Taking care of premature babies, how to avoid and tackle complications

Caring for a newborn, especially for first time parents, can be challenging. When a baby is born preterm and has to stay in the NICU for weeks/months , the joy of finally taking the baby home is coupled by a lot of trepidation for new parents. With adequate planning, you will be better prepared.

Firstly, a preemie will not be discharged unless the doctor deems fit. Baby should have reached at least 1.6-1.8kg, should be able to suckle well at the breast and accept expressed breast milk. Baby should maintain temperature independent of an incubator in a crib.

A few points one needs to know before taking baby home.

1. Feeding: Breastfeeding is advised once baby is independent of the feeding tube and able to swallow pumped milk by paladai. Make sure that you are confident of feeding baby expressed milk before going home, apart from direct breastfeeds, as baby would require measured feeds for a few weeks till weight gain is adequate. A feeding device called “paladai” is preferred to minimise infection , nipple confusion and overfeeding which can occur with bottle-feeding.

2. Infection Risk: The immune system of a preterm is immature compared to an older baby. This puts them at risk of catching infections easily. This can be minimised by strict handwashing before handling baby, restricting the number of caregivers, and minimising visitors. Avoid outings with baby to crowded areas like malls or family functions.

3. Temperature control: Ensure that the room you have prepared for your preemie is warm. In cold climates, a room heater is advisable, and baby should be wrapped adequately. Keep baby’s temperature at 36.6-37.2°C. If an air conditioner is used, set the ambient temperature to above 26°C. Postpone bathing and continue sponging till the baby reaches at least 2.5kg. Oil massages are beneficial in helping baby’s overall development and sleep.

4. Kangaroo mother care (KMC): Skin to skin contact in the “kangaroo care” position has been scientifically proven to enhance thermal protection, effective weight gain, better sleep, mother-baby bonding, and exclusive breastfeeding. Fathers are also encouraged to do this to bond with their baby and to give mum a break!

5. Respiratory problems.

a. Sometimes preterm babies are more prone to Apnea (cessation of breathing for a few seconds, which is usually reversible by stimulation, unless it goes unnoticed for a longer period of time). Some babies may be started on medications to prevent apnea. Your baby will be discharged only when the risk of apnea is negligible. However, make sure that you learn how to position the baby ’s head and neck while sleeping to minimise this, and to recognise danger signs. A “belly button monitor” is a useful tool to help you to monitor breathing at home.

b. Aspiration of feeds can cause respiratory distress and apnea. It can be minimised with proper positioning during feeds and burping the baby after, followed by keeping baby to sleep in a semi-inclined position with head end of the crib slightly elevated. Ensure that the bed is firm. Avoid pillows and loose blankets around baby. Sleeping on the tummy is not advisable for the first 6 months, as it can lead to a higher risk of SIDS (sudden infant death syndrome).

Be careful of co-sleeping as the baby has a higher risk of suffocation if you/partner rolls over unknowingly in sleep.

If you notice that baby is blue or not breathing after being put to sleep, immediately turn baby to the side and rub the back vigorously to stimulate breathing and to prevent any secretions/ milk from going into the lungs, and rush baby to the nearest hospital.It helps to learn the basics of CPR before being discharged.

6. Danger signs: Seek immediate medical help in case of any of the following:
-Temperature either too high or low can be a sign of infection
-If baby is not breathing or looks pale or bluish
-Poor feeding, lethargy
-Excessive irritability and inconsolability with feeds
- Abnormal jerky movements or suspected seizures

Caring for a preemie in the weeks following discharge can take a toll mentally and physically. Ensure that you get adequate rest and healthy diet. Some mothers experience post-partum blues. Do not hesitate to seek professional help if you feel depressed or overwhelmed. At the end of the day, a happy mother equals a happy baby!

Dr. Shalini Chico, Senior consultant , Neonatology and Paediatrics, Fortis Hospital, Richmond Road, Bangalore.