for long.
Your time in the hospital is also an opportunity to ask questions — you’ll likely have many! Fortunately, the answers are just down the hall. Part of the job of hospital staff is to help you make the transition to parenthood, whether this is your first baby or your fourth. Take advantage of their expertise.
In addition, many hospitals provide literature and videos about the care of newborns, ranging from feeding your baby to car seat safety. Your nurse can suggest which materials might be most helpful to you. If you have the opportunity, take some time to review this information. Once you get home, spare moments may be few and far between.
Many hospitals allow your baby to room in with you. This is a wonderful opportunity to get to know and spend time with your newborn. Realize, though, that it’s perfectly acceptable to request some quiet time away from your baby. Once you go home, you won’t have much time to rest. If you’re tired or you just need a break, trust that your nurses will take excellent care of your baby in the nursery.
In this chapter, you’ll learn about your newborn’s first days of life — what he or she may look like, and what exams and immunizations your baby may undergo. The chapter also discusses common conditions often seen in newborns and, if your son or daughter is born prematurely, possible complications.
When I was pregnant, I couldn’t wait to get my baby home — to dress him in his new clothes, put him to sleep in his beautiful new crib, and nurse him in the brand- new rocking chair we’d spent hours trying out and had placed in the sunniest spot in the living room. But, actually, arriving home was different than expected. I had a red-faced, screaming baby who spit up on all of those new outfits. My breasts were engorged from my milk coming in. And there was a sudden, overwhelming feeling that my husband and I were alone and suddenly — parents.
The first couple of weeks home were not the wonderful, hazy days I dreamed they would be. To be honest, they were overwhelming, and at times I felt like I was barely conscious. When my milk came in, I was so shocked I called my pediatrician’s office to ask if it was normal and how could I possibly get my son to latch on? When my son cried and was inconsolable from 5:00 to 6:00 each night, I called again to ask if this was normal and what we could do to try to help him. During night-time feedings, I was so tired that I fell asleep with the baby at my breast and woke up with a stiff, kinked neck.
It took us a couple of weeks to settle into our routine. Luckily for me, my husband was very supportive. I was in charge of “input” and my husband was in charge of “output” — I nursed the baby and he changed the diapers. Within two days, my breast engorgement had resolved and my baby was happily nursing. I tried to nurse as much as I could on my side, so at least I was off my feet and resting. Once we got past the immediate rush of visitors and people asking me what they could do to help, I happily replied, “Why don’t you bring us dinner.” It was great not to cook and to have some social interaction with other adults.
By my six-week postpartum visit, I was happy to report that my baby was starting to smile and coo. That made all the difference in the world. I had gone from being just a milk-supplier and diaper-changer to someone he actually recognized – his mom.
YOUR BABY’S APPEARANCE
Considering what they’ve just been through during labor and childbirth, it’s no wonder that newborns don’t look like the sweet little angels seen on television. Instead, your newborn will first appear somewhat messy looking. If your baby is like most, his or her head will be a bit misshapen and larger than you expected. The eyelids may be puffy, and his or her arms and legs may be drawn up as they were in the uterus. He or she may be somewhat bloody, wet and slippery from amniotic fluid.
In addition, most babies will be born with what appears like skin lotion. Called vernix, it’ll be most noticeable under your baby’s arms, behind the ears and in the groin. Most of this vernix will be washed off during your baby’s first bath.
Head At first, your baby’s head may appear flat, elongated or crooked. This peculiar elongation is one of the common features of a newly born baby.
A baby’s skull consists of several sections of bone that are flexibly joined so that the head shape can change to correspond to the shape of your pelvis as your baby moves through the birth canal. A long labor usually results in an elongated or tall skull shape at birth. The head of a breech baby may have a shorter, broader appearance. If a vacuum extractor was used to assist in the birth, your baby’s head may look particularly elongated.
Fontanels When you feel the top of your baby’s head, you’ll notice two soft areas. These soft spots, called fontanels, are where your baby’s skull bones haven’t grown together yet.
The fontanel toward the front of the scalp is a diamond-shaped spot roughly the size of a quarter. Though it’s usually flat, it may bulge when your baby cries or strains. In nine to 18 months, this fontanel will be filled in with hard bone. The smaller, less noticeable fontanel at the back of the head is about the size of a dime and it closes much quicker —around six weeks after birth.
Skin Most babies are born with some bruising, and skin blotches and blemishes are common.
A rounded swelling of the scalp is usually seen on the top and back of the baby’s head when a baby is born the usual way — headfirst. This puffiness of the skin disappears within a day or so.
Pressure from your pelvis during labor can cause a bruise on your baby’s head. The bruise may be noticeable for several weeks, and you might feel a small bump that persists for several months. You may also see scrapes or bruises on your baby’s face and head if forceps were used during delivery. These bruises and blemishes should go away within a couple of weeks.
Other skin conditions common in newborns include:
Milia. These are tiny white pimples on the nose and chin. Although they appear to be raised, they are nearly flat and smooth to the touch. Milia disappear in time, and they don’t require treatment.
Salmon patches. These red patches may be found over the nape of the neck, between the eyebrows or on the eyelids. Also called stork bites or angel kisses, they usually disappear over the first few months.
Erythema toxicum. It sounds scary, but erythema toxicum is the medical term for a skin condition that’s typically present at birth or appears within the first few days after birth. It’s characterized by small white or yellowish bumps surrounded by pink or reddish skin. The condition causes no discomfort and is not infectious. Erythema toxicum disappears in a few days.
Newborn acne. Newborn (infantile) acne refers to the red bumps and blotches similar to acne that are seen on the face, neck, upper chest and back. It’s most noticeable at a month or two and typically disappears without treatment within another month or two. This condition doesn’t necessarily mean that a baby will have acne later in life.
Mongolian spots. Also known as the blue-gray macule of infancy, these are large, flat gray or blue areas that contain extra pigment and appear on the lower back or buttocks. They’re especially common in black, American Indian and Asian infants and in babies with dark complexions. Mongolian spots don’t change color or fade like a bruise would, but they generally go away in later childhood.
Pustular melanosis. These small spots look like small white sesame seeds that quickly dry and peel off. They may look similar to skin infections (pustules), but pustular melanosis isn’t an infection and disappears without treatment. The spots are most commonly seen in the folds of the neck and on the shoulders and upper chest. They’re more common in dark-complected babies.
Strawberry hemangiomas. Caused by overgrowth of blood vessels in the top layers of skin, strawberry (capillary) hemangiomas are red, raised spots that may resemble a strawberry. Usually not present at birth, a hemangioma begins as a small, pale spot that becomes red in the center. A strawberry hemangioma enlarges during the baby’s first few months and eventually disappears without treatment.
Hair Your baby may be born bald, with a full head of thick hair — or almost anything in between! Don’t fall in love with your baby’s locks too quickly. The hair color your baby is born with isn’t necessarily what he or she will have six months down the road. Blond newborns, for example, may become darker blond as they get older, and their hair may develop a reddish tinge that isn’t apparent at birth.
You may be surprised to see that your newborn’s head isn’t the only place he or she has hair. Downy, fine hair called lanugo covers a baby’s body before birth and may temporarily appear on your newborn’s back, shoulders, forehead and temples. Most of this hair is shed in the uterus before the baby is delivered, making lanugo especially common in premature babies. It disappears in the weeks following birth.
Eyes It’s perfectly normal for your newborn’s eyes to be puffy. In fact, some infants have such puffy eyes that they aren’t able to open their eyes wide right away. But don’t worry, within a day or two, your baby will be able to look into your eyes.
You may also notice that your new baby sometimes looks cross-eyed. This, too, is normal and will be outgrown within several months.
Sometimes babies are born with red spots on the whites of their eyes. These spots are caused by the breakage of tiny blood vessels during birth. The spots are harmless and won’t interfere with your baby’s sight. They generally disappear in a week to two.
Like hair, a newborn’s eyes give no guarantee of future color. Although most newborns have dark bluish-brown, blue-black, grayish-blue or slate-colored eyes, permanent eye color may take six months or even longer to establish itself.
From the moment your little one is born, he or she is the focus of much activity. Your care provider or a nurse will clean his or her face. To make sure your baby can breathe properly, the nose and mouth are cleared of fluid as soon as the head appears — and again immediately after birth.
While baby’s airway is being cleared, his or her heart rate and circulation can be checked with a stethoscope or by feeling the pulse in the umbilical cord. All newborns look somewhat bluish-gray for the first several minutes, especially on their lips and tongue. By five to 10 minutes after birth, they become pink. Your baby’s umbilical cord is clamped with a plastic clamp, and you or your partner may be given the option to cut it.
In the next day or two, many things will take place. The medical team will conduct newborn examinations, administer screening tests and give immunizations. Here’s what to expect.
Examinations One of the first examinations of baby will be determining his or her Apgar scores.
Apgar scores Apgar scores — a quick evaluation of a newborn’s health — are given at one minute and five minutes after a baby is born. Developed in 1952 by anesthesiologist Virginia Apgar, this brief examination rates newborns on five criteria: color, heart rate, reflexes, muscle tone and respiration.
Each of these criteria is given an individual score of zero, 1 or 2. Then all scores are totaled for a maximum possible score of 10. Higher scores indicate the healthier infants, while scores below 5 mean an infant needs help at birth.
Some doctors downplay the significance of Apgar scores because most babies with lower scores ultimately turn out to be perfectly healthy.
Other checks and measurements Soon after birth, your newborn’s weight, length and head circumference are measured. Your baby’s temperature may be taken, and breathing and heart rate measured. Then, usually within 12 hours after your baby’s birth, a physical exam is conducted to detect any problems or abnormalities.
Treatments and vaccinations To prevent disease, the following protections are generally taken:
Eye protection To avert the possibility of gonorrhea being passed from mother to baby, all states require that infants’ eyes be protected from this infection immediately after birth. Gonorrheal eye infections were a leading cause of blindness until early in the 20th century, when treatment of babies’ eyes after birth became mandatory. An antibiotic ointment or solution, commonly either erythromycin or tetracycline, is placed onto his or her eyes. These preparations are gentle to the eyes and cause no pain.
Vitamin K injection In the United States, vitamin K is routinely given to infants shortly after they’re born. Vitamin K is necessary for normal blood coagulation, the body’s process for stopping bleeding after a cut or bruise. Newborns have low levels of vitamin K in their first few weeks. An injection of vitamin K can help prevent the rare possibility that a newborn would become so deficient in vitamin K that serious bleeding might develop. This problem is not related to hemophilia.
Hepatitis B vaccination Hepatitis B is a viral infection that affects the liver. It can cause such illnesses as cirrhosis and liver failure, or it can result in the development of liver tumors. Adults contract hepatitis through sexual contact, shared needles or exposure to the blood of an infected person. Babies, however, can contract hepatitis B from their mothers during pregnancy and birth.
The hepatitis B vaccine can protect infants if they are exposed to the virus. Therefore, your baby may be given the vaccine in the hospital or birthing center shortly after birth. Alternatively, hepatitis B vaccinations may be given along with other immunizations at 2 months.
Screening tests Before your baby leaves the hospital, a small amount of his or her blood is taken and sent to the state health department or a private laboratory working in collaboration with the state laboratory. This sample, which may be taken from a vein in your baby’s arm or a tiny nick made on the heel, is analyzed to detect the presence of rare but important genetic diseases. This testing is referred to as New Born Screening (NBS). Results should be available by your baby’s first office exam.
Occasionally, a baby needs to have the test repeated. Don’t be alarmed if this happens to your newborn. To ensure that every newborn with any of these conditions is identified, even borderline results are rechecked. Retesting is especially common for premature babies.
Each state independently operates its NBS program, resulting in slight differences between the tests offered. The American College of Medical Genetics recommends a panel of tests to check for 29 targeted diseases. Some states perform tests to check for additional diseases. Some of the more common diseases that can be detected by the NBS panel include:
Phenylketonuria (PKU). Babies with PKU retain excessive amounts of phenylalanine, an amino acid found in the protein of almost all foods. Without treatment, PKU can cause mental and motor retardation, poor growth rate and seizures. With early detection and treatment, growth and development should be normal.
Congenital hypothyroidism. About 1 in 3,000 babies have a thyroid hormone deficiency that slows growth and brain development. Left untreated, it can result in mental retardation and stunted growth. With early detection and treatment, normal development is possible.
Congenital adrenal hyperplasia (CAH). This group of disorders is caused by a deficiency of certain hormones. Signs and symptoms may include lethargy, vomiting, muscle weakness and dehydration. Infants with mild forms are at risk of reproductive and growth difficulties. Severe cases can cause kidney dysfunction and even death. Lifelong hormone treatment can suppress the disease.
Galactosemia. Babies born with galactosemia can’t metabolize galactose, a sugar found in milk. Although newborns with this condition typically appear normal, they may develop vomiting, diarrhea, jaundice and liver damage within a few days of their first milk feedings. Untreated, the disorder may result in mental retardation, blindness, growth failure and, in severe cases, death. Treatment includes eliminating milk and all other dairy (galactose) products from the diet.
Biotinidase deficiency. This deficiency is caused by the lack of an enzyme called biotinidase. Signs and symptoms of the disorder include seizures, developmental delay, eczema and hearing loss. With early diagnosis and treatment, all signs and symptoms can be prevented.
Maple syrup urine disease (MSUD). This disorder affects the metabolism of amino acids. Newborns with this condition typically appear normal, but by the first week of life they experience feeding difficulties, lethargy and failure to thrive. Left untreated, MSUD can lead to coma or death.
Homocystinuria. Caused by an enzyme deficiency, homocystinuria can lead to eye problems, mental retardation, skeletal abnormalities and abnormal blood clotting. With early detection and management — including a special diet and dietary supplements — growth and development should be normal.
Sickle cell disease. This inherited disease prevents blood cells from circulating easily throughout the body. Affected infants will have an increased susceptibility to infection and slow growth rates. The disease can cause bouts of pain and damage to vital organs such as the lungs, kidneys and brain. With early medical treatment, the complications of sickle cell disease can be minimized.
Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency. This rare hereditary disease results from the lack of an enzyme required to convert fat to energy. Serious life-threatening signs and symptoms and even death can occur. With early detection and monitoring, children diagnosed with MCAD can lead normal lives.
Cystic fibrosis. Cystic fibrosis is a genetic disease that causes the body to produce abnormally thickened mucous secretions in the lungs and digestive system. Signs and symptoms generally include salty-tasting skin, persistent coughing, shortness of breath and poor weight gain. Affected newborns can develop life-threatening lung infections and intestinal obstructions. With early detection and treatment, infants diagnosed with cystic fibrosis can live longer and in better health than they did in the past.
Hearing screening While your baby is in the hospital, he or she may have a hearing test. Although hearing tests are not done routinely at every hospital, newborn hearing screening is becoming widely available. The testing can detect possible hearing loss in the first days of a baby’s life. If possible hearing loss is found, further tests may be done to confirm the results.
These two tests are used to screen a newborn’s hearing. Both are quick (about 10 minutes), painless and can be done while your baby sleeps.
Automated auditory brainstem response. This test measures how the brain responds to sound. Clicks or tones are played through soft earphones into the baby’s ears while electrodes taped on the baby’s head measure the brain’s response.
Otoacoustic emissions. This test measures responses to sound waves presented to the ear. A probe placed inside the baby’s ear canal measures the response when clicks or tones are played into the baby’s ear.
If you have a baby boy, one of the decisions you’ll face soon after birth is whether to have him circumcised. Circumcision is an elective surgical procedure performed to remove the skin covering the tip of the penis. Knowing about the procedure’s potential benefits and risks can help you make an informed decision.
Issues to consider Although circumcision is fairly common in the United States, it’s still somewhat controversial. There’s some evidence that circumcision may have medical benefits, but the procedure also has risks. The American Academy of Pediatrics doesn’t recommend routine circumcision of all male newborns, saying there isn’t enough evidence of benefit.
Consider your own cultural, religious and social values in making this decision. For some people, such as those of the Jewish or Islamic faith, circumcision is a religious ritual. For others, it’s a matter of personal hygiene or preventive health. Some parents choose circumcision because they don’t want their son to look different from his peers. Others feel that circumcision is unnecessary. Some people feel strongly that circumcision is disfiguring to the baby’s normal appearance.
As you decide what’s best for you and your son, consider these potential health benefits and risks.
HOW IT’S DONE
If you decide to have your son circumcised, his care provider can answer questions about the procedure and help you make arrangements at your hospital or clinic. Usually, circumcision is preformed before you and your son leave the hospital. At times, circumcision is done in an outpatient setting. The procedure itself takes about 10 minutes.
Typically, the baby lies on a tray with his arms and legs restrained. After the penis and surrounding area are cleansed, a local anesthetic is injected into the base of the penis. A special clamp or plastic ring is attached to the penis, and the foreskin is cut away. An ointment, such as petroleum jelly, is applied. This protects the penis from adhering to the diaper.
If your newborn is fussy as the anesthetic wears off, hold him gently — being careful to avoid putting pressure on the penis. It usually takes about seven to 10 days for the penis to heal.
Before circumcision (left), the foreskin of the penis extends over the end of the penis (glans). After the brief operation, the glans is exposed (right).
Potential benefits of circumcision Some research suggests that circumcision provides certain benefits. These include:
Decreased risk of urinary tract infections. Although the risk of urinary tract infections in the first year is low, studies suggest that such infections may be up to 10 times more common in uncircumcised baby boys than in those who are circumcised. Uncircumcised boys are also more likely to be admitted to the hospital for a severe urinary tract infection during the first three months of life than are those who are circumcised.
Decreased risk of cancer of the penis. While this type of cancer is very rare, circumcised men show a lower incidence of cancer of the penis than do uncircumcised men.
Slightly decreased risk of sexually transmitted infections. Some studies have shown a lower risk of human immunodeficiency virus (HIV) and human papillomavirus (HPV) infections in circumcised men. However, safe sexual practices are much more important in the prevention of sexually transmitted infections than is circumcision.
Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis may narrow to the point where it’s difficult or impossible to retract, a condition called phimosis. Circumcision may then be needed to treat the problem. A narrowed foreskin can also lead to inflammation of the head of the penis (balanitis).
Ease of hygiene. Circumcision makes it easy to wash the penis. But even if the foreskin is intact, it’s still quite simple to keep the penis clean. Normally the foreskin adheres to the end of the penis in a newborn, then gradually stretches back during early childhood. Wash your baby’s genital area gently with soap and water. Later, when the foreskin retracts, your son can learn to wash it by gently pulling the foreskin back and cleansing the tip of the penis.
Potential risks of circumcision Circumcision is considered a safe procedure, and the risks related to it are minor. However, circumcision does have some risks. Possible drawbacks of the procedure include:
Risks of minor surgery. All surgical procedures, including circumcision, carry certain risks, such as excessive bleeding and infection. There’s also the possibility that the foreskin may be cut too short or too long, or that it doesn’t heal properly. If the remaining foreskin reattaches on the end of the penis, a minor surgery may be needed to correct it. However, these occurrences are uncommon.
Pain during the procedure. Circumcision does cause pain. Typically a local anesthetic is used to block the nerve sensations. Talk to your care provider about the type of anesthesia used.
Difficult to reverse. It’s difficult to re-create the appearance of an uncircumcised penis.
Cost. Some insurance companies don’t cover the cost of circumcision. If you’re considering circumcision, check whether your insurance company will cover it.
Complicating factors. Sometimes, circumcision may need to be postponed, such as if your baby is born prematurely, has severe jaundice or is feeding poorly. It also may not be feasible in certain situations, such as in the rare instance when baby’s urethral opening is in an abnormal position on the side or base of the penis (hypospadias). Other conditions that may prevent circumcision include ambiguous genitalia or a family history of bleeding disorders.
Circumcision doesn’t affect fertility. Whether it enhances or detracts from sexual pleasure for men or their partners hasn’t been proved. Whatever your choice, negative outcomes are rare and mostly minor.
If your newborn boy was circumcised, the tip of his penis may seem raw for the first week after the procedure. Or a yellowish mucus or crust may form around the area. This is a normal part of healing. A small amount of bleeding is also common the first day or two.
Clean the diaper area gently and apply a dab of petroleum jelly to the end of the penis with each diaper change. This will keep the diaper from sticking while the penis heals. If there’s a bandage, change it with each diapering. At some hospitals, a plastic ring is used instead of a bandage. The ring will remain on the end of the penis until the edge of the circumcision has healed, usually within a week. The ring will drop off on its own. It’s OK to wash the penis as it’s healing.
Problems after a circumcision are rare. But call your baby’s care provider in the following situations:
Your baby doesn’t urinate normally six to eight hours after the circumcision.
Bleeding or redness around the tip of the penis is persistent.
The penis tip is swollen.
A foul-smelling drainage comes from the penis tip, or there are crusted sores that contain fluid.
The ring is still in place two weeks after the circumcision.
Some babies have a bit of trouble adjusting to their new world. Fortunately, most of the problems they experience are minor and soon resolved.
Jaundice More than half of all newborn babies develop jaundice, a yellow tinge to the skin and eyes. Signs generally develop a few days after birth, and the condition may last several weeks.
A baby develops jaundice when bilirubin, which is produced by the breakdown of red blood cells, accumulates faster than his or her liver can break it down and pass it from the body. Jaundice usually disappears on its own, and it doesn’t cause any discomfort to your baby.
Your baby may develop jaundice for a few reasons:
Bilirubin is being produced more quickly than the liver can react.
The baby’s developing liver isn’t able to remove bilirubin from the blood.
Too much of the bilirubin is reabsorbed from the intestines before the baby gets rid of it in a bowel movement.
Although mild levels of jaundice don’t require treatment, more-severe cases can require a newborn to stay longer in the hospital. Jaundice may be treated in several ways:
You may be asked to feed the baby more frequently, which increases the amount of bilirubin passed with bowel movements.
A doctor may place your baby under a bilirubin light. This treatment, called phototherapy, is quite common. A special lamp helps rid the body of excess bilirubin.
Your baby may be given intravenous immune globulin to decrease the severity of the jaundice if the bilirubin level becomes extremely high.
Rarely, an exchange blood transfusion is done to reduce the bilirubin level.
Infection A newborn’s immune system isn’t adequately developed to fight infection. Therefore, any type of infection can be more critical for newborns than for older children or adults.
Serious bacterial infections, which are uncommon, can invade any organ or the blood, urine or spinal fluid. Prompt treatment with antibiotics is necessary, but even with early diagnosis and treatment, a newborn infection can be life-threatening.
For this reason, doctors are cautious when treating a possible or suspected infection. Antibiotics often are given early, and their use is stopped only when an infection doesn’t seem likely. Although the majority of the test results come back showing no evidence of infection, it’s better to err on the side of safety by quickly treating a baby than to risk not treating a baby with an infection soon enough.
Viruses can cause infections in newborns, although viral infections are less common than are bacterial infections. Certain newborn viral infections such as herpes, varicella, HIV and cytomegalovirus may be treated with antiviral medication.
Learning to eat Whether you choose to breast-feed or bottle-feed, for the first few days after your baby’s birth, you may find it difficult to interest your newborn in eating. This is fairly common. Some babies seem to adopt a slow-and-sleepy approach to eating. If you’re concerned that your baby isn’t getting enough nourishment, talk to your baby’s nurse or doctor. Occasionally, slow eaters require tube feedings to help them along for a few days. But soon they catch on and breast-feed or bottle-feed with enthusiasm.
Over the first week, a newborn will lose about 10 percent of his or her birth weight and will gradually gain that weight back, and more!
THE PREMATURE NEWBORN
Every parent dreams of having a healthy, full-term baby. Unfortunately, that dream isn’t always the reality. Although most infants are born full-term and free of medical problems, some are born too early. Prematurity — defined as being born before 37 weeks gestation — is often, though not always, accompanied by medical complications.
Due to medical progress, the outlook for these newborns is much more hopeful than it was years ago. In fact, more than two-thirds of babies born at 24 to 25 weeks can survive with the proper medical care. This section explains some of the types of problems and treatments that can arise with prematurity.
The setting Your first close-up look at your premature baby will likely be in the neonatal intensive care unit (NICU). You’ll probably be amazed, overwhelmed — and perhaps a little shocked — by this first look.
You may first notice the array of tubes, catheters and electrical leads taped to your tiny baby. This equipment may be overwhelming and intimidating. It’s important to remember that it helps keep your baby healthy and the medical staff informed about your baby’s condition.
Because premature babies have less body fat than do full-term babies, they need help staying warm. They’re often placed in an infant incubator, an enclosed and warmed plastic box, called an isolette, to help them maintain a normal body temperature.
In the NICU, your baby will receive specialized care, including a feeding plan tailored to your baby’s needs. For the first few days after delivery, premature babies are usually fed intravenously because their gastrointestinal and respiratory systems may be too immature for formula feedings. When your baby is ready, the intravenous feeding will end and a new form of feeding, called tube feeding, will likely be the next step. With tube feedings, your baby receives breast milk or formula through a tube that delivers the food directly to the stomach or upper intestine.
THE NEONATAL INTENSIVE CARE UNIT TEAM
In the neonatal intensive care unit (NICU), your baby is cared for by many specialists and other health care professionals. The team attending to your baby may include:
Neonatal nurses — registered nurses with special training in caring for premature and high-risk newborns
Neonatal respiratory therapists — staff trained to assess respiratory problems in newborns and adjust ventilators and other respiratory equipment
Neonatologists — pediatricians who specialize in the diagnosis and treatment of problems of the newborn
Pediatric surgeons — surgeons trained in the diagnosis and treatment of newborn conditions that may require surgery
Pediatricians — doctors who specialize in treating children
Pediatric resident physicians — doctors receiving specialized training in treating children
What baby may look like You’ll definitely notice your baby’s tiny size. He or she may be considerably smaller than a full-term infant.
Your baby’s features will appear sharper and less rounded than a full-term baby’s. A premature baby’s skin also has a number of notable characteristics. The skin and cartilage that form baby’s outer ears will be very soft and pliable. The skin may be covered with more fine body hair (lanugo) than is common in full-term babies, and it may look thin, fragile and somewhat transparent, allowing you to see baby’s blood vessels.
These characteristics will be easy to see because most premature babies aren’t dressed or wrapped in blankets. This is so the nursery staff can closely observe their breathing and general appearance.
Getting involved Become physically involved with your baby as early as possible. Loving care is important to your baby’s growth and development.
When you were pregnant, you probably daydreamed about holding, bathing and feeding your new baby. As the parent of a premature baby, you probably won’t be able to spend these first weeks with your baby in the way you had envisioned. Still, you can be involved with your baby in important ways.
You can reach through the openings in the isolette to hold your baby’s hand or gently stroke him or her. Gentle contact with your premature baby can help him or her thrive. Help your newborn get to know you by humming a lullaby or talking softly to him or her.
As your baby’s condition improves, you’ll be able to hold and rock your baby. Skin-to-skin contact, sometimes called kangaroo care, can be a powerful way to bond with your baby. In kangaroo care, a nurse can help place your baby on your bare chest, then loosely cover him or her with a blanket. Studies have shown that premature babies respond positively to this skin-to-skin contact with their parents and that kangaroo care can improve babies’ recovery times.
Another way mom can be involved in her baby’s health is by providing breast milk, which contains proteins that help fight infection and promote growth. In the NICU, your baby will likely be fed every one to three hours through a tube that goes from the nose or mouth to the stomach. A nurse can show you how to pump breast milk, which can be refrigerated and used as your baby needs it.
WHEN YOUR BABY IS HOSPITALIZED
Spend time touching and talking to your newborn. Premature babies respond positively to skin-to-skin contact.
Learn as much as you can about your baby’s medical condition, especially what parents should watch for and how parents can help care for the condition.
Take an active role in your baby’s care, especially as your baby becomes close to leaving the hospital.
Don’t be afraid to ask questions. Medical terminology can be confusing and intimidating. Have your baby’s doctor or nurse write down any key diagnoses. Ask for printed patient information sheets or websites you can visit for further information.
Lean on someone. Talk the situation over with your partner or other family members. Invite family members and friends to join you at the hospital. Ask to meet with the hospital social worker.
Inquire if public health nurses or visiting nurses can assist with your baby’s care after you’re home.
Ask if your baby should be enrolled in special infant follow-up or infant development programs.
Complications of prematurity Not all premature babies develop complications, but the earlier a child is born, the greater the chances a problem may occur. Some complications are apparent at birth, while others may not develop for weeks or months. Some of these conditions may include:
Respiratory distress syndrome Respiratory distress syndrome (RDS) is the most common breathing problem among newborns, occurring almost exclusively in premature infants. With RDS, a baby’s immature lungs lack an important liquid substance called surfactant, which gives normal, fully developed lungs the elastic qualities required for easy breathing.
RDS is usually diagnosed within the first minutes to hours after birth. The diagnosis is based on the extent of breathing difficulty and on abnormalities seen on the baby’s chest X-ray.
Treatment. Babies with RDS require various degrees of help with their breathing. Supplemental oxygen is usually required until the lungs improve.
A ventilator, also called a respirator, can give the baby carefully controlled breaths. These can range from a few extra breaths per minute to entirely taking over the work of breathing.
Some babies benefit from breathing assistance called continuous positive airway pressure (CPAP). A plastic tube that fits in the nostrils provides additional pressure in the air passages to keep the tiny air sacs in the lungs properly inflated.
Babies with severe RDS are often given doses of surfactant preparation directly into the lungs. Other medications that increase urine output, rid the body of extra water, reduce inflammation in the lungs, reduce wheezing and minimize pauses in breathing (apnea) also may be used.
Bronchopulmonary dysplasia A premature baby’s lung problems generally improve within several days to several weeks. Babies who still require help with ventilation or supplemental oxygen a month after birth are often described as having bronchopulmonary dysplasia (BPD). This condition is also called chronic lung disease.
Treatment. Babies with BPD continue to need supplemental oxygen for an extended period. If they develop a bad cold or pneumonia, they may need breathing assistance, such as that provided by a ventilator. Some of these babies may need to continue using supplemental oxygen, even after they go home from the hospital. As these babies grow, their need for supplemental oxygen lessens and their breathing becomes easier. However, they’re more likely than are other children to have episodes of wheezing or asthma.
Apnea and bradycardia Premature babies typically have immature breathing rhythms that cause them to breathe in spurts: 10 to 15 seconds of deep breathing followed by five- to 10-second pauses. This condition is called periodic breathing.
Treatment. The reduced breathing, heart rate and oxygen saturation in a premature baby with apnea and bradycardia typically return to normal on their own. If they don’t, a nurse may gently stimulate the baby by rubbing or wiggling him or her awake. In more-severe spells, the baby may need brief assistance with breathing.
Patent ductus arteriosus Before birth, a baby’s lungs aren’t used and, therefore, they require minimal blood flow. Because of this, a short blood vessel called the ductus arteriosus diverts blood away from the lungs and eventually back to the placenta.
Before birth, a chemical compound called prostaglandin E circulates in the baby’s blood, keeping the ductus arteriosus open. Once a full-term infant is born, levels of prostaglandin E fall sharply, causing the ductus arteriosus to close. This allows for the change from pre-birth circulation to after-birth, or postpartum, circulation.
Occasionally, especially in premature babies, prostaglandin E circulates at higher than normal levels. This causes the ductus arteriosus to remain open and can result in respiratory or circulation difficulties.
Treatment. Patent ductus arteriosus is often treated with a medication that stops or slows the production of prostaglandin E. If this medication isn’t effective, an operation might be needed.
Intracranial hemorrhage Premature babies who are born at less than 34 weeks are at risk of bleeding in their brains. The earlier a baby is born, the higher the risk of this complication. Therefore, if premature birth seems inevitable, the mother may be given certain medications to help lessen the likelihood of a severe intracranial hemorrhage in the newborn.
Treatment. Babies with minor degrees of intracranial hemorrhage require only observation. Those with serious degrees of bleeding may undergo various treatments. Babies with severe intracranial hemorrhage are at risk of developmental problems such as cerebral palsy, spasticity and mental retardation.
Necrotizing enterocolitis For reasons that aren’t entirely clear, some premature babies — usually those at less than 28 weeks of gestation — develop a problem called necrotizing enterocolitis. In this condition, a portion of the baby’s intestine develops poor blood flow. This can lead to infection in the bowel wall. Signs include a bloated abdomen, feeding intolerance, breathing difficulty and bloody stools.
Treatment. Babies with this condition may be treated with intravenous feedings and antibiotics. In severe cases, an operation may be required to remove the affected portion of the intestine.
Retinopathy of prematurity Retinopathy of prematurity (ROP) is abnormal growth of the blood vessels in an infant’s eyes. It’s most common in very premature babies. Most babies born at 23 to 26 weeks of gestational age, for example, will experience at least some ROP, and babies beyond about 30 weeks of gestational age rarely develop ROP.
During fetal life, the retina develops from the back of the eye forward, and the process is complete just about the time a baby is full term. When a baby is born prematurely, the retinal development isn’t finished, which may allow a number of factors to disturb it.
Treatment. If your baby is at risk of ROP, an eye specialist (ophthalmologist) can examine the eyes after 6 weeks of age. Fortunately, most cases of ROP are mild and will resolve without additional treatment. More-severe degrees of retinopathy are often successfully treated with procedures such as laser treatment or cryotherapy. Fortunately, today, blindness is uncommon and affects only the smallest and most unstable premature babies.